Diagnostic Balance Tests for Assessing Risk of Falls and Distinguishing Older Adult Fallers and Non-Fallers: A Systematic Review with Meta-Analysis (original) (raw)

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.

A Pilot Study to Detect Balance Impairment in Older Adults Using an Instrumented One-Leg Stance Test

Journal of Biomechanical Engineering, 2020

The aim of this study was to investigate whether parameters from an instrumented one-leg stance (OLS) on a force plate could provide relevant information related to fall risk in older people. Forty-two community dwelling older people including 17 fallers and 25 non-fallers, and 25 young subjects performed a one-leg stance while standing on a force plate, with parameters related to transferring weight onto one leg and postural sway in singe-leg stance evaluated. No differences were observed between older fallers and non-fallers and the younger participants for any of the weight transfer parameters. The younger participants were able to reduce their postural sway during the OLS test after the first 0-2 second period, unlike older participants who swayed the same amount throughout the test. The older fallers swayed significantly more than both non-fallers and younger participants throughout the 10-seconds of OLS evaluated. When the tests were used to classify older participants as fallers, the instrumented OLS achieved 100% accuracy, compared to 69.0% classification accuracy for the five times sit-to-stand test, 61.9% for the standard OLS and 47.6% for the timed-up-and-go test. These findings suggest that the standard OLS test might not be suitable to detect fall risk. In contrast, an instrumented version of the OLS could provide valuable additional information that could identify older fallers. Future work will include a prospective study of the instrumented OLS in a larger population of older people.

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.

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.

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.

Relevance of balance measurement tools and balance training for fall prevention in older adults

Journal of Clinical Gerontology and Geriatrics, 2014

Approximately one in three older people fall each year owing to gait/balance disorder/weakness, the second leading cause of falls in older adults. This review evaluates the capability of different balance measurement tools to predict falls in the elderly, which are used routinely for assessing balance impairment. Balance measurement tools reviewed are the Timed Up and Go test, Berg Balance Scale, Tinetti Performance Oriented Mobility Assessment, Functional Reach Test, Clinical Test of Sensory Integration for Balance, and the postural sway measurements or center of pressure. The effect of balance training on the postural control mechanism and its efficacy in fall prevention in older adults were also reviewed. The current evidence is not conclusive enough to favor existing balance measurement tools and balance training implemented for fall prevention in older adults.

Elderly individuals with increased risk of falls show postural balance impairment

Fisioterapia em Movimento, 2015

Introduction: Falls are a serious public health problem. Objective: The aim of this study was to evaluate whether elderly individuals with increased risk of falls have a postural balance deficit, evaluated using a force platform during a one-leg stance. Materials and methods: The sample consisted of 94 physically independent elderly individuals from the EELO project. The instruments used were the Downton scale, in

Selected Tools for Assessing the Risk of Falls in Older Women

BioMed Research International

Background and Aim. This study is aimed at comparing the Functional Reach Test (FRT), Timed Up and Go (TUG), and a modified Unterberger test with stabilographic parameters (Biodex Balance System—BBS), to assess fall risk (FR) in older women. Methods. Fifty-five females were examined (May 2018-June 2019). Stabilographic examinations were performed with eyes open (EO) and closed (EC). An analysis of variance (ANOVA) and Spearman rank correlation were performed to determine the relationships and differences between the above tests. Results. The results of the TUG correlate with the overall stability index (OSI) EO ( r = 0.314 ), medial-lateral stability index (MLSI) EO ( r = 0.297 ), and fall risk index (FRI6-2; r = 0.435 ) in stabilographic examinations and the FRT ( r = − 0.399 ). The results of the modified Unterberger test correlate with MLSI EO ( r = 0.276 ), OSI EC ( r = 0.310 ), and MLSI EC ( r = 0.378 ). There are statistically significant differences between faller and nonfall...

Postural stability in the elderly: a comparison between fallers and non-fallers

Age and Ageing, 2004

Background: the identification of specific risk factors for falls in community-dwelling elderly persons is required to identify older people at risk of falling. Objective: the aim of the study was to determine the ability of various biomechanical measures of postural stability to identify fallers in the elderly population. Method: 19 subjects (78.4 ± 1.3 years old) who reported having fallen unexpectedly at least twice in the last 6 months, and 124 non-fallers (77.8 ± 0.53 years old) participated in the study. Balance measurements were made in the upright position in six different conditions using a force platform, and the Limits of Stability Test was carried out. Static two-point discrimination (TPD) testing to the underside of the first toe was made to evaluate the innervation density of the slowly adapting receptors. Finally, maximal isometric lower limb strength was measured in major muscle groups. Repeated measures analysis of variance tests were performed to assess the mean differences between the two groups (fallers and non-fallers). The level of significance was set to 0.05. Results and discussion: results suggest that control of balance in narrow base stance may be an important tool in identifying elderly fallers. The findings show an increase in mediolateral sway in narrow base stance in older people who experienced recurrent falls. Also, TPD appears to be impaired in elderly fallers (14.93 ± 1.1 mm versus 12.98 ± 0.3 mm). Conclusions: simple and safe laboratory quantitative tests were able to differentiate between elderly fallers and elderly individuals who did not fall, suggesting a possible clinical application as a preliminary screening tool for predicting future risk of falling.