Performance on physical function tests and the risk of fractures and admissions: Findings from a national health screening of 557,648 community-dwelling older adults.
OBJECTIVE
Falls and fractures in older adults are often preventable, yet remain major health concerns as comprehensive physical function assessment may not be readily available. This study investigated whether simple timed up and go test (TUG) and unipedal stance test (UST) are effective in identifying people with an increased risk of fractures, femoral fractures, or admissions due to femoral fractures.


METHODS
Community-dwelling Korean older adults aged 66 years participated in the Korean National Screening Program for the Transitional Ages (n=557,648) between 2007 and 2010. Overall fractures, femoral fractures, and admissions due to femoral fracture during this period were outcome measures. The outcome measures were overall fractures, femoral fractures, and admissions due to femoral fracture after the health screening. The associations between inferior physical function test results and outcome measures were evaluated.


RESULTS
A total of 523,502 subjects were followed-up for a mean period of 1.42 years, which resulted in 12,965 subjects with any fractures. Fracture data were retrieved from medical claims record. Subjects who performed poorly on one or both of the two physical function tests experienced higher number of overall fractures (aHR 1.21, 95% CI: 1.16-1.26), femoral fractures (aHR 1.80, 95% CI: 1.59-2.17), and admissions due to femoral fractures (aHR 1.85, 95% CI: 1.55-2.22) as compared to subjects with normal results on both tests. Combining TUG and UST was not superior to performing UST alone in predicting the increased risk of overall fractures (p=0.347), femoral fractures (p=0.402) or admissions due to femoral fractures (p=0.774).


CONCLUSIONS
Poor performance on physical performance tests is associated with a higher risk of overall fractures, femoral fractures and admissions due to femoral fractures. The TUG and UST can be used to identify community-dwelling older individuals who are more vulnerable to fractures.
International Health Services, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Department of Family Medicine, Seoul National University Hospital, Seoul, Republic of Korea. Electronic address: sohyun.chun@gmail.com.
So Hyun
SH
Chun
Department of Family Medicine, Seoul National University Hospital, Seoul, Republic of Korea; Department of Family Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea. Electronic address: belong.cho@snu.ac.kr.
Belong
B
Cho
Department of Family Medicine, Seoul National University Hospital, Seoul, Republic of Korea; Cancer Policy Branch, National Cancer Control Research Institute, National Cancer Center, Goyang, Republic of Korea. Electronic address: seesky1@gmail.com.
Hyung-Kook
HK
Yang
Department of Family Medicine, Seoul National University Hospital, Seoul, Republic of Korea; Cancer Policy Branch, National Cancer Control Research Institute, National Cancer Center, Goyang, Republic of Korea. Electronic address: mdlark@gmail.com.
Eunmi
E
Ahn
Department of Family Medicine, Seoul National University Hospital, Seoul, Republic of Korea. Electronic address: ilovebeeth@gmail.com.
Min Kyu
MK
Han
Department of Family Medicine, Seoul National University Hospital, Seoul, Republic of Korea; Department of Family Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Republic of Korea. Electronic address: micro39@gmail.com.
Bumjo
B
Oh
Department of Family Medicine, Seoul National University Hospital, Seoul, Republic of Korea; Department of Family Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; JW Lee Center for Global Medicine, College of Medicine, Seoul National University, Seoul, Republic of Korea. Electronic address: dwshin.snuh@gmail.com.
Dong Wook
DW
Shin
Department of Family Medicine, Seoul National University Hospital, Seoul, Republic of Korea; Department of Family Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea. Electronic address: mdsky75@gmail.com.
Ki Young
KY
Son
D000058:Accidental Falls / Q000517:prevention & control / Q000706:statistics & numerical data; D000368:Aged; D005080:Exercise Test; D005260:Female; D005264:Femoral Fractures / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D005500:Follow-Up Studies; D015577:Geriatric Assessment; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D057187:Independent Living; D008297:Male; D008403:Mass Screening; D010809:Physical Fitness; D026741:Physical Therapy Modalities; D056910:Republic of Korea / Q000453:epidemiology; D018570:Risk Assessment; D012307:Risk Factors
Elderly; Fall; Fracture; Physical function; Prevention