Objectives: we studied visual acuity (VA) and co-existing hearing impairment and poor standing balance as predictors of falls.

Design: prospective study with 1-year follow-up.

Setting: research laboratory and residential environment.

Participants: 428 women aged 63–76 years from the Finnish Twin Study on Aging.

Measurements: participants were followed up for incidence of falls over 1 year. VA, hearing ability and standing balance were assessed at the baseline. The incidence rate ratios (IRR) for falls were computed using the negative binomial regression model.

Results: during the follow-up, 47% of participants experienced a fall. After adjusting for age and interdependence of twin sisters, participants with vision impairment (VA of <1.0) but no other sensory impairments had a higher, but non-significant, risk for falls compared to persons with normal vision (IRR 1.5, 95% CI 0.6–4.2). Co-existing vision impairment and impaired balance increased the risk (IRR 2.7, 95% CI 0.9–8.0), as also did co-existing vision and hearing impairment (IRR 4.2, 95% CI 1.5–11.3), compared to those with normal vision. Among persons with all three impairments, the IRR for falls increased to 29.4 (95% CI 5.8–148.3) compared to participants with good vision.

Conclusion: the impact of vision impairment on fall risk was higher when accompanied with other sensory and balance impairments, probably because the presence of other impairments prevented the reception of compensatory information about body posture and environment being received from other sensory sources. When aiming to prevent falls and their consequences in older people, it is important to check whether poor vision is accompanied with other impairments.