Home Hazards Amplify Fall Risk in Older Adults with Visual Impairment: JAMA

Visual function is critically important for balance, navigation, and hazard detection. Distance visual acuity and contrast sensitivity are especially important for detecting obstacles, floor transitions, and tub/bath safety features. Yet most older adults live in homes with identifiable yet preventable environmental hazards, including lack of grab bars, tripping hazards, and broken flooring. This study aimed to investigate how variation in visual function interacts with select home hazards to influence fall risk among community-dwelling US older adults.

This population-based cross-sectional study was based on data from the National Health and Aging Trends Study, a nationally representative survey of US Medicare beneficiaries aged 65 years and older. In the current analysis, 4,648 community-dwelling older adults completed both objective visual function testing and a detailed home environment assessment in person in 2022. Data analyses were performed between September 2024 and March 2025. Among participants, as expected from the demographic composition of the older US population, 53.6% were women.

Key findings

• Among the 4648 participants, 47.0% were missing grab bars in the bathroom, 9.5% reported tripping hazards, 4.5% reported broken flooring, and 7.3% had two or more of these hazards.

• An association between worse distance visual acuity and contrast sensitivity with increased odds of falls was seen consistently in the context of home hazards.

• In homes without grab bars, the fall odds ratio was 1.14 per unit worsening in distance visual acuity and 0.91 per unit improvement in contrast sensitivity.

• The ORs rose in homes with tripping hazards for both distance visual acuity (1.29) and contrast sensitivity (0.87), increased again in those with broken flooring (1.47 for distance visual acuity and 0.79 for contrast sensitivity).

• The impact is further accentuated by the presence of multiple hazards; living in homes with two or more of the target hazards was associated with worse distance visual acuity at an odds ratio of 1.31 and improved contrast sensitivity at an odds ratio of 0.93, indicating increased vulnerability with declining visual function.

The correlation of visual function and falls in the elderly was found to be greatly influenced by the occurrence of home environmental hazards in this nationally representative survey. The results imply that fall-prevention strategies should not only consider intrinsic factors like visual impairment but also extrinsic factors like home safety. Interventions focusing on both vision care and home hazard reduction could provide effective means to decrease falls and enhance safety among older adults.

Reference:

Xu S, Clarke P, Sun MJ, Ehrlich JR. The Role of Home Hazards in the Association Between Visual Function and Falls in Older Adults. JAMA Ophthalmol. Published online December 11, 2025. doi:10.1001/jamaophthalmol.2025.5057