Are activity-based assessments of balance and gait in the elderly predictive of risk of falling and/or type of fall?
OBJECTIVE
To determine whether an activity-based test of balance and gait is predictive of the risk of: (1) falling in situations that are related to specific tasks evaluated as part of the test, (2) experiencing falls precipitated by different classes of biomechanical events, or (3) falling in general; and to compare the predictive ability of the activity-based test for the falls described in (2) and (3) to that of a posturography test that has been found previously to be predictive of falling risk.


METHODS
Cohort study.


METHODS
Baseline tests performed in balance laboratory; subsequent history of falling monitored prospectively for 1 year in two residential-care facilities.


METHODS
Seventeen male and 83 female consecutive volunteers (mean age = 83, SD = 6) who were independent in activities of daily living and able to stand unaided.


METHODS
Independent variables were derived from an activity-based balance-and-gait test and a posturography test. Dependent variables were the numbers of subjects with one or more: (1) falls in specific situations related to activity-based test items, (2) falls related to general classes of biomechanical precipitant, and (3) falls in general.


RESULTS
Subjects who were rated as "abnormal" in activity-based test items related to transfers, turning or reaching were more likely to experience one or more falls in related situations in everyday life. Activity-based scores were predictive of risk of experiencing falls with no obvious biomechanical precipitant and falls precipitated by center-of-mass perturbation, but not falls precipitated by base-of-support perturbation. In comparison, a posturographic measure of spontaneous medial-lateral postural sway (blindfolded conditions) failed to predict falls having no biomechanical precipitant, but provided the best predictions of both center-of-mass and base-of-support falls, as well as risk of falling in general.


CONCLUSIONS
Activity-based testing of certain tasks (transfer, turning, reaching) may be useful in indicating a specific need for intervention to reduce the risk of falling during related everyday activities. In terms of predicting falling risk, a static posturography test may provide better prediction overall of the different classes of falls and may be useful as a quick and simple screening tool to help identify high-risk individuals.
Topper
A K
AK
Centre for Studies in Aging, Sunnybrook Health Science Centre, University of Toronto, Ontario, Canada.
Maki
B E
BE
Holliday
P J
PJ
D000058:Accidental Falls / Q000706:statistics & numerical data*; D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D001696:Biomechanical Phenomena; D015331:Cohort Studies; D005260:Female; D005684:Gait; D015577:Geriatric Assessment; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D004856:Postural Balance; D011187:Posture; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012112:Residential Facilities; D012307:Risk Factors; D011795:Surveys and Questionnaires