title: Balance impairment as a risk factor for falls in community-dwelling older adults who are high functioning: a prospective study.
abstract: BACKGROUND
  Screening should have simple and easy-to-administer methods that identify impairments associated with future fall risk, but there is a lack of literature supporting validation for their use.
  
  
  OBJECTIVE
  The aim of this study was to evaluate the independent contribution of balance assessment on future fall risk, using 5 methods to quantify balance impairment, for the outcomes "any fall" and "any injurious fall" in community-dwelling older adults who are higher functioning.
  
  
  METHODS
  This was a prospective cohort study.
  
  
  METHODS
  A sample of 210 community-dwelling older adults (70% male, 30% female; mean age=79.9 years, SD=4.7) received a comprehensive geriatric assessment at baseline, which included the Berg Balance Scale to measure balance. Information on daily falls was collected for 12 months by each participant's monthly submission of a falls log calendar.
  
  
  RESULTS
  Seventy-eight people (43%) fell, of whom 54 (30%) sustained an injurious fall and 32 (18%) had recurrent falls (> or =2 falls). Different balance measurement methods identified different numbers of people as impaired. Adjusted relative risk (RR) estimates for an increased risk of any fall were 1.58 (95% confidence interval [CI]=1.06, 2.35) for self-report of balance problems, 1.58 (95% CI=1.03, 2.41) for one-leg stance, and 1.46 (95% CI=1.02, 2.09) for limits of stability. An adjusted RR estimate for an increased risk of an injurious fall of 1.95 (95% CI=1.15, 3.31) was found for self-report of balance problems. Limitations The study was a secondary analysis of data.
  
  
  CONCLUSIONS
  Not all methods of evaluating balance impairment are associated with falls. The number of people identified as having balance impairment varies with the measurement tool; therefore, the measurement tools are not interchangeable or equivalent in defining an at-risk population. The thresholds established in this study indicate individuals who should receive further comprehensive fall assessment and treatment to prevent falls.
authors.affiliation: Department of Medicine, Division of Geriatric Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, Parkwood Hospital, Room A-283, 801 Commissioners Rd East, London, Ontario N6C5J1, Canada. susan.muir@uwo.ca
authors.forename: Susan W
authors.initials: SW
authors.lastname: Muir
authors.forename: Katherine
authors.initials: K
authors.lastname: Berg
authors.forename: Bert
authors.initials: B
authors.lastname: Chesworth
authors.forename: Neil
authors.initials: N
authors.lastname: Klar
authors.forename: Mark
authors.initials: M
authors.lastname: Speechley
mesh_terms: D000058:Accidental Falls / Q000706:statistics & numerical data; D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D005260:Female; D005684:Gait; D015577:Geriatric Assessment; D006801:Humans; D008297:Male; D004856:Postural Balance; D011446:Prospective Studies; D012008:Recurrence; D018570:Risk Assessment; D012307:Risk Factors; D011795:Surveys and Questionnaires