Postural stability in the elderly: a comparison between fallers and non-fallers (original) (raw)
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Fall Risk Assessment in Older People
Almost one-third of older people experience fallscaused bymedical factors and/or frailty.Falls may lead to devastating results. The rapid increase in life expectancy has made fall-detection and analysis an important issue. In order to identify trends and the state of the art in fall risk and balance assessment in older people,this paper carries out a review of the literature in this field. The focus has been on works that studied various assessment tools developed for fall risk assessment in people above 65 years old. The reviewed papers are categorized into two large groups of Clinical Fall Risk Assessment Methods and Quantitative Fall Risk Analysis Methods. For the studies in the first group, in addition to the contribution and limitations of each cited work, thevalidity and reliability factors are highlighted. The majority of the works reported in the second group are still in the development stage and have not been applied in real clinical applications. Hence, issues such as sensitivity and specificity are not considered. The review reveals that despite the high number of studies, there is no consistent worldwide standard for fall risk and balance disorder analysis and assessment. Many of the methods proposed havenot been validated forlarge groups of subjects and the results are generalized without reliable evidence. High cost, complexity, and length of the procedure are the major drawbacks of many of the proposed methods. The frailty of older people can make routine gait analysis challenging. The results of the analysis of the current literature reveal a lack of any comprehensive, objective and accurate method.
The physiology of falling: assessment and prevention strategies for older people
Journal of Science and Medicine in Sport, 2005
Balance calls upon contributions from vision, peripheral sensation, vestibular sense, muscle strength, neuromuscular control and reaction time. With increased age, there is a progressive loss of functioning of these systems and an increased likelihood of falls. Falls cml mark the beginning of a decline in function and independence and are the leading cause of injury-related hospitalisation in older people. By using simple tests of vision, leg sensation, muscle strength, reaction time and standing balance, it is possible to identify accurately older people at risk of falls and assess intervention outcomes. This approach overcomes the limitations associated with traditional methods of assessing falls risk via medical diagnoses, including varied severity between individuals. Using a physiological approach provides information at the impairment and functional capacity levels to assist in understanding fails and developing and evaluating optimal falls prevention strategies for older people. (J Sci Med Sport 2005;8:1:35-42)
Fall risk in an active elderly population--can it be assessed?
Journal of negative results in biomedicine, 2007
Falls amongst elderly people are often associated with fractures. Training of balance and physical performance can reduce fall risk; however, it remains a challenge to identify individuals at increased risk of falling to whom this training should be offered. It is believed that fall risk can be assessed by testing balance performance. In this study a test battery of physiological parameters related to balance and falls was designed to address fall risk in a community dwelling elderly population. Ninety-four elderly males and females between 70 and 80 years of age were included in a one year follow-up study. A fall incidence of 15% was reported. The test battery scores were not different between the fallers and non-fallers. Test scores were, however, related to self-reported health. In spite of inclusion of dynamic tests, the test battery had low fall prediction rates, with a sensitivity and specificity of 50% and 43% respectively. Individuals with poor balance were identified but fa...
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.
Evaluation of balance in fallers and non-fallers elderly
Brazilian Journal of Otorhinolaryngology, 2012
Fal ls present a substantial health problem among the elderly population. Approximately one-third of community-dwelling people over 65 years of age will experience one or more each year. Objective: The purpose of this study was to evaluate balance between fallers and non-fallers elderly. Study Design: Clinical study. Methods: We studied 30 subjects older than 65 years of age. 15 subjects had a history of falls within a year (Group I) and 15 subjects had no history of falls (Group II). The scores of Computerized Dynamic Posturography (CDP); Sensory Organization Test (SOT), Limits of Stability (LOS), Rhytmic Weight Shift (RWS) and Berg Balance Scale (BBS) findings gathered from the individuals from Group I and Group II, were compared. Results: The SOT 3, 6, composite, BBS scores and left-right on-axis velocity score of RWS test of the Group I were found to be significantly lower the Group II (p < 0.05). A positive correlation between the SOT 3, 5, composite and BBS scores of Group I and the SOT 4, 5, 6, composite and BBS scores of Group II is determined (p < 0.05). Conclusion: The CDP and BBS scores in fallers were found to be significiantly lower as compared to the non-fallers elderly.
Clinical Biomechanics, 2016
Background: Identification of future non-fallers, infrequent and frequent fallers among older people would permit focusing the delivery of prevention programs on selected individuals. Posturographic parameters have been proven to differentiate between non-fallers and frequent fallers, but not between the first group and infrequent fallers. Methods: In this study, postural stability with eyes open and closed on both a firm and a compliant surface and while performing a cognitive task was assessed in a consecutive sample of 130 cognitively able elderly, mean age 77(7)years, categorized as non-fallers (N = 67), infrequent fallers (one/two falls, N = 45) and frequent fallers (more than two falls, N = 18) according to their last year fall history. Principal Component Analysis was used to select the most significant features from a set of 17posturographic parameters. Next, variables derived from principal component analysis were used to test, in each task, group differences between the three groups. Findings: One parameter based on a combination of a set of Centre of Pressure anterior-posterior variables obtained from the eyes-open on a compliant surface task was statistically different among all groups, thus distinguishing infrequent fallers from both non-fallers (P b 0.05) and frequent fallers (P b 0.05). Interpretation: For the first time, a method based on posturographic data to retrospectively discriminate infrequent fallers was obtained. The joint use of both the eyes-open on a compliant surface condition and this new parameter could be used, in a future study, to improve the performance of protocols and to verify the ability of this method to identify new-fallers in elderly without cognitive impairment.
Dynamic Parameters of Balance Which Correlate to Elderly Persons with a History of Falls
PLoS ONE, 2013
Poor balance in older persons contributes to a rise in fall risk and serious injury, yet no consensus has developed on which measures of postural sway can identify those at greatest risk of falling. Postural sway was measured in 161 elderly individuals (81.8y67.4), 24 of which had at least one self-reported fall in the prior six months, and compared to sway measured in 37 young adults (34.9y67.1). Center of pressure (COP) was measured during 4 minutes of quiet stance with eyes opened. In the elderly with fall history, all measures but one were worse than those taken from young adults (e.g., maximal COP velocity was 2.76 greater in fallers than young adults; p,0.05), while three measures of balance were significantly worse in fallers as compared to older persons with no recent fall history (COP Displacement, Short Term Diffusion Coefficient, and Critical Displacement). Variance of elderly subjects' COP measures from the young adult cohort were weighted to establish a balance score (''B-score'') algorithm designed to distinguish subjects with a fall history from those more sure on their feet. Relative to a young adult B-score of zero, elderly ''non-fallers'' had a B-score of 0.334, compared to 0.645 for those with a fall history (p,0.001). A weighted amalgam of postural sway elements may identify individuals at greatest risk of falling, allowing interventions to target those with greatest need of attention.
Use of Clinical and Impairment-Based Tests to Predict Falls by Community-Dwelling Older Adults
Physical Therapy, 2003
Background and Purpose. Few tests have been found to be strongly predictive of falls in community-dwelling older adults. The purpose of this study was to determine whether data from 5 balance tests—combined with data regarding fall history, number of medications, dizziness, visual problems, use of an assistive device, physical activity level, sex, and age—could predict falls in community-dwelling older adults who were independent. Subjects. Ninety-nine community-dwelling older adults aged 65 to 90 years (X̄= 74.02, SD=5.64) were tested. Methods. Subjects were tracked for falls over a 1-year period following testing. Impairment-based tests, which are tests that attempt to specifically identify which sensory systems are impaired or how motor control is impaired (eg, speed, accuracy of movement), were the Modified Clinical Tests of Sensory Interaction for Balance (Modified CTSIB) and the 100% Limits of Stability Test, both of which were done on the Balance Master 6.1. Performance-based...
The contribution of postural balance analysis in older adult fallers: A narrative review
Journal of Bodywork and Movement Therapies, 2016
Objective. Falls are a serious health problem for older adults. Several studies have identified the decline of postural balance as one of the main risk factors for falls. Contrary to what may be believed, the capability of force platform measurements to predict falls remains uncertain. The focus of this narrative review is the identification of postural characteristics of older adults at risk of falling using both static and dynamic postural balance assessments. Methods. The literature analysis was conducted on Medline/PubMed. The search ended in May 2015. Results. Centre of pressure (CoP) path length, CoP velocity and sway in medial lateral and anterior-posterior are the variables that distinguish older adult fallers from non-fallers. Discussion. Recommendations to medical personnel on how to provide efficient balance training for older adults are offered, discussing the relevance and limitations of postural stability on static and dynamic board in falling risk prevention.