Lateral Balance Factors Predict Future Falls in Community-Living Older Adults

Abstract

Objective To prospectively determine the capacity of measures of mediolateral (ML) protective stepping performance, maximum hip abduction torque, and trunk mobility, in order to predict the risk of falls among community-living older people. Design Cross-sectional study. Setting A balance and falls research laboratory. Participants Medically screened and functionally independent community-living older adult volunteers (N=51). Interventions Not applicable. Main Outcome Measures Measures included: (1) protective stepping responses: percentage of trials with multiple balance recovery steps and sidestep/crossover step recovery patterns, and first step length following motor-driven waist-pull perturbations of ML standing balance; (2) hip abduction strength and axial mobility: (3) peak isokinetic hip abduction joint torque and trunk functional axial rotation (FAR) range of motion; and (4) fall incidence: monthly mail-in reporting of fall occurrences with follow-up contact for 1 year post-testing. One- and 2-variable logistic regression analysis models determined which single and combined measures optimally predicted fall status. Results The single variable model with the strongest predictive value for falls was the use of multiple steps in all trials (100% multiple steps) (odds ratio, 6.2; P=.005). Two-variable models, including 100% multiple steps and either hip abduction torque or FAR variables, significantly improved fall prediction over 100% multiple steps alone. The hip abduction and FAR logistic regression optimally predicted fall status. Conclusions The findings identify new predictor variables for risk of falling that underscore the importance of dynamic balance recovery performance through ML stepping in relation to neuromusculoskeletal factors contributing to lateral balance stability. The results also highlight focused risk factors for falling that are amenable to clinical interventions for enhancing lateral balance function and preventing falls.

Hip abductor neuromuscular capacity: A limiting factor in mediolateral balance control in older adults?

“…Impaired ML-balance control in standing has been identified as a common cause of falls among older adults (Robinovitch et al, 2013) and hip abductor strength is predictive of future falls (Hilliard et al, 2008). We therefore suggested that hip abductor strength might limit ML-weight-shifting performance.…”

“…Incorrect weight shifting is the most common cause of falling, and standing is one of the three classes of activities during which most falls in older adults occur (Robinovitch et al, 2013). Balance impairment, particularly in mediolateral (ML) direction, is suggested to be an important risk factor for such falls (Hilliard et al, 2008;Lord et al, 1999;Tinetti et al, 1988), and community-dwelling older adults are less able to actively control ML displacement of the center of mass (CoM) than young adults (Cofre Lizama et al, 2014).…”

Efectos de un programa de estimulación físico-cognitiva sobre la autopercepción de la funcionalidad en adultos mayores

“…En el programa de estimulación motora, se realizaron ejercicios de miembros inferiores con énfasis en musculatura de cadera (abductores de cadera), ya que se ha demostrado que se encuentra fuertemente implicada en el mantenimiento del equilibrio y la marcha (Domínguez-Carrillo, Arellano-Aguilar & Leos-Zierold, 2007;Graham, Carty, Lloyd & Barret, 2015;Hilliard et al, 2008). También se trabajó musculatura de tronco mediante actividades de estabilización, giros y transferencias, ya que se han documentado mejorías del equilibrio dinámico luego de realizar este tipo de ejercicios (Granacher, Lacroix, Muehlbauer, Roettger & Gollhofer, 2013).…”

Footwear width and balance-recovery reactions: A new approach to improving lateral stability in older adults

“…There is considerable evidence that many such individuals have impaired balance-recovery reactions and may be at increased risk of falls [7][8][9][10] ; hence, stabilizing-footwear could well be of benefit to this demographic. Of course, older adults having more pronounced balance impairments or disorders may well benefit the most from improved footwear, and further research is needed to examine the effects of widened footwear in such populations.…”

“…Older adults often appear to experience difficulty in responding to lateral balance perturbation [7][8][9][10][11][12][13][14] , and a number of these difficulties have been found to predict increased risk of falling in daily life [7][8][9][10][11] . Older adults tend to be less able than younger persons to maintain upright stance without exceeding their BOS stability limits, i.e.…”