ARE ACTIVITY-BASED ASSESSMENTS OF BALANCE AND GAIT IN THE ELDERLY PREDICTIVE OF RISK OF FALLING AND OR TYPE OF FALL

Objective: To determine whether an activity-based test of balance and gait is predictive of the risk of: (1) falling in situations that are related to specific tasks evaluated as part of the test, (2) experiencing falls precipitated by different classes of biomechanical events, or (3) falling in general; and to compare the predictive ability of the activity-based test for the falls described in (2) and (3) to that of a posturography test that has been found previously to be predictive of falling risk. Design: Cohort study. Setting: Baseline tests performed in balance laboratory; subsequent history of falling monitored prospectively for 1 year in two residential-care facilities. Participants: Seventeen male and 83 female consecutive volunteers (mean age = 83, SD = 6) who were independent in activities of daily living and able to stand unaided. Measurements: Independent variables were derived from an activity-based balance-and-gait test and a posturography test. Dependent variables were the numbers of subjects with one or more: (1) falls in specific situations related to activity-based test items, (2) falls related to general classes of biomechanical precipitant, and (3) falls in general. Main Results: Subjects who were rated as 'abnormal' in activity-based test items related to transfers, turning or reaching were more likely to experience one or more falls in related situations in everyday life. Activity-based scores were predictive of risk of experiencing falls with no obvious biomechanical precipitant and falls precipitated by center-of-mass perturbation, but not falls precipitated by base-of-support perturbation. In comparison, a posturographic measure of spontaneous medial-lateral postural sway (blindfolded conditions) failed to predict falls having no biomechanical precipitant, but provided the best predictions of both center-of-mass and base-of-support falls, as well as risk of falling in general. Conclusions: Activity-based testing of certain tasks (transfer, turning, reaching) may be useful in indicating a specific need for intervention to reduce the risk of falling during related everyday activities. In terms of predicting falling risk, a static posturography test may provide better prediction overall of the different classes of falls and may be useful as a quick and simple screening tool to help identify high-risk individuals.