I note a glaring omission in Karen Janzon and colleagues' feature on the needs of people in residential care ('Lost and confused', pages 26-29, 9 November): namely, the absence of any mention of visual impairment.

Sight loss is highly prevalent among older people, much of it undetected. Visual impairment is also one of three major independent risk factors for falls in elderly people, and the risk of hip fracture doubles with poor to moderately impaired vision - a fact noted by the government's 'Slips, Trips and Broken Hips' prevention initiative.

Visual impairment may lead to reduced mobility due to a lack of confidence and navigation skills, a decreased ability to carry out activities of daily living, increased depression and anxiety, loss of independence and increased social isolation, which all contribute to a deterioration in quality of life and health among older people.

Given the prevalence of sight problems among this group, it is essential that visual impairment is considered at assessment, that optometric input is sought and delivered as part of the primary care package and that appropriate low-vision rehabilitation services are provided. The impact of visual impairment is so great that we cannot afford to ignore it if we are seriously hoping to meet older people's health needs.

Rebecca Griffith Health promotion officer Royal National Institute for the Blind