History and mobility exam index to identify community-dwelling elderly persons at risk of falling

Background. Falls are common in community-dwelling elderly persons and are a frequent source of morbidity. Simple indices to prospectively stratify people into categories at different fall-risk would be useful to health care practitioners. Our goal was to develop a fall-risk index that discriminated between people at high and low risk of falling. Methods. We evaluated the risk of falling over a one-year period in 557 elderly persons (mean age 81.6) living in a retirement community. On the baseline interview, we asked subjects if they had fallen in the previous year and evaluated risk factors in six additional conceptual categories. On the follow-up interview. one year later, we again asked subjects if they had fallen in the prior year. We evaluated risk factors in the different conceptual categories and used logistic regression to determine: the independent predictors of falling over a one-year period. We used these independent predictors to create a fall-risk index. We compared the ability of a prior falls history with other risk factors and with the combination of a falls history and other risk factors to discriminate fallers from nonfallers. Results. A fall in the previous year (OR = 2.42, 95% Cl = 1.49-3.93). a symptom of either balance difficulty or dirtiness (OR = 1.83. 95% CI = 1.16-2.89). or an abnormal mobility exam (OR = 2.61. 95% CI = 1.64-4.26) were independent predictors of falling over the subsequent year. These three risk factors together (L statistic = .71) discriminated fallers from nonfallers better than previous history of falls alone (e statistic = .61) or the symptomatic and exam risk factors alone ( statistic = .68). When combined into a risk index, the three independent risk factors stratify people into groups whose risk for falling over the subsequent year ranges from 10% to 51%. Conclusion, A history of falling over the prior year, a risk factor that can be obtained from a clinical history (balance difficulty or dizziness), and a risk factor that can be obtained from a physical exam (mobility difficulty) stratify people into groups at low and high risk of falling over the subsequent year. This risk index may provide a simple method of assessing fall risk in community-dwelling elderly persons. However, it requires validation in other subjects before it can be recommended for widespread use.