While We Waited: Incidence and Predictors of Falls in Older Adults With Cataract.

PURPOSE: Strong evidence indicates an increased fall risk associated with cataract. Although cataract surgery can restore sight, lengthy wait times are common for public patients in many high-income countries. This study reports incidence and predictors of falls in older people with cataract during their surgical wait. METHODS: Data from a prospective study of falls in adults aged ≥65 years who were awaiting cataract surgery in public hospitals in Australia were analyzed. Participants underwent assessment of vision, health status, and physical function, and recalled falls in the previous 12 months. Falls were self-reported prospectively during the surgical wait. RESULTS: Of 329 participants, mean age was 75.7 years; 55.2% were female. A total of 267 falls were reported by 101 (30.7%) participants during the surgical wait (median observation time, 176 days): an incidence of 1.2 falls per person-year (95% confidence interval [CI] 1.0-1.3). Greater walking activity (incidence rate ratio [IRR] 1.06, 95% CI 1.01-1.10; P = 0.02, per additional hour/week), poorer health-related quality of life (IRR 1.12, 95% CI 1.05-1.20; P < 0.001, per 5-unit decrease), and a fall in the prior 12 months (IRR 2.48, 95% CI 1.57-3.93; P < 0.001) were associated with incident falls. No visual measure independently predicted fall risk. More than one-half (51.7%) of falls were injurious. CONCLUSIONS: We found a substantial rate of falls and fall injury in older adults with cataract who were awaiting surgery. Within this relatively homogenous cohort, measures of visual function alone inadequately predicted fall risk. Assessment of exposure to falls through physical activity frequency may prove valuable in identifying those more likely to fall during the surgical wait

While We Waited: Incidence and Predictors of Falls in Older Adults With Cataract

Purpose: Strong evidence indicates an increased fall risk associated with cataract. Although cataract surgery can restore sight, lengthy wait times are common for public patients in many high-income countries. This study reports incidence and predictors of falls in older people with cataract during their surgical wait. Methods: Data from a prospective study of falls in adults aged ≥65 years who were awaiting cataract surgery in public hospitals in Australia were analyzed. Participants underwent assessment of vision, health status, and physical function, and recalled falls in the previous 12 months. Falls were self-reported prospectively during the surgical wait. Results: Of 329 participants, mean age was 75.7 years; 55.2% were female. A total of 267 falls were reported by 101 (30.7%) participants during the surgical wait (median observation time, 176 days): an incidence of 1.2 falls per person-year (95% confidence interval [CI] 1.0–1.3). Greater walking activity (incidence rate ratio [IRR] 1.06, 95% CI 1.01–1.10; P = 0.02, per additional hour/week), poorer health-related quality of life (IRR 1.12, 95% CI 1.05–1.20; P < 0.001, per 5-unit decrease), and a fall in the prior 12 months (IRR 2.48, 95% CI 1.57–3.93; P < 0.001) were associated with incident falls. No visual measure independently predicted fall risk. More than one-half (51.7%) of falls were injurious. Conclusions: We found a substantial rate of falls and fall injury in older adults with cataract who were awaiting surgery. Within this relatively homogenous cohort, measures of visual function alone inadequately predicted fall risk. Assessment of exposure to falls through physical activity frequency may prove valuable in identifying those more likely to fall during the surgical wait

The true cost of hidden waiting times for cataract surgery in Australia

Cataract surgery is a safe, effective and common elective procedure in Australia but access is inequitable. True waiting times for cataract care are undisclosed or inconsistently reported by governments. Estimates of true waiting times range from 4 to 30 months and have been extended during the coronavirus disease 2019 (COVID-19) pandemic. Comparative analysis revealed that reducing waiting periods from 12 to 3 months would result in estimated public health system cost savings of $6.6 million by preventing 50 679 falls. Investment in public cataract services to address current unmet needs would prevent avoidable vision impairment and associated negative consequences

Local critical behaviour at aperiodic surface extended perturbation in the Ising quantum chain

The surface critical behaviour of the semi--infinite one--dimensional quantum Ising model in a transverse field is studied in the presence of an aperiodic surface extended modulation. The perturbed couplings are distributed according to a generalized Fredholm sequence, leading to a marginal perturbation and varying surface exponents. The surface magnetic exponents are calculated exactly whereas the expression of the surface energy density exponent is conjectured from a finite--size scaling study. The system displays surface order at the bulk critical point, above a critical value of the modulation amplitude. It may be considered as a discrete realization of the Hilhorst--van Leeuwen model.Comment: 13 pages, TeX file + 6 figures, epsf neede

Heterologous Expression of Alteromonas macleodii and Thiocapsa roseopersicina [NiFe] Hydrogenases in Synechococcus elongatus

Oxygen-tolerant [NiFe] hydrogenases may be used in future photobiological hydrogen production systems once the enzymes can be heterologously expressed in host organisms of interest. To achieve heterologous expression of [NiFe] hydrogenases in cyanobacteria, the two hydrogenase structural genes from Alteromonas macleodii Deep ecotype (AltDE), hynS and hynL, along with the surrounding genes in the gene operon of HynSL were cloned in a vector with an IPTG-inducible promoter and introduced into Synechococcus elongatus PCC7942. The hydrogenase protein was expressed at the correct size upon induction with IPTG. The heterologously-expressed HynSL hydrogenase was active when tested by in vitro H2 evolution assay, indicating the correct assembly of the catalytic center in the cyanobacterial host. Using a similar expression system, the hydrogenase structural genes from Thiocapsa roseopersicina (hynSL) and the entire set of known accessory genes were transferred to S. elongatus. A protein of the correct size was expressed but had no activity. However, when the 11 accessory genes from AltDE were co-expressed with hynSL, the T. roseopersicina hydrogenase was found to be active by in vitro assay. This is the first report of active, heterologously-expressed [NiFe] hydrogenases in cyanobacteria

Depressive symptoms in older adults awaiting cataract surgery.

BACKGROUND: To assess the prevalence and predictors of depressive symptoms in a cohort of older adults awaiting cataract surgery and establish threshold vision at which depressive symptoms may emerge. DESIGN: Analysis of cross-sectional baseline data from a longitudinal cohort study of patients aged ≥65 years on Australian public hospital cataract surgery waiting lists. PARTICIPANTS: We included 329 participants enrolled October 2013-August 2015. METHODS: Participants completed assessment of depressive symptoms, visual disability, quality of life, social participation and exercise frequency at least one month prior to cataract surgery. High and low contrast habitual vision was examined and systemic comorbidities noted. MAIN OUTCOME MEASURE: Depressive symptoms prior to first eye cataract surgery. RESULTS: The prevalence of depressive symptoms was 28.6% (94/329). Univariate analysis identified that participants with poorer high contrast vision, reduced quality of life, greater patient-reported visual disability, higher comorbidity score and who were taking more medications were more likely to exhibit signs of depression. Greater patient-reported visual disability (P = 0.02), reduced quality of life (P = 0.003) and a higher comorbidity score (P = 0.02) remained significantly associated with depressive symptoms in the multivariable model. Depressive symptoms emerged at a visual acuity of 6/12. CONCLUSIONS: These findings demonstrate a high prevalence of depressive symptoms in older persons with cataract, emerging at modest levels of vision loss. Efficient referral processes, timely surgical management, and improved screening and coordinated treatment of depressive symptoms during the surgical wait may minimize the negative psychological effects of cataract in this already vulnerable population

Fear of falling and physical function in older adults with cataract: Exploring the role of vision as a moderator.

AIM: To examine fear of falling and associated factors in a cohort of older adults with cataract, and investigate the interplay of vision and physical function with respect to fear of falling. METHODS: We analyzed baseline data from a longitudinal study of adults aged ≥65 years referred for cataract surgery. Fear of falling was assessed by the Short Falls Efficacy Scale-International. Physical function was determined by the Short Physical Performance Battery. Participants underwent assessment of visual acuity, contrast sensitivity, visual disability, quality of life, depressive symptoms, exercise frequency, comorbidity and falls history. Factors associated with fear of falling were assessed using linear regression. Planned stepwise regression investigated vision as a potential moderator of the relationship between physical function and fear of falling. RESULTS: Among 322 participants, 32.9 % (n = 106) showed high fear of falling. Poorer physical function, more comorbidities and greater visual disability were independently associated with a higher fear of falling (all P < 0.001). Visual disability moderated the relationship between physical function and fear of falling (β = -0.10, P = 0.04). The impact of physical function on fear of falling was strongest in participants with higher (+1 standard deviation above the mean) visual disability (b = -0.21, P < 0.001). CONCLUSIONS: Fear of falling in older adults with cataract is greatest in those with poorer physical function and higher levels of visual disability. Perceived visual ability has a moderating role in the relationship between physical function and fear of falling; physical function alone might not adequately predict falls concern. Geriatr Gerontol Int 2017; 17: 1551-1558