Are activity-based assessments of balance and gait in the elderly predictive of risk of falling and/or type of fall?

Topper, A.K.; Maki, B.E.; Holliday, P.J.

Journal of the American Geriatrics Society 41(5): 479-487


ISSN/ISBN: 0002-8614
PMID: 8486878
DOI: 10.1111/j.1532-5415.1993.tb01881.x
Accession: 008185567

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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. Design: Cohort study. Setting: Baseline tests performed in balance laboratory; subsequent history of falling monitored prospectively for 1 year in two residental-care facilities. Participants: 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. Measurements: 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. Main 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. 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 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.

Are activity-based assessments of balance and gait in the elderly predictive of risk of falling and/or type of fall?