A Simple Clinical Scale to Stratify Risk of Recurrent Falls in Community-Dwelling Adults Aged 65 Years and Older

Abstract

Correct identification of people at risk for recurrent falls facilitates the establishment of preventive and rehabilitative strategies in older adults. The purposes of this study were: (1) to develop and validate a simple clinical scale to stratify risk for recurrent falls in community-dwelling elderly people based on easily obtained social and clinical items and (2) to evaluate the added value of 3 clinical balance tests in predicting this risk. This was a prospective measurement study. A population of 1,618 community-dwelling people over 65 years of age underwent a health checkup, including performance of 3 clinical balance tests: the One-Leg-Balance Test, the Timed "Up & Go" Test, and the Five-Times-Sit-to-Stand Test. Falls were recorded using a self-administered questionnaire that was completed a mean (SD) of 25+/-5 months after the visit. Participants were randomly divided into either group A (n=999), which was used to develop the scale, or group B (n=619), which was used to prospectively validate the scale. Logistic regression analysis identified 4 variables that independently predicted recurrent falls in group A: history of falls, living alone, taking >or=4 medications per day, and female sex. Thereafter, 3 risk categories of recurrent falls (low, moderate, and high) were determined. Predicted probability of recurrent falls increased from 4.1% to 30.1% between the first and third categories. This scale subsequently was validated with great accuracy in group B. Only the Five-Times-Sit-to-Stand Test provided added value in the estimation of risk for recurrent falls, especially for the participants who were at moderate risk, in whom failure on the test (duration of >15 seconds) doubled the risk. Falls were assessed only once, and length of follow-up was heterogeneous (18-36 months). Clinicians could easily classify older patients in low-, moderate-, or high-risk groups of recurrent falls by using 4 easy-to-obtain items. The Five-Times-Sit-to-Stand Test provides added value to stratify risk for falls in people at moderate risk.