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Predicting incident falls: relationship between postural sway and functional limits of stability in older adults
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine. (Healthy Ageing Initiative)ORCID iD: 0000-0001-7912-5786
Umeå University, Faculty of Medicine, Department of Integrative Medical Biology (IMB), Physiology.
Umeå University, Faculty of Medicine, Department of Integrative Medical Biology (IMB), Physiology.
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine. (Healthy Ageing Initiative)
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(English)Manuscript (preprint) (Other academic)
Abstract [en]

Background: We have previously shown that objective measurements of postural sway predicts fall risk, although it is currently unknown how functional limits of stability (LOS) might influence these results.

Research question: How integrated postural sway and LOS measurements predict the risk of incident falls in a population-based sample of older adults.

Methods: The sample for this prospective observational study was drawn from the Healthy Ageing Initiative cohort and included data collected between June 2012 and December 2016 for 2396 men and women, all 70 years of age. LOS was compared to postural sway with measurements during eyes-open (EO) and eyes-closed (EC) trials, using the previously validated Wii Force Plate. Fall history was assessed during baseline examination and incident falls were collected during follow-up at 6 and 12 months. Independent predictors of incident falls and additional covariates were investigated using multiple logistic regression models.

Results: During follow-up, 337 (14%) fallers were identified. Unadjusted regression models from the EO trial revealed increased fall risk by 6% (OR 1.06, 95% CI 1.02 – 1.11) per each centimeter squared increase in sway area and by 16 % (OR 1.16, 95% CI 1.07 – 1.25) per 1-unit increase in Sway-Area-to-LOS ratio. Odds ratios were generally lower when analyzing EC trials and only slightly attenuated in fully adjusted models.

Significance: Integrating postural sway and LOS parameters provides valid fall risk prediction and a holistic analysis of postural stability. Future work should establish normative values and evaluate clinical utility of these measures.

National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
URN: urn:nbn:se:umu:diva-143872OAI: oai:DiVA.org:umu-143872DiVA, id: diva2:1173156
Available from: 2018-01-11 Created: 2018-01-11 Last updated: 2018-06-09Bibliographically 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. p. 52
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1944
Keywords
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: 2018-06-09Bibliographically approved

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