title: The relationship between balance measured with a modified bathroom scale and falls and disability in older adults: a 6-month follow-up study.
abstract: BACKGROUND
  There are indications that older adults who suffer from poor balance have an increased risk for adverse health outcomes, such as falls and disability. Monitoring the development of balance over time enables early detection of balance decline, which can identify older adults who could benefit from interventions aimed at prevention of these adverse outcomes. An innovative and easy-to-use device that can be used by older adults for home-based monitoring of balance is a modified bathroom scale.
  
  
  OBJECTIVE
  The objective of this paper is to study the relationship between balance scores obtained with a modified bathroom scale and falls and disability in a sample of older adults.
  
  
  METHODS
  For this 6-month follow-up study, participants were recruited via physiotherapists working in a nursing home, geriatricians, exercise classes, and at an event about health for older adults. Inclusion criteria were being aged 65 years or older, being able to stand on a bathroom scale independently, and able to provide informed consent. A total of 41 nursing home patients and 139 community-dwelling older adults stepped onto the modified bathroom scale three consecutive times at baseline to measure their balance. Their mean balance scores on a scale from 0 to 16 were calculated-higher scores indicated better balance. Questionnaires were used to study falls and disability at baseline and after 6 months of follow-up. The cross-sectional relationship between balance and falls and disability at baseline was studied using t tests and Spearman rank correlations. Univariate and multivariate logistic regression analyses were conducted to study the relationship between balance measured at baseline and falls and disability development after 6 months of follow-up.
  
  
  RESULTS
  A total of 128 participants with complete datasets--25.8% (33/128) male-and a mean age of 75.33 years (SD 6.26) were included in the analyses of this study. Balance scores of participants who reported at baseline that they had fallen at least once in the past 6 months were lower compared to nonfallers--8.9 and 11.2, respectively (P<.001). The correlation between mean balance score and disability sum-score at baseline was -.51 (P<.001). No significant associations were found between balance at baseline and falls after 6 months of follow-up. Baseline balance scores were significantly associated with the development of disability after 6 months of follow-up in the univariate analysis--odds ratio (OR) 0.86 (95% CI 0.76-0.98)-but not in the multivariate analysis when correcting for age, gender, baseline disability, and falls at follow-up-OR 0.94 (95% CI 0.79-1.11).
  
  
  CONCLUSIONS
  There is a cross-sectional relationship between balance measured by a modified bathroom scale and falls and disability in older adults. Despite this cross-sectional relationship, longitudinal data showed that balance scores have no predictive value for falls and might only have limited predictive value for disability development after 6 months of follow-up.
authors.affiliation: School for Public Health and Primary Care (CAPHRI), Department of Health Services Research, Maastricht University, Maastricht, Netherlands. j.vermeulen@maastrichtuniversity.nl.
authors.forename: Joan
authors.identifier: http://orcid.org/0000-0002-0258-7525
authors.initials: J
authors.lastname: Vermeulen
authors.forename: Jacques C L
authors.identifier: http://orcid.org/0000-0003-4042-9365
authors.initials: JC
authors.lastname: Neyens
authors.forename: Marieke D
authors.identifier: http://orcid.org/0000-0002-5798-0041
authors.initials: MD
authors.lastname: Spreeuwenberg
authors.forename: Erik
authors.identifier: http://orcid.org/0000-0002-2056-2874
authors.initials: E
authors.lastname: van Rossum
authors.forename: April B C G
authors.identifier: http://orcid.org/0000-0002-6231-4107
authors.initials: AB
authors.lastname: Boessen
authors.forename: Walther
authors.identifier: http://orcid.org/0000-0003-3031-5735
authors.initials: W
authors.lastname: Sipers
authors.forename: Luc P
authors.identifier: http://orcid.org/0000-0002-3013-2640
authors.initials: LP
authors.lastname: de Witte
mesh_terms: D000058:Accidental Falls / Q000706:statistics & numerical data; D000368:Aged; D000369:Aged, 80 and over; D006233:Persons with Disabilities; D005260:Female; D005500:Follow-Up Studies; D006794:Household Articles; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D004856:Postural Balance
keywords: balance; bathroom scale; disability; falls; older adults; telemonitoring; validity