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.