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Increased postural sway during quiet stance as a risk factor for prospective falls in community-dwelling elderly individuals
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
Umeå University, Faculty of Medicine, Department of Integrative Medical Biology (IMB).
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2017 (English)In: Age and Ageing, ISSN 0002-0729, E-ISSN 1468-2834, Vol. 46, no 6, 964-970 p.Article in journal (Refereed) Published
Abstract [en]

Objective: fall-related injuries constitute major health risks in older individuals, and these risks are projected to increase in parallel with increasing human longevity. Impaired postural stability is a potential risk factor related to falls, although the evidence is inconclusive, partly due to the lack of prospective studies. This study aimed to investigate how objective measures of postural sway predict incident falls.

Design, setting and participants: this prospectively observational study included 1,877 community-dwelling individuals aged 70 years who participated in the Healthy Ageing Initiative between June 2012 and December 2015.

Measurements: postural sway was measured during eyes-open (EO) and eyes-closed (EC) trials using the Wii Balance Board. Functional mobility, muscle strength, objective physical activity and cognitive performance were also measured. Participants reported incident falls 6 and 12 months after the examination.

Results: during follow-up, 255 (14%) prospective fallers were identified. Division of centre of pressure (COP) sway lengths into quintiles revealed a nonlinear distribution of falls for EO trial data, but not EC trial data. After adjustment for multiple confounders, fall risk was increased by 75% for participants with COP sway lengths ≥400 mm during the EO trial (odds ratio [OR] 1.75, 95% confidence interval [CI] 1.09-2.79), and approximately doubled for sway lengths ≥920 mm during the EC trial (OR 1.90, 95% CI 1.12-3.22).

Conclusion: objective measures of postural sway independently predict incident falls in older community-dwelling men and women. Further studies are needed to evaluate whether postural sway length is of interest for the prediction of incident falls in clinical settings.

Place, publisher, year, edition, pages
Oxford University Press, 2017. Vol. 46, no 6, 964-970 p.
Keyword [en]
incident fall, postural sway, older people, cohort study, posturography
National Category
Physiotherapy Geriatrics
Identifiers
URN: urn:nbn:se:umu:diva-135433DOI: 10.1093/ageing/afx083ISI: 000413549300016PubMedID: 28531243OAI: oai:DiVA.org:umu-135433DiVA: diva2:1098954
Available from: 2017-05-29 Created: 2017-05-29 Last updated: 2018-01-15Bibliographically approved
In thesis
1. The Healthy Ageing Initiative: Prevention of falls and fractures
Open this publication in new window or tab >>The Healthy Ageing Initiative: Prevention of falls and fractures
2018 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The world is currently experiencing a dramatic increase in the number of older individuals, an amount that is expected to double between 2015 and 2050. This increase will likely affect the prevalence of age-related functional impairments, such as those caused by fractures. Fractures are often immobilizing events leading to increased individual suffering and vast healthcare costs. Prevention of these events and detection of underlying risk factors are hence of utmost importance. Fracture prevention strategies have traditionally focused on strengthening the skeleton by improving bone mineral density, partly through the mechanical load of increased physical activity. However, research has shown that nine out of ten hip fractures are attributed to falls. While several risk factors behind falls have been identified, there is less knowledge about how aspects such as gait patterns and postural stability predict future falls. The aim of this thesis was to expand upon the current knowledge by investigating objective measures of physical activity in relation to bone parameters, and measures of gait patterns and postural stability in relation to incident falls, in a large population-based sample of 70-year-olds.

The samples investigated in the four included studies were drawn from the Healthy Ageing Initiative (HAI) cohort. Study I examined associations between physical activity, objectively measured using accelerometers, and bone parameters, measured by Dual-energy X-ray Absorptiometry and Peripheral Quantitative Computed Tomography. Study II examined how gait variability, measured using the GAITRite electronic walkway system, predicted incident falls in men and women. Studies III and IV examined how center of pressure (COP) sway and limits of stability (LOS), measured using a force platform, predicted incident falls. Independent prediction of bone parameters and incident falls were investigated using multiple linear and logistic regression models.

Study I revealed that moderate-to-vigorous physical activity and vertical peak acceleration independently predicted parameters of bone in the weight-bearing skeleton. Study II showed that women’s increased risk of falling could be explained by increased gait variability during dual-task assignments. Study III revealed that the risk of falling was increased by 75-90% for individuals in the highest quintile of COP sway. Study IV integrated COP and LOS data, showing that fall risk was increased by 9-16% per 1-unit increase in COP-LOS ratio. In conclusion, this thesis highlighted several objective predictors of incident falls among older adults. Future studies and recommendations should emphasize strategies to improve balance, muscle strength and physical activity in order to prevent falls and fractures.

Place, publisher, year, edition, pages
Umeå: Umeå universitet, 2018. 52 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1944
Keyword
prospective falls, cohort study, fall risk, gait variability, postural stability, physical activity, bone properties, objective measurements, older individuals
National Category
Public Health, Global Health, Social Medicine and Epidemiology Geriatrics
Identifiers
urn:nbn:se:umu:diva-143873 (URN)978-91-7601-830-9 (ISBN)
Public defence
2018-02-09, KBE303 (Stora hörsalen), KBC-huset, Umeå, 09:00 (Swedish)
Opponent
Supervisors
Funder
Swedish Research Council, 2011-2976
Available from: 2018-01-19 Created: 2018-01-15 Last updated: 2018-01-15Bibliographically approved

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Johansson, JonasNordström, AnnaGustafson, YngveWestling, GöranNordström, Peter
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