Influences of Age, Obesity, and Adverse Drug Effects on Balance and Mobility Testing Scores in Ambulatory Older Adults (original) (raw)
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Clinical determinants of failure in balance tests in elderly subjects
Archives of Gerontology and Geriatrics, 2008
We assessed the role of clinical and biological parameters on performance in four balance tests in elderly subjects. An observational study was conducted in the Center for Preventive Medicine of Nancy (France) in 2368 community-living elderly subjects aged 60 and older. Body mass index (BMI), Mini-Mental State Examination (MMSE), clock test, ''Health score'' and use of psychotropic drugs (UPD) were assessed. Participants performed four balance tests: ''one-leg-stand'' (OLS), ''timed-up-and-go'' (TUG), ''rise-from-the-floor'' (RFF) and ''sit-to-stand'' (STS). The statistical analysis showed that women were almost twice as likely to fail balance tests as men. In both women and men, the following determinant factors of the performance in balance tests were found: for OLS: age, BMI and health score; for TUG: age, BMI, clock test and health score; for RFF: BMI and health score. In addition, in women other determinant factors were: MMSE for OLS, UPD for TUG, age and clock test for RFF. In men, the clock test and the UPD were also significant determinant factors for OLS. Similar results were found for STS. In conclusion, female sex, overweight, low cognitive status, low self-perception of health and UPD were associated with a higher risk of failure in balance tests. #
Are Scores on Balance Screening Tests Associated with Mobility in Older Adults?
Journal of Geriatric Physical Therapy, 2006
Purpose: To examine associations between measures of static and dynamic balance and performance of mobility tasks in older adults. Methods: A cross-sectional analysis from 95 community dwelling participants (mean age 80.9 years, range 65 -03 years). Participants performed tests of static (tandem stance) and dynamic (360° turn) balance and mobility (walking speed and timed chair rise). Associations among balance and mobility measures were examined using correlation and logistic regression. Results: Static and dynamic balance were moderately associated (r = -.462). Relationships between dynamic balance and mobility were stronger than those between static balance and mobility. The association between dynamic balance and walking speed was particularly strong (r = -.70). Using logistic regression, age, and balance performance were significant predictors for outcomes of walking speed (dichotomized to < .0 m/s, ≥ .0 m/s), and timed chair rise (dichotomized to ≤ 3.6 s, > 3.6 s). Faster 360° turn times were independently associated with faster walking speed and chair rise time. Conclusion: Mobility tasks require both dynamic and static balance. As falls are a major health risk for older adults, including brief assessments of dynamic and static balance in the examination of older adults provides valuable information about physical function and mobility.
Risk of drug-related falls among noninstitutionalized older adults
Revista da Escola de Enfermagem da U S P, 2018
To determine the number of drugs taken per day, which represents a risk factor for falls among noninstitutionalized older adults with a history of falls in the last year. This was a descriptive study that used random sampling and the following measurement instruments: the WHO questionnaire for the study of falls in older adults, gait scale and geriatric depression scale and gait and balance. Univariate and bivariate analysis, nonparametric chi-squared test, and binary logistic regression were performed using the SPSS statistical program version 21.0. 214 individuals participated in the study. Those who took ≥ 4 drugs presented higher risk of falling, p=0.010 OR=4.034. The same was not true for individuals who took ≤ 3 drugs, p=0.006 OR=0.335. The use of four or more drugs per day was considered a risk factor for falls among older adults.
Preventive Medicine, 2019
This study assesses the prevalence of falls, factors predicting future falls, and health impacts of falls and balance or walking problems for U.S. older adults. Data were from participants ≥65 years in the Medicare Health Outcomes Survey Cohort 15 (baseline survey in 2012; follow-up survey in 2014; n = 164,597). We examined baseline factors predicting falls at follow-up and estimated the impact of falls and balance/walking problems on health-related quality of life (HRQOL), mortality, and quality-adjusted life years (QALYs). About 23% reported falls and 34% reported balance/walking problems in the past 12 months. The strongest predictors of falls were previous falls [adjusted odds ratio (OR) = 2.9] and balance/walking problems (OR = 1.7). Many self-reported chronic conditions (e.g., depression, stroke, and diabetes), geriatric symptoms (e.g., urine leakage), and limitations of activities of daily living (e.g., transferring and walking) also predicted falls, but at a smaller magnitude (ORs = 1.1-1.3). Having balance/walking problems was associated with a greater decrease in HRQOL scores (0.195 points) than falls (0.077 points), while falls were associated with a greater increase in mortality [adjusted hazard ratio (HR) = 1.5] than balance/walking problems (HR = 1.1). Falls were associated with a 4.6year (48%) decrease in QALYs, while balance/walking problems was associated with a 7.3-year (62%) decrease in QALYs. Falls are a major problem for U.S. elderly and will continue to have an even greater impact as the population ages. The nearly 50% decrease in QALYs for falls and > 60% decrease for balance or walking problems demonstrates the substantial burden associated with these problems among older Americans.
Assessment of balance and risk for falls in a sample of community-dwelling adults aged 65 and older
Chiropractic & osteopathy, 2006
Falls are a major health concern for older adults and their impact is a significant public health problem. The chief modifiable risk factors for falls in community-dwellers are psychotropic drugs, polypharmacy, environmental hazards, poor vision, lower extremity impairments, and balance impairments. This study focused on balance impairments. Its purpose was to assess the feasibility of recruiting older adults with possible balance problems for research conducted at a chiropractic research center, and to explore the utility of several widely used balance instruments for future studies of the effect of chiropractic care on balance in older adults. This descriptive study was conducted from September through December 2004. Participants were recruited through a variety of outreach methods, and all were provided with an educational intervention. Data were collected at each of two visits through questionnaires, interviews, and physical examinations. Balance was assessed on both visits usin...
Simple Balance and Mobility Tests Can Assess Falls Risk When Cognition Is Impaired
Geriatric Nursing, 2008
Simple balance tests can help assess falls risk, particularly in cognitively impaired elderly who have elevated falls risk and might not accurately recall previous falls. In 2006, almost 500 million people worldwide were aged 65 years of age or older. The National Institute on Aging projects that by 2030, this number will increase to 1 billion and represent 1 of every 8 persons in the world. 1 Health problems of the elderly therefore constitute rapidly growing public health concerns. Falls are a particularly prevalent health problem among the elderly and are associated with significant morbidity and mortality. In the United States, among those aged 65-74, falls cause 48% of unintentional nonfatal injuries, and 23.4% of unintentional fatal injuries. 2 These proportions are even higher among those 75 years and older, in whom falls make up 71.2% of unintentional nonfatal injuries and 39.3% of unintentional fatal injuries. 2 More than a third of the population 65 years of age or older falls each year, and half of these falls are recurrent. 3 As the U.S. population ages, the total direct cost for falls is expected to be $43.8 billion by the year 2020. 4 Although falls are a preventable source of morbidity, health care utilization, and functional decline in older adults, only 34% of elderly patients receive any type of fall evaluation. 5,6 In 2001, an expert panel on falls prevention 7 recommended that all older patients in all health care settings be asked whether they have fallen in the past year, with affirmative responses triggering mobility testing using a measure such as the Get Up and Go (GUG) test. 8,9 New guidelines, updated in 2006 but still unpublished, recommend screening questions and risk assessment followed by multifactorial assessment in those identified as at risk for falls. 10 One key quality measure recommended in the Physician Quality Reporting Initiative (PQRI), Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
Using the Drug Burden Index to identify older adults at highest risk for medication-related falls
BMC Geriatrics
Background The Drug Burden Index (DBI) was developed to assess patient exposure to medications associated with an increased risk of falling. The objective of this study was to examine the association between the DBI and medication-related fall risk. Methods The study used a retrospective cohort design, with a 1-year observation period. Participants (n = 1562) were identified from 31 community pharmacies. We examined the association between DBI scores and four outcomes. Our primary outcome, which was limited to participants who received a medication review, indexed whether the review resulted in at least one medication-related recommendation (e.g., discontinue medication) being communicated to the participant’s health care provider. Secondary outcomes indexed whether participants in the full sample: (1) screened positive for fall risk, (2) reported 1+ falls in the past year, and (3) reported 1+ injurious falls in the past year. All outcome variables were dichotomous (yes/no). Results...
Balance performance in older adults and its relationship with falling
Aging Clinical and Experimental Research, 2014
Background and aims A normal consequence of aging is a general deterioration in a number of musculoskeletal and sensory systems that affect postural control and balance. The aim of this study was to evaluate history of falls among active older individuals in Iran, and estimate the risk factors for falls among this population. Methods A total of 448 active older subjects from rural region of Rasht city, Iran, were included. They were divided into three groups depending on their age: youngold (n = 266); middle-old (n = 154) and oldest-old (n = 28). We assessed balance performance by One-Leg Balance (OLB), Functional Reach (FR), Timed Up and Go (TUG) and Romberg tests. Results The fall rate ([2 in the last year) was 27.0 %. The cutoff point 13.75 s for TUG test showed 84.7 % sensitivity and 56 % specificity. Also the best cutoff point for OLB test was 12.7 s (63 % sensitivity and 83.5 % specificity). Logistic regression analysis revealed that age, BMI, diabetes, and failure in OLB, FR, and Romberg tests predicted fall risk. The decision tree classification of older individuals showed three categorical variables, which in their order of importance included diabetes, Romberg test, and OLB test. Conclusions This study revealed the value of history taking about diabetes as a predictor for existing falling. Decision tree technique showed that Romberg and OLB tests help in identifying older adults with balance problems. Given the incidence and consequences of falls among older adults, large-scale prospective studies on older individuals to identify those prone to falls are warranted.
Age and Ageing, 2007
Objective: to conduct a systematic review of published studies that test the validity and reliability of fall-risk assessment tools for use among older adults in community, home-support, long-term and acute care settings. Methods: searches were conducted in EbscoHost and MEDLINE for published studies in the English language between January 1980 and July 2004, where the primary or secondary purpose was to test the predictive value of one or more fall assessment tools on a population primarily 65 years and older. The tool must have had as its primary outcome falls, fall-related injury or gait/balance. Only studies that used prospective validation were considered. Findings: thirty-four articles testing 38 different tools met the inclusion criteria. The community setting represents the largest number of studies (14) and tools (23) tested, followed by acute (12 studies and 8 tools), long-term care (LTC) (6 studies and 10 tools) and home-support (4 studies and 4 tools). Eleven of the 38 tools are multifactorial assessment tools (MAT) that cover a wide range of fall-risk factors, and 27 are functional mobility assessment tools (FMA) that involve measures of physical activity related to gait, strength or balance. Conclusion: fall-risk assessment tools exist that show moderate to good validity and reliability in most health service delivery areas. However, few tools were tested more than once or in more than one setting. Therefore, no single tool can be recommended for implementation in all settings or for all subpopulations within each setting.