Background: The use of falls risk screening tools may aid in targeting fall prevention interventions in older individuals most likely to benefit. Objective: To determine the optimal physical or cognitive test to screen for falls risk in frail older people. Methods: This prospective cohort study involved recruitment from 213 day-care centers in Japan. The feasibility study included 3,340 ambulatory individuals aged 65 years or older enrolled in the Tsukui Ordered Useful Care for Health (TOUCH) program. The external validation study included a subsample of 455 individuals who completed all tests. Physical tests included grip strength (GS), chair stand test (CST), one-leg standing test (OLS), functional reach test (FRT), tandem walking test (TWT), 6-meter walking speed at a comfortable pace (CWS) and at maximum pace (MWS), and timed up-and-go test (TUG). The mental status questionnaire (MSQ) was used to measure cognitive function. The incidence of falls during 1 year was investigated by self-report or an interview with the participant’s family and care staff. Results: The most practicable tests were the GS and MSQ, which could be administered to more than 90% of the participants regardless of the activities of daily living status. The FRT and TWT had lower feasibility than other lower limb function tests. During the 1-year retrospective analysis of falls, 99 (21.8%) of the 455 validation study participants had fallen at least once. Fallers showed significantly poorer performance than non-fallers in the OLS (p = 0.003), TWT (p = 0.001), CWS (p = 0.013), MWS (p = 0.007), and TUG (p = 0.011). The OLS, CWS, and MWS remained significantly associated with falls when performance cut-points were determined. Logistic regression analysis revealed that the TWT was a significant and independent, yet weak predictor of falls. A weighting system which considered feasibility and validity scored the CWS (at a cut-point of 0.7 m/s) as the best test to predict risk of falls. Conclusion: Clinical tests of neuromuscular function can predict risk of falls in frail older people. When feasibility and validity were considered, the CWS was the best test for use as a screening tool in frail older people, however, these preliminary results require confirmation in further research.

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ObjectivesTo identify appropriate clinical tests for determining the demand for personal care in older Japanese people.DesignCross-sectional observation study.SettingObu Study of Health Promotion for the Elderly (Obu, Aichi) and Tsukui Ordered Useful Care for Health (241 day-care centres) cohorts in Japan.ParticipantsA total of 10 351 individuals aged 65 years or older (6791 with personal care and 3560 without personal care) participated in the study.MeasuresPhysical performance tests included grip strength, the chair stand test, walking speed at a comfortable pace, and the timed up-and-go test. Personal care was defined as participants who had been certified in the national social long-term care insurance in Japan.ResultsIndividuals who received personal care showed a significantly poorer performance than those without personal care for all physical performance tests (p<0.001). Gait speed was the most useful of the physical performance tests to determine the demand for personal care (receiver operating characteristic curve statistics: men, 0.92; women, 0.94; sensitivity: men, 86; women, 90; specificity: men, 85; women, 85). After adjustment for age, sex, cognitive impairment and other physical tests, all physical performance tests were individually associated with the demand for personal care. A slow gait speed (<1 m/s) was more strongly correlated with the demand for personal care than other performance measures (gait speed OR: 5.9; 95% CI: 5.0 to 6.9).ConclusionsClinical tests of physical performance are associated with the demand for personal care in older people. Preventive strategies to maintain physical independence may be required in older adults who show a gait speed slower than 1 m/s. Further research is necessary to confirm these preliminary results.

Abstract.[Purpose] The aim of this study was to identify the age-associated changes in gait speed, stride length, cadence and step width, and to examine the relationship between these gait variables with a history of falls and life-space experience among elderly people.[Subjects] The participants were 848 healthy elderly adults (mean age 80 years, range 73-91, 76.8% women) living independently at home. [Methods] Gait speed, stride length, cadence and step width were measured at a normal pace using WalkWay, a device for measuring the distribution of foot pressure during walking. Any history of falls in the previous year was investigated by self-report and a life-space assessment was used to investigate the activity status of the subjects.[Results] Gait speed and stride length decreased markedly from age 85 years in women, and from age 90 years in men. Cadence and step width did not change consistently with aging. Gait speed was associated significantly with a history of falls and with life-space restriction, although these relationships were weak. [Conclusion] Gait speed reduces with age and might reflect a functional decline in elderly people.

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