Predicting Falls in Older Adults

Abstract

Accelerometers have been evaluated extensively regarding their ability to assess postural sway. Horizontal center of mass (COM) accelerations have been reported to be positively associated fall risk in older adult populations. In fact, we previously reported that an accelerometer-based balance assessment (ABA) was superior to select clinical measures at retrospectively discriminating fallers from non-fallers. PURPOSE: Understanding that a retrospective analysis of fall risk is inherently flawed, we aimed to prospectively evaluate the ABA. METHODS: Ninety-three independent community-living otherwise healthy older adults (age 86±6 years) were recruited from multiple facilities. For the baseline assessment, participants completed the ABA (8 static balance tasks), Timed Up-and-Go (TUG), Berg Balance Scale (BBS), and the Activities-Specific Balance Confidence (ABC) Scale. Participants were then called weekly for 12 months to evaluate falls after the baseline assessment. We then compared outcomes from the ABA and clinical assessments between participants who never fell, participants who fell once, and participants who fell two or more times during the follow-up period. RESULTS: During the 12-month follow-up, 22/93 (24%) of the participants fell once and 32/93 (34%) fell at least twice. The average root mean square of the horizontal COM accelerations across the 8 ABA static balance conditions for non-fallers, one time fallers, and multiple fallers (0.0126 ± 0.0049 g, 0.0122 ± 0.0030 g, and 0.0129 ± 0.0042 g, respectively) were statistically similar. Likewise, there were no significant differences between non-fallers, one time fallers, and multiple fallers with respect to the TUG (15.7 ± 12.0 s, 17.1 ± 10.2 s, and 12.8 ± 4.7 s, respectively), BBS (46.7 ± 7.4, 45.1 ± 10.1, and 47.3 ± 5.1, respectively), or the ABC Scale (69.6 ± 19.1, 68.0 ± 16.2, and 65.8 ± 18.1, respectively). CONCLUSIONS: In this 12-month prospective study, 58% of our study population fell at least once, but baseline performance on the ABA, TUG, BBS, and ABC Scale was not significantly associated with future single or multiple falls.