# Visual Assessment in Elderly Inpatients Following a Fall

## TL;DR

This study shows that simple interventions like staff training and better tools can help improve visual assessments for elderly patients after a fall, even though results weren't statistically significant.

## Contribution

The study introduces low-cost interventions to improve compliance with national guidelines for vision assessment in elderly inpatients following a fall.

## Key findings

- Documented visual acuity assessment increased from 7.8% to 16.7% after interventions.
- Confrontational visual field testing improved from 5.9% to 19% post-intervention.
- Positive trends were observed despite non-significant statistical results.

## Abstract

Introduction

Falls are a major cause of morbidity in older adults, with visual impairment recognized as a key modifiable risk factor. National guidelines recommend vision assessment following a fall; however, adherence remains suboptimal. This quality improvement project aimed to evaluate compliance with national recommendations and implement interventions to improve visual assessment rates in elderly inpatients.

Methods

A two-cycle retrospective cross-sectional review was conducted at a tertiary hospital in London. Electronic records of inpatients aged ≥65 admitted across two time points, one year apart, were analyzed. The first cycle assessed baseline documentation of vision assessments, defined as visual acuity (VA) or confrontational fields. Interventions included staff education sessions, distribution of visual prompts, and improved access to bedside VA tools. A re-audit was performed post-intervention to evaluate the impact.

Results

A total of 337 patient records were reviewed (181 pre-intervention; 156 post-intervention). Among patients admitted after a fall (n=51 pre-intervention, n=42 post-intervention), documented VA assessment increased from 7.8% to 16.7% (p=0.21), and confrontational visual field testing increased from 5.9% to 19% (p=0.061) post-intervention. While these changes did not reach statistical significance, they demonstrate a positive trend following low-cost interventions.

Conclusion

Visual assessments remain underperformed in elderly inpatients following a fall despite national guidance. Targeted low-cost interventions, including staff education and improved access to assessment tools, can improve compliance. Continued multidisciplinary engagement, system-level changes, and regular audit cycles are necessary to embed vision assessment as a routine component of post-fall care and to reduce fall-related harm.