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Assessment of balance control in relation to fall risk among older people
Umeå University, Faculty of Medicine, Community Medicine and Rehabilitation.
2008 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Falls and their consequences among older people are a serious medical and public health problem. Identifying individuals at risk of falling is therefore a major concern. The purpose of this thesis was to evaluate measurement tools of balance control and their predictive value when screening for fall risk in physically dependent individuals ≥65 years old living in residential care facilities, and physically independent individuals ≥75 years old living in the community. Following baseline assessments falls were monitored during six months in physically dependent individuals based on staff reports, and during one year in physically independent individuals based on self reports.

In physically dependent individuals test-retest reliability of the Timed Up&Go test (TUG) was established in relation to cognitive impairment. Absolute reliability measures exposed substantial day-to-day variability in mobility performance at an individual level despite excellent relative reliability (ICC 1.1 >0.90) regardless of cognitive function (MMSE ≥10). Fifty-three percent of the participants fell at least once during follow-up. Staff judgement of their residents’ fall risk had the best prognostic value for ruling in a fall risk in individuals judged with ‘high risk’ (positive Likelihood ratio, LR+ 2.8). Timed, and subjective rating of fall risk (modified Get Up&Go test, GUG-m) were useful for ruling out a high fall risk in individuals with TUG scores <15 seconds (negative LR, LR- 0.1) and GUG-m scores of ‘no fall risk’ (LR- 0.4), however few participants achieved such scores.

In physically independent individuals balance control was challenged by dual-task performances. Subsequent dual-task costs in gait (DTC), i.e. the difference between single walking and walking with a simultaneous second task, were registered using an electronic mat. Forty-eight percent of the participants fell at least once during follow-up. A small prognostic guidance for ruling in a high fall risk was found for DTC in mean step width of ≤3.7 mm with a manual task (LR+ 2.3), and a small guidance for ruling out a high fall risk with DTC in mean step width of ≤3.6 mm with a cognitive task (LR- 0.5). In cross-sectional evaluations DTC related to an increased fall risk were associated with: sub-maximal physical performance stance scores (Odds Ratio, OR, 3.2 to 3.8), lower self-reported balance confidence (OR 2.6), higher activity avoidance (OR 2.1), mobility disability (OR 4.0), and cautious walking out-door (OR 3.0). However, these other measures of physical function failed to provide any guidance to fall risk in this population of seemingly able older persons.

In conclusion – Fall risk assessments may guide clinicians in two directions, either in ruling in or in ruling out a high fall risk. A single cut-off score, however, does not necessarily give guidance in both directions. Staff experienced knowledge is superior to a single assessment of mobility performance for ruling in a high fall risk. Clinicians need to consider the day-to-day variability in mobility when interpreting the TUG score of a physically dependent individual. DTC of gait can, depending on the type of secondary task, indicate a functional limitation related to an increased fall risk or a flexible capacity related to a decreased fall risk. DTC in mean step width seems to be a valid measure of balance control in physically independent older people and may be a valuable part of the physical examination of balance and gait when screening for fall risk as other measures of balance control may fail to provide any guidance of fall risk in this population.

Place, publisher, year, edition, pages
Umeå: Samhällsmedicin och rehabilitering , 2008. , 95 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1198
Keyword [en]
older people, falls, interactive gait, TUG, GUG, balance confidence, likelihood ratio, validity, reliability, risk factors, assessment, balance, gait, mobility, physical function, dual-task costs, step width
National Category
Physiotherapy
Identifiers
URN: urn:nbn:se:umu:diva-1933ISBN: 978-91-7264-606-3 (print)OAI: oai:DiVA.org:umu-1933DiVA: diva2:142487
Public defence
2008-12-13, Aulan, Vårdvetarhuset, Byggnad 15, Umeå Universitet, 901 87, Umeå, 10:00 (English)
Opponent
Supervisors
Available from: 2008-11-24 Created: 2008-11-24 Last updated: 2010-01-18Bibliographically approved
List of papers
1. Timed "Up & Go" test: reliability in older people dependent in activities of daily living - focus on cognitive state.
Open this publication in new window or tab >>Timed "Up & Go" test: reliability in older people dependent in activities of daily living - focus on cognitive state.
2006 (English)In: Physical Therapy, ISSN 0031-9023, E-ISSN 1538-6724, Vol. 86, no 5, 646-655 p.Article in journal (Refereed) Published
Keyword
Activities of Daily Living, Age Factors, Aged, Aged; 80 and over, Cognition, Cognition Disorders/diagnosis, Data Interpretation; Statistical, Female, Geriatric Assessment, Homes for the Aged, Humans, Locomotion, Logistic Models, Male, Mental Status Schedule, Sex Factors, Walking
Identifiers
urn:nbn:se:umu:diva-7064 (URN)16649889 (PubMedID)
Available from: 2008-01-03 Created: 2008-01-03 Last updated: 2017-12-14Bibliographically approved
2. Prognostic validity of the Timed Up-and-Go test, a modified Get Up-and-Go test, staff's global judgement and fall history in evaluating fall risk in residential care facilities
Open this publication in new window or tab >>Prognostic validity of the Timed Up-and-Go test, a modified Get Up-and-Go test, staff's global judgement and fall history in evaluating fall risk in residential care facilities
Show others...
2008 (English)In: Age and Ageing, ISSN 0002-0729, E-ISSN 1468-2834, Vol. 37, no 4, 442-448 p.Article in journal (Refereed) Published
Research subject
Physiotherapy
Identifiers
urn:nbn:se:umu:diva-3677 (URN)
Available from: 2008-11-24 Created: 2008-11-24 Last updated: 2017-12-14Bibliographically approved
3. Interactive gait and the risk of falling among physically independent older people
Open this publication in new window or tab >>Interactive gait and the risk of falling among physically independent older people
Article in journal (Refereed) Submitted
Identifiers
urn:nbn:se:umu:diva-3678 (URN)
Available from: 2008-11-24 Created: 2008-11-24Bibliographically approved
4. Associations between dual-task costs in step width and other measures of physical function and their relevance to future fall risk among independent older people
Open this publication in new window or tab >>Associations between dual-task costs in step width and other measures of physical function and their relevance to future fall risk among independent older people
Article in journal (Refereed) Submitted
Identifiers
urn:nbn:se:umu:diva-3679 (URN)
Available from: 2008-11-24 Created: 2008-11-24Bibliographically approved

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