Self-reported Fall History Research Articles

The Prevalence of Cognitive Impairment Among Medicare Beneficiaries Who Use Outpatient Physical Therapy.

The objective of this study was to estimate the prevalence of cognitive impairment (including cognitive impairment no dementia [CIND] and dementia) among Medicare fee-for-service beneficiaries who used outpatient physical therapy and to estimate the prevalence of cognitive impairment by measures that are relevant to rehabilitation practice. This cross-sectional analysis included 730 Medicare fee-for-service beneficiaries in the 2016 wave of the Health and Retirement Study with claims for outpatient physical therapy. Cognitive status, our primary variable of interest, was categorized as normal, CIND, or dementia using a validated approach, and population prevalence of cognitive impairment (CIND and dementia) was estimated by sociodemographic variables and Charlson comorbidity index score. Age-, gender- (man/woman), race-/ethnicity-adjusted population prevalence of CIND and dementia were also calculated for walking difficulty severity, presence of significant pain, self-reported fall history, moderate-vigorous physical activity (MVPA) ≤1×/week, and sleep disturbance frequency using multinomial logistic regression. Among Medicare beneficiaries with outpatient physical therapist claims, the prevalence of any cognitive impairment was 20.3% (CIND:15.2%, dementia:5.1%). Cognitive impairment was more prevalent among those who were older, Black, had lower education attainment, or higher Charlson comorbidity index scores. The adjusted population prevalence of cognitive impairment among those who reported difficulty walking across the room was 29.8%, difficulty walking 1 block was 25.9%, difficulty walking several blocks was 20.8%, and no difficulty walking was 16.3%. Additionally, prevalence of cognitive impairment among those with MVPA ≤1×/week was 27.1% and MVPA >1×/week was 14.1%. Cognitive impairment prevalence did not vary by significant pain, self-reported fall history, or sleep disturbance. One in 5 older adults who use outpatient physical therapist services have cognitive impairment. Furthermore, cognitive impairment is more common in older physical therapist patients who report worse physical function and less physical activity. Physical therapists should consider cognitive screening for vulnerable older adults to inform tailoring of clinical practice toward a patient's ability to remember and process rehabilitation recommendations.

Falls and hospitalization during chemotherapy in older women with early breast cancer.

12035 Background: Hospitalizations are frequent, burdensome, and potentially avoidable complications of cancer treatment in older adults. While geriatric assessments can identify older patients at risk for hospitalization, the use of these assessments in clinic is limited by time and resources. Screening for falls in the past 6 months is a quick and simple question that clinicians can ask in clinic and fall history has been linked to chemo-related toxicity. Here, we hypothesized that in older adults with cancer fall history prior to chemo is associated with an increased risk of hospitalization during chemo. Methods: In a prospective multicenter study of 497 women age ≥65 with stage I-III breast cancer treated with neo/adjuvant chemo, we assessed baseline self-reported fall history in the past 6 months as a dichotomous (yes/no) and continuous variable (no. of falls). Our primary endpoint was hospitalization during chemo (yes/no, yes defined as incident hospitalization assessed from start to end of chemo and attributed to toxicity from chemo). We used multivariable logistic regression to examine the association between fall history and hospitalization during chemo, adjusting for sociodemographic and clinical covariates. Results: The median age was 70 (65-86), 65% had stage II/III disease, 37% had anthracycline, and 72% received primary prophylaxis with G-CSF. Of the 497 participants, 60 (12%) reported falls (median 1.0 [1-6]) at baseline, and 114 (23%) were hospitalized during chemo (median 1.0 [1-4]). The most common toxicities that resulted in hospitalization were febrile neutropenia (25%), anemia (13%), dehydration (13%), and fatigue (13%). Women who fell in the 6 months prior to chemo had greater odds (adjusted OR = 2.69, 95% CI 1.42-5.11, p= 0.003) of being hospitalized during chemo compared to women who did not fall. Conclusions: In this cohort of older women with early breast cancer, fall history prior to chemo was associated with an increased risk of hospitalization during chemo, independent of sociodemographic and clinical factors. Oncologists do not routinely assess fall history when considering chemo in older adults. Screening for falls is a quick, simple, and important indicator of vulnerability that oncologists may use to identify patients at risk for hospitalization during chemo and inform personalized, patient-partnered treatment decisions. Clinical trial information: NCT01472094 . [Table: see text]

Validation of the Self-Assessed Dynamic Gait Index in People with Multiple Sclerosis

Background and Purpose The Dynamic Gait Index (DGI) is a validated clinical measure of walking ability in people with multiple sclerosis (MS). There is need for a self-assessed version of the DGI that can be conducted remotely and that demonstrates concurrent validity with the original DGI in people with MS. We therefore developed a self-assessed Dynamic Gait Index (sDGI). The purpose of this study is to evaluate the relationship between the sDGI, clinically-assessed DGI, and falls in people with MS with gait impairment. Methods We will enroll 50 ambulatory people with MS with gait impairment. Participants will complete the sDGI (online questionnaire) and then, within 4-weeks, the DGI (in-person evaluation by a physical therapist). Other outcome measures include: modified Telephone Interview for Cognitive Status (TICS-M) and self-reported fall history in the past 3 months. We will calculate concordance between the sDGI and DGI, and use linear regression to determine if concordance is impacted by cognition. The ability of the sDGI to identify fallers will be evaluated using the receiver operating characteristic curve. Results At time of submission, 41 participants are enrolled, 31 have completed the study. Anticipated date of study completion is March 2023. Full study results will be presented at the meeting. Discussion The sDGI has potential to be used by physicians, physical therapists, and others to remotely assess walking ability and identify fallers in people with MS. Information from this study will determine how self-assessment of walking ability compares with clinically-assessed walking ability in people with MS. Our study will also determine if cognition impacts the validity of the sDGI. If concordance between sDGI and DGI is lower in those with worse cognitive performance, users of the sDGI might exercise greater caution using this measure to approximate DGI and predict fall risk in individuals with cognitive impairment. The Dynamic Gait Index (DGI) is a validated clinical measure of walking ability in people with multiple sclerosis (MS). There is need for a self-assessed version of the DGI that can be conducted remotely and that demonstrates concurrent validity with the original DGI in people with MS. We therefore developed a self-assessed Dynamic Gait Index (sDGI). The purpose of this study is to evaluate the relationship between the sDGI, clinically-assessed DGI, and falls in people with MS with gait impairment. We will enroll 50 ambulatory people with MS with gait impairment. Participants will complete the sDGI (online questionnaire) and then, within 4-weeks, the DGI (in-person evaluation by a physical therapist). Other outcome measures include: modified Telephone Interview for Cognitive Status (TICS-M) and self-reported fall history in the past 3 months. We will calculate concordance between the sDGI and DGI, and use linear regression to determine if concordance is impacted by cognition. The ability of the sDGI to identify fallers will be evaluated using the receiver operating characteristic curve. At time of submission, 41 participants are enrolled, 31 have completed the study. Anticipated date of study completion is March 2023. Full study results will be presented at the meeting. The sDGI has potential to be used by physicians, physical therapists, and others to remotely assess walking ability and identify fallers in people with MS. Information from this study will determine how self-assessment of walking ability compares with clinically-assessed walking ability in people with MS. Our study will also determine if cognition impacts the validity of the sDGI. If concordance between sDGI and DGI is lower in those with worse cognitive performance, users of the sDGI might exercise greater caution using this measure to approximate DGI and predict fall risk in individuals with cognitive impairment.

Patient reported outcomes in ALS: characteristics of the self-entry ALS Functional Rating Scale-revised and the Activities-specific Balance Confidence Scale

Objective: This study characterized two patient-reported outcome measures (PROMs): a patient-facing adaptation of the revised amyotrophic lateral sclerosis (ALS) Functional Rating Scale (“self-entry ALSFRS-R”) and the Activities-specific Balance Confidence (ABC) Scale. Methods: ALS patients presenting to clinic completed PROMs that included (1) the self-entry ALSFRS-R, (2) the Activities-specific Balance Confidence Scale (ABC Scale), and (3) a question about falls. PROM data were compared to one another and to the traditional ALSFRS-R collected by trained evaluators in clinic (“standard ALSFRS-R”). Results: Over the data collection period, 449 ALS patients completed at least one of the three PROMs. Self-entry vs. standard ALSFRS-R total scores (n = 183) had high agreement (intraclass correlation (ICC)=0.81, 95% CI = 0.67, 0.88). Self-entry ALSFRS-R total scores were significantly higher than standard ALSFRS-R total scores (2.3 points, p < 0.001). In a subset of participants who contributed data at two timepoints, the average ALSFRS-R decline was not significantly different between methods (n = 49). ABC scores correlated highly with self-entry and standard ALSFRS-R Gross Motor subdomain scores (Pearson’s r = 0.72, p < 0.001 and Pearson’s r = 0.76, p < 0.001, respectively; n = 130). ABC score was negatively correlated with the number of reported falls within the last month (Spearman’s r=–0.40; p < 0.001; n = 130). A 10-point decrease in ABC score increased odds of a reported fall by 16%. Conclusions: In a multidisciplinary clinic setting, self-entry and standard ALSFRS-R scores were similar, but not interchangeable. Self-entry scores were higher than standard ALSFRS-R scores but declined at a similar rate to the standard ALSFRS-R. ABC scores correlated with self-reported fall history and thus may provide useful data for clinical care.

The Short Physical Performance Battery (SPPB): A Quick and Useful Tool for Fall Risk Stratification Among Older Primary Care Patients

ObjectivesEvaluate fall risk with the Short Physical Performance Battery (SPPB) and examine its application within the Stopping Elderly Accidents, Deaths, and Injuries (STEADI) tool advocated by the Centers for Disease Control and Prevention. DesignProspective longitudinal cohort study. Setting and Participants417 community-dwelling adults aged ≥65 years at risk for mobility decline, recruited from 9 primary care practices. MethodsThe SPPB, a 3-part performance-based test (gait time, chair stand, and balance), was assessed at baseline. Previously established cutpoints were used to categorize participant scores into 3 groups: low, middle, and best performers. Self-reported falls were assessed in-person at baseline and via phone interviews quarterly for 4 years. Multivariable negative binomial regression models were used to evaluate the relationship of the SPPB and each of its 3 components with fall rates over 1 and 4 years of follow-up. Additional analysis were stratified by fall risk screen status (+/−) based on self-reported fall history and balance self-efficacy using an adapted STEADI model. ResultsParticipants had median age 76 years (interquartile range 70-82) and were 67.2% female with mean baseline SPPB 8.7 ± 2.3. Poor performance on the SPPB and on each of its 3 components independently predicted higher fall risk in the first year. After 4 years, the low total baseline SPPB [rate ratio (RR) 1.53, confidence interval (CI) 1.09-2.17] and gait time performances (RR 1.61, CI 1.07-2.41) predicted higher fall risk. After stratifying the sample according to the STEADI model, we observed the highest 1-year fall risk among those with a (+) fall risk screen who also scored lowest on the SPPB. Conclusions and ImplicationsThe SPPB is a performance measure with clinical utility for fall risk stratification over 1 and 4 years of follow-up among older adults. It shows promise as a complement to the STEADI guidelines, but its full benefits should be confirmed within a larger study.

PHYSICAL ACTIVITY, FALLS, AND FALL INJURIES: THE STUDY OF WOMEN’S HEALTH ACROSS THE NATION

Physical activity (PA) is positively associated with physical functioning, but relations of domain-specific PA with falls is less clear. In 2015, women (n=1,962) self-reported fall history and PA. The Kaiser Physical Activity Survey (KPAS) assessed sports, non-sports leisure, household/caregiving, and total activity. Risk ratios (RR) were generated from poisson regression. One-third (29.7%) of women (mean age=65.1 years [SD 2.7]) reported ≥1 fall and 18.3% reported ≥1 fall injury in the previous 12 months. Women in the highest quartile of sports activity had an increased risk of ≥1 fall (RR=1.19;95%CI:1.00,1.41;p=0.049). Women in the highest quartile of total activity had an increased risk of injurious falls (RR=1.31;95%CI:1.04,1.65;p=0.021), but there was no association for domain-specific indices. KPAS may identify women and activity domains, such as sports, at high risk for falls and injuries. Future work should incorporate device-based PA assessments within domains to understand fall patterns among community-dwelling older adult women.

Daily Use of Bilateral Custom-Made Ankle-Foot Orthoses for Fall Prevention in Older Adults: A Randomized Controlled Trial.

To examine the effects of bilateral custom-made ankle-foot orthoses (AFOs) to prevent falls for older adults with concern about or at risk for falling over 12-month daily use. Secondary analysis of a randomized controlled trial. Community-dwelling older adults. Half of the participants were randomly allocated to an intervention group (IG) that received fitted walking shoes and bilateral custom-made AFOs, and the other half were randomly allocated to a control group (CG) that only received fitted walking shoes. Self-reported fall history of 12-month duration was investigated at baseline and 12-month follow-up for both groups. Fall incidence rate and proportion of fallers were used as outcome measures to determine effects of 12-month footwear intervention in either group. Adults aged 65 years and older with concern about or at risk for falling (n = 44). No significant between-group differences in participant characteristics were observed at the baseline (P = .144-.882). Within the IG, significant reductions were found in the fall incidence rate (P = .039) and the proportion of fallers (P = .036) at the 12-month follow-up compared to the baseline. Within the CG, no significant change was found at the 12-month follow-up compared to the baseline for the fall incidence rate (P = .217) or the proportion of fallers (P = .757). When comparing the IG with the CG, there was no significant difference in the change from the baseline to the 12-month follow-up for the fall incidence rate (P = .572) or the proportion of fallers (P = .080). This study failed to demonstrate a significant benefit of bilateral custom-made AFOs to reduce falls compared to fitted walking shoes. However, the AFO users had significant reductions in falls compared to the preceding year. A future study with a larger sample size is recommended to confirm these observations. CLINICAL TRIAL REGISTRATION-URL: http://www.clinicaltrials.gov. Unique identifier: NCT02819011. J Am Geriatr Soc 67:1656-1661, 2019.

Modified dynamic gait index and limits of stability in myotonic dystrophy type 1.

The purpose of this study was to describe and compare the performance of balance and walking tests in relation to self-reported fall history in adults with myotonic dystrophy type 1 (DM1). Twenty-two (13 male) participants with DM1 completed, a 6-month fall history questionnaire, the modified Dynamic Gait Index (mDGI), limits of stability (LoS) testing, and 10-m walking tests. Mean (SD) falls in 6 months was 3.7 (3.1), and 19 (86%) participants reported at least 1 fall. Significant differences in mDGI scores (P = 0.006) and 10-m fast walking gait velocity (P = 0.02) were found between those who had been classified as "fallers" and those who had been classified as "nonfallers." Significant correlations were found between mDGI scores and 10-m walking time. Falls are common in DM1, and the mDGI may have potential to distinguish fallers from nonfallers, whereas the LoS failed to detect such impairment. Future studies should further explore use of the mDGI in DM1. Muscle Nerve 58: 694-699, 2018.

Fall Characteristics In Community-living Older Adults

Falls among older adults represent a significant health concern due to the high number of incidents, the involvement of many different risk factors, and the consequential post-fall morbidity and mortality. Prospective studies are beneficial as they help to identify the causes and outcomes of falls in older adults, and in turn, help health care providers better assess fall risk. PURPOSE: The specific aim was to characterize fall information through a 12 month prospective fall study among older adults. METHODS: Ninety-three independent community-living otherwise healthy older adults (age 86±6 years) were recruited from multiple facilities. Participants were asked how many times they had fallen in the past six months. Participants were called weekly for 12 months to evaluate falls after the baseline assessment. The date, time, location, activity at the time of the fall, injuries, assistive device use, and medication changes were all recorded at each follow up call. Fall characteristic data were presented as percentages of total falls. RESULTS: At the time of testing, 36/93 participants (38.7%) self-reported at least one fall in the preceding six months. Of the 36 participants with a self-reported fall history, 24 (66.7%) fell at least once in the subsequent 12 months of follow-up. Of the 57 participants without a self-reported fall history, 30 (52.6%) fell at least once in the subsequent 12 months of follow-up. A majority of the 147 total falls occurred inside (78.2%) and/or at home (67.3%), and sometime between 6:00 a.m.-10:00 p.m. (83.0%). An injury was reported in 40.1% of the falls and 6.1% resulted in a fracture. Falls that occurred while using an assistive device comprised of 18.4%. Lastly, a recent medication change was found in 5.4% of the falls. CONCLUSIONS: Due to the high incidence of falls that occurred during the 12-month follow up period (many injurious) in those with and without a recent history of falls, this study suggests that greater precautions must be taken to ensure the safety of these older adults regardless of perceived fall risk. Given that most falls occurred at home during waking hours, it is advised that the home environment be evaluated more rigorously and appropriate preventive modifications made. It may also be prudent to further assess the proper use of assistive devices, as it is presently unclear whether the device contributed to a fall or if individuals already at an increased risk of falling use an assistive device.

Older adults who have previously fallen due to a trip walk differently than those who have fallen due to a slip

Studying the relationships between centre of mass (COM) and centre of pressure (COP) during walking has been shown to be useful in determining movement stability. The aim of the current study was to compare COM–COP separation measures during walking between groups of older adults with no history of falling, and a history of falling due to tripping or slipping. Any differences between individuals who have fallen due to a slip and those who have fallen due to a trip in measures of dynamic balance could potentially indicate differences in the mechanisms responsible for falls. Forty older adults were allocated into groups based on their self-reported fall history during walking. The non-faller group had not experienced a fall in at least the previous year. Participants who had experienced a fall were split into two groups based on whether a trip or slip resulted in the fall(s). A Vicon system was used to collect full body kinematic trajectories. Two force platforms were used to measure ground reaction forces. The COM was significantly further ahead of the COP at heel strike for the trip (14.3±2.7cm) and slip (15.3±1.1cm) groups compared to the non-fallers (12.0±2.7cm). COM was significantly further behind the COP at foot flat for the slip group (−14.9±3.6cm) compared to the non-fallers (−10.3±3.9cm). At mid-swing, the COM of the trip group was ahead of the COP (0.9±1.6cm), whereas for the slip group the COM was behind the COP (−1.2±2.2cm). These results show identifiable differences in dynamic balance control of walking between older adults with a history of tripping or slipping and non-fallers.

Identification of Fall Risk Predictors in Daily Life Measurements

Background. Gait characteristics extracted from trunk accelerations during daily life locomotion are complementary to questionnaire- or laboratory-based gait and balance assessments and may help to improve fall risk prediction. Objective. The aim of this study was to identify gait characteristics that are associated with self-reported fall history and that can be reliably assessed based on ambulatory data collected during a single week. Methods. We analyzed 2 weeks of trunk acceleration data (DynaPort MoveMonitor, McRoberts) collected among 113 older adults (age range, 65-97 years). During episodes of locomotion, various gait characteristics were determined, including local dynamic stability, interstride variability, and several spectral features. For each characteristic, we performed a negative binomial regression analysis with the participants’ self-reported number of falls in the preceding year as outcome. Reliability of gait characteristics was assessed in terms of intraclass correlations between both measurement weeks. Results. The percentages of spectral power below 0.7 Hz along the vertical and anteroposterior axes and below 10 Hz along the mediolateral axis, as well as local dynamic stability, local dynamic stability per stride, gait smoothness, and the amplitude and slope of the dominant frequency along the vertical axis, were associated with the number of falls in the preceding year and could be reliably assessed (all P < .05, intraclass correlation > 0.75). Conclusions. Daily life gait characteristics are associated with fall history in older adults and can be reliably estimated from a week of ambulatory trunk acceleration measurements.

Fall-Related Self-efficacy in Instrumental Activities of Daily Living is Associated with Falls in Older Community-Living People

ABSTRACTIntroduction: The aim of this study was to identify fall risk factors in community-living people 75 years or older. Methods: From a random selection of 525 older adults, a total of 378 (72%) individuals participated in the study. Mean age was 81.7 years (range 75–101 years). A study-specific questionnaire including self-reported fall history for the past 6 months, the Falls-Efficacy Scale (Swedish version: FES(S)) and EuroQol 5 Dimensions (EQ5D) was used. Logistic regression analysis was conducted to find risk factors for falls. Results: The strongest significant predictor of falls was scoring low on FES(S) in instrumental activities of daily living (IADL), with an odds ratio of 7.89 (95% confidence interval 2.93–21.25). One fifth had experienced one or more falls during the past 6 months. Both fall-related self-efficacy and health-related quality of life were significantly lower among fallers. Conclusion: Our results imply that identifying community-living older adults with an increased risk of falling should include a measure of fall-related self-efficacy in IADL.

Development of a Clinical Multiple-Lunge Test to Predict Falls in Older Adults

Wagenaar R, Keogh JW, Taylor D. Development of a clinical Multiple-Lunge Test to predict falls in older adults. ObjectiveTo develop a new Multiple-Lunge Test to distinguish between fallers and nonfallers in community-dwelling older adults. DesignA cross-sectional design was used to establish the sensitivity and specificity of the test to predict faller status based on retrospective self-reported fall history. SettingLocal retirement villages. ParticipantsCommunity-dwelling older adults (N=130; mean age ± SD, 77±7y) with (n=40) and without (n=90) a history of falls. InterventionsThe Multiple-Lunge Test required individuals to lunge forward to a step length determined as 60% of their leg length, and return to start, for 5 consecutive repetitions. Interday and intraday test-retest reliability of the Multiple-Lunge Test was established across 2 testing occasions. Main Outcome MeasuresNumber of steps performed correctly, total time to complete 5 steps. ResultsThe Multiple-Lunge Test was found to be reliable across trials (Intraday: intraclass correlation coefficient [ICC]=.79–.81 for steps, ICC=.86–.88 for time; Interday: ICC=.77 for steps; ICC=.84 for time). Sensitivity and specificity values were calculated as 73% and 63%, respectively, for predicting multiple fallers using the measure of all 5 steps done correctly. ConclusionsThe test is easily administered and because of its challenging nature, it may be well suited to detect subtle differences in abilities of higher functioning, community-dwelling older adults. A practitioner can be confident in 7 of 10 cases that an older adult who cannot complete all 5 steps of the Multiple-Lunge Test is at high risk of falls. The results suggest that there is potential for the Multiple-Lunge Test to be used in clinical practice; however, additional research on how to further increase its validity appears warranted.

Falls and physical activity in persons with multiple sclerosis.

Objectives. To examine the association between fall history and physical activity using an objective measure of physical activity (i.e., accelerometry) in persons with multiple sclerosis. Design. A community-based sample of 75 ambulatory persons with multiple sclerosis volunteered for the investigation. Participants self-reported fall history in the last year, underwent a neurological exam to determine Expanded Disability Status Scale (EDSS) score, and wore an accelerometer around the waist for 7 consecutive days to determine physical activity. Results. Overall, 37 persons (49.3% of the sample) reported falling in the last year with 28 of the 37 falling more than once. Persons who fell in the last year had a significantly lower number of steps/day than nonfallers (3510 versus 4940 steps/day; P < .05). However, when controlling for disability status there was no statistically significant difference between fallers and nonfallers (4092 versus 4373 steps/day; P > .05). Conclusions. Collectively, the findings suggest that fall history may have little impact on current physical activity levels in persons with multiple sclerosis.

Predicting Which Older Adults Will or Will Not Fall Using the Fullerton Advanced Balance Scale

Hernandez D, Rose DJ. Predicting which older adults will or will not fall using the Fullerton Advanced Balance Scale. Objective The purpose of this study was to determine if the Fullerton Advanced Balance (FAB) scale can predict faller status in a group of independently functioning older adults. Design A cross-sectional design was used to establish the sensitivity and specificity of the FAB scale to predict faller status based on a retrospective self-reported fall history. For the purpose of this study, a faller was classified as an older adult with a history of 2 or more falls in the previous 12 months. Setting Multipurpose senior centers in an urban community. Participants A sample of independently functioning older adults (N=192; mean age ± SD, 77±6.5y). Interventions Not applicable. Main Outcome Measures FAB scale, a retrospective history of falls. Results Binary logistic regression analysis indicated that the total FAB scale score could be used to predict faller status (as determined by a retrospective self-reported fall history). In the present sample, the probability of falling increased by 8% with each 1-point decrease in total FAB scale score. Receiver operating characteristic analysis determined that a cut-off score of 25 out of 40 on the FAB scale produced the highest sensitivity (74.6%) and specificity (52.6%) in predicting faller status. Five individual test items on the FAB scale were particularly predictive of faller status and could be combined to form a short version of the scale that may be even more predictive of faller status and require less time to administer. Conclusions The FAB scale is a predictive measure of faller status when used with independently functioning older adults. A practitioner can be confident in more than 7 out of 10 cases that an older adult who scores 25 or lower on the FAB scale is at high risk for falls and in need of immediate intervention.

An Examination of the Predictive Properties of the Fullerton Advanced Balance (FAB) Scale.

Through early detection of balance and mobility limitations, preventative strategies can be implemented to reduce the risk factors that predispose older adults to falls and fall-related injuries. The development of performance-based tests that are sensitive to subtle changes in balance abilities and also capable of identifying older adults at different levels of fall risk are particularly important. PURPOSE: The purpose of this study was to determine if the Fullerton Advanced Balance (FAB) scale can predict faller status in a sample of 200 independently functioning older adults (60–93 years). METHODS: A cross-sectional design was used to establish the sensitivity and specificity of the FAB scale to predict faller status (based on a retrospective self-reported fall history). Independently-residing older adults attended a community fall risk screening event and were assessed using multiple measures of balance and gait. To be eligible for inclusion in the study, participants had to be: (a) 65 years or older, (b) independently residing in the community, (c) of normal cognition, (d) able to ambulate independently for a distance of 200 feet, and (e) not diagnosed with a progressive neurological condition or severe musculoskeletal condition. The session was approximately 90 minutes in duration. RESULTS: Binary logistic regression analysis indicated that the total FAB scale score can be used to predict faller status. In the present sample, the likelihood of falling increased by 10% with each one point decrease in total FAB scale score. Receiver Operating Curve (ROC) analysis determined that a cut-off score of 26/40 on the FAB scale produced the highest sensitivity (80.3%) and specificity (47.5%) in predicting faller status. CONCLUSION: The FAB scale demonstrates strong predictive validity with respect to faller status and can be used to identify independently functioning older adults at high risk for falls who should be referred to a fall risk reduction program.

The dynamic gait index relates to self-reported fall history in individuals with vestibular dysfunction

The purpose of this study was to determine the relationship between gait instability and falls history in people with vestibular disorders. A total of 247 people (164 women, 83 men) participated in the study (mean age = 62.5). Falls history within the last 6 months and scores on the Dynamic Gait Index (DGI) were compared using the Mantel-Hantzel Chi-square statistic. Thirty-seven percent of all subjects reported falling within the last 6 months. Odds ratios in favor of falls with DGI scores of 19 or lower was 2.58 (95% C.I. 1.47-4.53). Subjects with DGI scores of 19/24 or less were 2.58 times more likely to have reported a fall in the previous 6 months than subjects with scores above 19. Younger subjects (those under 65 years of age) with vestibular disorders reported more falls than persons 65 years of age or over. Younger people may be more willing to risk a fall while actively having a vestibular disorder. The DGI appears to be a good indicator of fall status in persons with vestibular disorders, regardless of age.