Releases Saturday 21 October 2000
No 7267 Volume 321
Please remember to credit the BMJ as source when publicising
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(1) STANDARD SIGHT TEST FOR DRIVING IS
UNRELIABLE
(2) PREVENTING
FALLS IN ELDERLY PEOPLE
(1) STANDARD SIGHT TEST FOR DRIVING IS
UNRELIABLE
(Reliability of Snellen charts for
testing visual acuity for
driving: prospective study and postal
questionnaire)
http://bmj.com/cgi/content/full/321/7267/990
(Another look at visual standards
and driving)
http://bmj.com/cgi/content/full/321/7267/972
Guidelines to assess whether a person's
vision is good enough
to drive are a poor predictor of an individual's
chance of
meeting the legal visual standard for
driving and need
clarification, finds a study in this week's
BMJ.
The legal standard required for driving
a private car or
motorbike is to be able to read a number
plate at 20.5
metres. Guidelines issued by the Driver
and Vehicle Licensing
Authority suggest that this corresponds
to a score of between
6/9 and 6/12 on a standard visual acuity
chart (known as the
Snellen chart). Researchers at the Royal
Hallamshire Hospital
in Sheffield tested 50 patients with 6/9
vision and 50 with
6/12 vision on their ability to read a
number plate from a
distance of 20.5 metres. They also assessed
the advice given
to these patients by healthcare professionals
using a postal
questionnaire.
They found that 26% of patients with 6/9
vision failed the
test, and 34% with 6/12 vision passed
it. Of the general
practitioners advising patients with 6/9
vision, 76% said the
patients could drive, 13 said they should
not drive and 11%
were unsure. Of the general practitioners
advising patients
with 6/12 vision, 21% said the patients
could drive, 54% said
they should not drive, and 25% were unsure.
It cannot be assumed that a driver with
a visual acuity of 6/9
will meet the standard for driving, say
the authors.
Conversely, it should not be assumed that
a driver with a
visual acuity of 6/12 is below the standard
for driving. All
drivers with 6/9 vision or less should
be encouraged to self
assess their vision, they conclude.
In an accompanying editorial, William Westlake
at The Lions
Eye Institute in Australia argues that
more sophisticated tests
are required to help determine the driving
ability of people
who do not meet the current standards
and, when
appropriate, allow them to retain their
licenses. He stresses
the need for the Driver and Vehicle Licensing
Authority in the
UK to monitor the results of the current
visual requirements
to "confirm that there is at least some
benefit to be gained for
society from the devastating effect that
removal of a driving
licence can have upon a visually impaired
individual."
Contacts:
Zanna Currie, Specialist Registrar, Royal
Hallamshire
Hospital, Sheffield, UK
Email: zanna{at}zcurrie.freeserve.co.ukv
William Westlake, Visiting Research Fellow,
The Lions Eye
Institute, Western Australia
Email: westlake{at}networx.net.au
(2) PREVENTING FALLS IN ELDERLY PEOPLE
(Effects of a programme of multifactorial
home visits on falls
and mobility impairments in elderly
people at risk: randomised
controlled trial)
http://bmj.com/cgi/content/full/321/7267/994
(Guidelines for the prevention of
falls in people over 65)
http://bmj.com/cgi/content/full/321/7267/1007
Falling is a serious problem among elderly
people, with a
substantial impact on health and healthcare
costs. Two
papers in this week's BMJ explore the
effectiveness of
various strategies to prevent falls and
reduce mobility
problems among elderly people, improving
our ability to
address this serious public health problem.
Haastregt and colleagues identified over
300 people aged 70
and over and living in the community,
with mobility problems
or a history of recent falls. Over a period
of one year, half
received five home visits by a community
nurse. The other
half did not receive any special intervention.
They found that
home visits had no effect on falls and
mobility problems.
Furthermore, the home visits had no effects
on other factors
such as physical complaints, perceived
health, social
functioning and loneliness.
A programme of home visits is clearly not
effective at
reducing falls and mobility problems in
elderly people at risk
living in the community, say the authors.
Alternative strategies
need to be developed and tested in different
healthcare
settings, they conclude.
Feder and colleagues translated evidence,
based on 21 trials
about prevention of falls, into recommendations
that can be
implemented in different healthcare settings.
To test their
feasibility in different care settings,
the guidelines were piloted
in two general practices, a residential
home and a general
hospital. Despite large gaps in the evidence,
the authors
recommend focusing on multifaceted programmes
of
intervention, assessment of high risk
residents in nursing
homes and the provision of hip protectors
for residents of
nursing homes to reduce falls. Home assessment
of older
people at risk of falls is not recommended.
The authors stress the need for further
research in many
areas, and suggest that these guidelines
should be regularly
updated as new evidence emerges.
Contacts:
Jolanda C M van Haastregt, Health Scientist,
Institute for
Rehabilitation Research, Netherlands
Email: jolanda.vanhaastregt{at}irv.nl
Professor Gene Feder, Queen Mary and Westfield
College,
London, UK
Email: g.s.feder{at}mds.qmw.ac.uk
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