Vision screening in older adults who attend hospital following a fall: a scoping review

TL;DR

This review examines how vision is assessed in older adults who fall and go to the hospital, finding inconsistent practices and a need for standardized protocols.

Contribution

The study identifies gaps and variability in vision screening practices for older adults post-fall, suggesting a need for standardized tools and implementation research.

Findings

27 studies from 13 countries showed varied vision assessment methods for older adults after a fall.

Common assessments included visual symptoms, last eye test, and distance visual acuity.

Standardized tools like STEADI and KAS-Screen were used in only six studies.

Abstract

The assessment of impaired vision is included in falls prevention guidance for older adults, but implementation is variable. We conducted a scoping review to better understand current practice and inform future implementation research around vision assessments for older adults attending acute hospitals following a fall. We explored the extent and types of evidence, key concepts, methods, emerging topics and identified evidence gaps.

JBI methodology was followed. MEDLINE, AMED, EMBASE, PsychInfo, CINAHL and WebofScience were systematically searched for literature on the assessment of vision in older adults attending acute hospitals following a fall. Sources eligible for inclusion had a mean/median population age of 65 years or over, included patients presenting to an acute hospital setting following a fall and described vision assessments in these patients. Grey literature, conference abstracts and sources without a full text were excluded. Title, abstract and full-text screening were completed by two independent reviewers. Data extraction and charting of the data were performed by the primary author. Data analysis comprised descriptive statistics of study characteristics and content analysis of vision assessment methods used.

We included 27 studies from 13 countries, between 1806 and 2024. Studies reported various vision assessment methods. Questions frequently asked in vision assessments included: presence of visual symptoms (n = 9), date of last eye test (n = 9) and previous ocular history (n = 5). The most common visual function assessed was distance visual acuity (n = 12). Six studies used standardised screening tools, including: the Stopping Elderly Accidents, Deaths & Injuries (STEADI) 12-question falls risk screening tool, a modified Kombinert Alvorlig Sansesvikt (Combined Serious Sensory Impairment) (KAS-Screen), procedures of the InterRAI-AC, the St Thomas’s Risk Assessment Tool In Falling elderly inpatients (STRATIFY), the Physiological Profile Assessment (PPA) and the Look Out! Bedside vision check. The most common post-screening interventions were: advising an eye test with an optometrist (n = 8), advising an ophthalmology referral (n = 7) and patient education (n = 6).

The literature on vision screening in this population was sparse and there was heterogeneity in current practices, highlighting the need for standardised screening protocols. More research is needed to evaluate vision screening services in this population and to explore implementation barriers.

The online version contains supplementary material available at 10.1186/s12877-025-06435-1.

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