Correlates of Recurrent Falling in Independent Community-Dwelling Older Adults

Abstract

This study compared the ability of selected measures of vision, health, physical activity and performance, and fall history to predict the risk of recurrent falls in independent community-dwelling older adults. Of particular interest was the association between visual field (VF) constriction and falling. Age-related VF constriction is well documented and is known to accelerate in persons over age 55. Although several authors have implied that VF constriction in older adults could contribute to instability and falls, there has been no attempt to systematically examine this relationship. A battery of tests were administered to men and women (N = 96) 60-88 years of age. Falls were closely monitored for 1 year following the testing. Fifty of the 96 participants (52%) fell during the 1-year monitoring period, amassing a total of 91 falls, 5 of which resulted in fractures. There were 46 nonfallers, 27 one-time fallers, and 23 recurrent fallers. A stepwise logistic regression analysis revealed that average VF constriction, use of eyeglasses, and low systolic blood pressure were independently associated with recurrent falling. On discriminant function analysis, these 3 variables predicted status as a recurrent faller correctly in 48% of cases, and predicted nonfaller status correctly in 93% of cases. The overall performance of the model was 70%. Hypotheses are offered for how average VF constriction, use of eyeglasses, and low systolic blood pressure could influence stability and fall risk in older adults.

Evidence-Based Guidelines for the Secondary Prevention of Falls in Older Adults

“…A NR ?imp't (p>.05) [30] acutiy RR=1.5 (1.1-2.1) [18] acuity RR=1.8 (1.1-3.0) [24] acuity RR=1.3 (0.8-2.2) [26] Snellen <6/12 women RR=1.3 (0.6-2.8) [26] Snellen <6/12 men RR=1.5 (0.9-2.3) [26] verticality women RR=1.6 (1.1-2.4) [16] >50% impaired OR=2.1 (1.1-4.2) [18] decreased depth perception RR=1.7 (1.2-2.3) [19] near loss of vision RR=1.4 (0.9-2.0) [19] distant loss of vision OR=3.1 (1.0-9.1) [33] cataracts NR not imp't (p>.05) [22] OR = .8 (.3-2.1) [58] visual acuity A OR = 2.6 p<.05 [58] visual field A OR = 5.4 p<.05 [58] wears eyeglasses RR=3.5 (p<.05) [45] decreased distant vision A OR=1.7 (0.9-3.5) [43] distant vision loss A NR imp't (p=.41) [44] acuity A OR=1.6 (0.6-4.3) [46] poor vision-interview with nurse OR = 1.2 (0.3-5.5) [50] visual problem A OR = 6.7 (1.3-33.4) [59] ophthalmic disease RR = 1.6 (1.1-2.2) [59] cataract Mod Hearing RR=1.3 (0.9-2.0) [16] >5 whispered words missed NR imp't (p>.05) [22] RR=2.1 (p>.05) [45] subjective hearing loss A OR=2.7 (1.1-7.1) [46] poor hearing-interview with nurse NR imp't (p<.05) [47] medical record Mod Balance NR imp't (p>.05) [34] subjective balance problems NR imp't (p=.03) [25] static and dynamic balance NR imp't (p>.05) [25] sway eyes open NR imp't (p>.05) [25] sway eyes closed NR imp't (p<.01) [25] sway foam eyes open NR imp;t (p<.05) [25] sway foam eyes closed RR=1.5 (1.04-2.2) [24] sway present eyes closed RR=1.70 (1.2-2.4) [24] sway present eyes open A RR =2.6 (1.3-...…”

“…Balance cont'd A OR=7.0 (1.2-40.5) [24] abnormal reaction to push RR=1.5 (1.1-2.2) [19] unsteady at push on sternum RR=1.6 (1.2-2.2) [19] unable to stand on one leg RR=1.6 (1.2-2.2) [18] one leg < 2 sec RR=1.7 (1.2-2.4) [19] unsteady sitting down RR=1.6 (1.1-2.3) [19] unsteady turning RR=1.9 (1.2-3.2) [18] >5 steps for 180 degree turn RR=3.0 (1.9-4.6) [16] balance and gait score NR imp't (p<.05) [31] -method not specified A Rate Ratio .7 (.5-1.0) [35] >34 cm functional reach A Rate Ratio 0.7 (.5-1.0) [35] tandem stand eyes closed OR=1.2 (0.3 -4.4) [36] <27 Tinetti balance and gait A Rate Ratio 3.3 (1.6-6.7) [27] poor balance after hospital stay A Rate Ratio 1.5 (1.2-2.0) [21] balance problem NR not imp't (p>.05) [22] balance confidence OR = 1.2 (.4-3.2) [58] with vision OR = .6 (.2-1.6) [58] without vision RR=5.4 (p<.0001) [45] decreased balance score OR = 4.7 (1.5-14.2) [52] distracted balance test RR = .8 (.5-1.4) [59] unsteady eyes open RR= .8 (.5-1.2) [59] unsteady eyes closed RR = 1.0 (.7-1.5) [59] turning 360 degrees…”

“…Morale Scale NR not imp't (p=.09) [59] Moreland/Richardson/Chan/O'Neill/ Bellissimo/Grum/Shanks Mod Urinary Incontinence RR=1.5 (1.1-2.1) [19] RR=1.9 (1.2-2.9) [30] RR=1.4 (1.1-1.9) [31] A OR = 1.3 (1.1-1.4) [32] urge incontinence A OR = 1.1 (.95-1.2) [32] stress incontinence A OR=2.8 (1.5-3.8) [30] OR=1.8 (1.1-2.9) [49] OR = 0.9 (.4-1.5) [49] nocturia OR = 0.3 (0.0-2.6) [50] OR= 1.2 (0.1-10.4) [50] nocturia OR = 1.2 (0.1-11.1) [50] frequency Ed Orthostatic/Post prandial Hypotension RR=0.8 (0.5-1.4) [19] NR not imp't (p>.05) [17] RR=1.5 (0.9-2.3) [26] fall in systolic of 20 mm in standing women RR=3.3 (1.3-8.3) [26] systolic hypotension bp<110 women OR = 3.2 (1.1-9.1) [58] light-headed getting up A OR = 5.6 (p<.05) [58] low systolic blood pressure RR=3.4 (p<.05) [45] A Risk Ratio=1.2 (1.1-1.2) [51] A OR=2.0 (1.0-4.2) [43] A NR not imp't (p=.08-.39) [44] IDR=1.6 (1.1-2.3) [41] NR not imp't (p=.47) [59] NR imp't (p=.05) [59] pulse change Mod /Ed Dizziness A IRR=2.0 (1.3-2.8) [29] RR=1.7 (1.1-2.5) [16] RR=1.2 (0.8-1.6) [19] RR=1.1 (0.7-1.8) [17] NR not imp't (p>.05) [22] A OR=2.3 (1.2-4.3) [43] A NR not impt (p=.47) [44] OR = 1.7 (0.3-9.7) [50] RR = 1.7 (1.1-2.6) [59] RR = 1.4 (1.0-2.0) [59] dizziness on truning neck…”

“…Moreland/Richardson/Chan/O'Neill/ Bellissimo/Grum/Shanks Decreased Lower Extremity Strength or Disability cont'd RR=1.9 (1.3-3.7) [18] hip/knee pain RR=2.1 (0.9-6.3) [26] joint replacement women RR=2.5 (0.8-8.1) [26] joint replacement men OR = .9 (.3-2.4) [58] reduced knee strength OR = .5 (.2-1.4) [58] reduced ankle strength OR= 1.6 (.4-4.2) [58] reduced knee flexibility OR = 1.1 (.4-3.0) [58] reduced ankle flexibility Mod Nursing Subjective Assessment of General Weakness OR=1.5 (.8-2.8) [49] OR = 3.7 (0.4-29.1) [50] Mod Decreased Lower Extremity Coordination RR=2.7 (1.9-4.0) [16] ten foot taps > 6.6 sec RR=1.7 (1.2-2.3) [18] reaction time OR = .6 (.2-1.8) [58] movement time OR = 1.1 (.4-3.0) [58] reaction time RR=3.3 (p<.01) [45] decreased lateral foot tapping Mod Loss of Spinal Range of Motion RR=8.4 (p<.01) [45] unwilling to extend back RR=8.2 (p<.05) [45] decreased neck range of motion Mod Decreased Peripheral Neruomuscular Function A Rate Ratio=2.2 (1.2-3.9) [37] proprioception NR not imp't (p<.01) [25] proprioception NR imp't ? (p<.05) [31] proprioception NR imp't ?…”

“…Body Mass Index RR=1.0 (0.7-1.5) [16] worst quartiles A Rate Ratio 1.5 (1.1-2.1) [35] heigtht OR = 1.1 (.4-3.0) [58] body mass index NR not imp't (p=.08) [53] NR not imp't p=.82 [59] Nmod Abnormal Muscle Tone/ OR=3.0 (1.5-6.1) [19] palmomental reflex RR=2.4 (1.7-3.4) [18] abnormal muscle tone RR=2.1 (1.3-3.7) [18] pronator drift RR=1.5 (1.0-2.2) [18] absent knee reflex Mod Decreased Grip Strength or Upper Extremity Disability RR=1.7 (1.1-2.5) [16] signature >13.5 sec RR=2.2 (1.5-3.2) [16] arm strength RR=1.4 (1.1-2.0) [18] grip strength A RR=1.7 (0.9-3.1) [26] grip strength <120mm Hg women RR=1.5 (1.1-2.1) [19] any UE disability A NR not imp't (p=.03) [44] grip strength NR not imp't (p=.04) [53] grip strength A NR not imp't (p=.24-.50) [44] reaction time IDR=1.6 (1.03-2.6) [41] manual muscle testing Mod Decreased Lower Extremity Strength or Disability A Rate Ratio=1.5 (0.8-2.9) [37] ankle strength NR not imp't (p>.05) [25] ankle strength NR not imp't (p<.05) [31] ankle strength NR imp't (p>.05) [25] quads strength NR imp't (p<.01) [31] quads strength RR=1.6 (0.9-2.7) [26] quads <120 mmHg women RR=1.9 (1.4-2.6) [18] decreased LE strength RR=2.6 (1.7-3.9) [16] three chair stands > 10 se A OR=3.0 (1.2-7.2) [18] >2 sec to stand once RR=1.7(1.2-2.4) [24] abnormal sit/stand RR=2.5 (1.5-4.3) [26] unable to rise from chair women A Rate Ratio 1.4 (1.0-1.9) [35] chair stands A RR=3.4 (1.4-8.4) [26] unable to rise from RR=1.7 (1.2-2.3) [18] step-ups < 3 in 10 sec RR=1.7 (1.2-2.4) [24] unable to bend to knees A OR=3.8 (2.2-6.7) [19]…”