Home environment shapes fall risk in visually impaired older adults, study shows

Older adults with poor visual function have an increased risk of falling at home, specifically if there are no grab bars, tripping hazards or broken flooring, according to a study published in JAMA Ophthalmology. 

Researchers, including corresponding author Joshua R. Ehrlich, M.D., M.P.H., from the Department of Ophthalmology and Visual Sciences at the University of Michigan, studied data from 4,648 Medicare beneficiaries from September 2024 to March 2025 using the National Health and Aging Trends Study (NHATS). Fall data gathered was self-reported.

“Existing evidence consistently supports the association between vision loss and falls,” Ehrlich writes in the study. “Our findings confirm this association and further demonstrate that the association between falls and vision is concentrated among older adults living with home hazards—a finding that may have key implications for fall prevention strategies.”

Visual functioning was measured using binocular presenting distance visual acuity (DVA), which measures the sharpness of objects at 20 feet, and contrast sensitivity, which measures the ability to detect differences in brightness or shades. Home hazards were reported during home visits with a NHATS interviewer. They identified the absence of grab bars in the bathroom in 47% of homes, tripping hazards in 10% and broken flooring in 5%.

In visually impaired older adults, broken flooring, such as torn carpet, had the greatest fall risk at a 47% increase, followed by tripping hazards, like unsecured throw rugs or electrical cords, at 29% and the absence of grab bars by 14%.

In homes without hazards, fall risk remained at approximately 10% for all variables across all levels of DVA.

Older adults with worsening CS living in a home without grab bars had a 9% increase in fall risk, a 13% increase if tripping hazards were present and 21% increase if there was broken flooring. Approximately fall risk remained at 13% if there were no hazards present.

More than 1 in 4 older adults experience a fall in their home every year, making it a leading cause of injury, disability and mortality in this population. They also lead to high health care costs—approximately $80 billion annually on non-fatal falls.

Vision loss is also common in older people. Of those with severe vision loss or blindness, approximately half have fallen in the past year, compared with 28% of older adults without impairments. This is because decreased vision can impact balance and spatial awareness.

Ways to mitigate fall risk include installing grab bars to promote independence and safety, adding extra light so that hazard detection increases and making appropriate home repairs, according to Ehrlich and his colleagues.

“These home-based interventions should be viewed not only as short-term fall prevention strategies but also as long-term public health investments, with the potential for cost savings when adopted at scale,” Ehrlich said. “Future research should incorporate both indoor and outdoor environmental assessments to comprehensively understand fall risk.”