Balance Impairment as a Risk Factor for Falls in Community-Dwelling Older Adults Who Are High Functioning: A Prospective Study

• Published in: Physical therapy Vol. 90; no. 3; pp. 338 - 347
• Main Authors: Muir, Susan W., Berg, Katherine, Chesworth, Bert, Klar, Neil, Speechley, Mark
• Format: Journal Article
• Language: English
• Published: United States American Physical Therapy Association 01.03.2010; Oxford University Press
• Subjects: Accidental falls; Accidental Falls - statistics & numerical data; Activities of Daily Living; Aged; Aged, 80 and over; Colleges & universities; Data collection; Demographic aspects; Drug Prescriptions - statistics & numerical data; Educational materials; Equilibrium (Physiology); Falls (Accidents); Family physicians; Female; Frail elderly; Gait; Geriatric Assessment; Health aspects; Health risk assessment; Health sciences; Human subjects; Humans; Male; Older people; Physical therapists; Postural Balance; Prevention; Prospective Studies; Recurrence; Risk Assessment; Risk Factors; Surveys and Questionnaires; Veterans; United States
• ISSN: 0031-9023; 1538-6724; 1538-6724
• DOI: 10.2522/ptj.20090163

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. 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. This was a prospective cohort study. 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. 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. 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.