Risk of Fall for Individuals With Intellectual Disability

Abstract

Our aim was to identify risk factors for falling and establish a method to assess risk for falls in adults with intellectual disabilities. In a cross-sectional survey of 144 Japanese adults, we found that age, presence of epilepsy, and presence of paretic conditions were independent risk factors. The Tinetti balance and gait instrument was successfully administered to this population and resulted in high diagnostic accuracy (sensitivity 88.9%, specificity 91.9%) for identifying individuals at risk when the cutoff score was set at 25. Participants whose balance and gait deteriorated showed a decrease in the Tinetti score of at least 2 points per year. Thus, the Tinetti instrument may be an effective tool to detect an increased risk of fall in this population.

Gait and Balance

“…Such factors, apart from age, include the presence of seizures, epilepsy, arthritis and paretic conditions (Chiba et al 2009;Cox et al 2010;Hsieh et al 2001;Hsieh et al 2012;Willgoss et al 2010), the intake of anxiolytics, antipsychotics, anticonvulsants, more than four medicaments and medication in general (Chiba et al 2009;Cox et al 2010;Hale et al 2007;Hsieh et al 2001;Hsieh et al 2012;Wagemans and Cluitmans 2006), the existence of past fractures (Cox et al 2010), the level of disability and mobility (Grant et al 2001;Hale et al 2007;Hsieh et al 2012;Wagemans and Cluitmans 2006;Willgoss et al 2010), the existence of behavioral problems (Hale et al 2007;Hsieh et al 2001;Willgoss et al 2010), the sex (Grant et al 2001;Hsieh et al 2012), the place of residence (home or institution) (Grant et al 2001), the context and environment of falling (Hale et al 2007), and the physical condition (Hale et al 2007;Hsieh et al 2012). Furthermore, fallers with ID have prominent characteristics during gait such as greater base of stance width, shorter step length, and lower walking speed compared to non-fallers with ID (Chiba et al 2009). …”

“…Therefore, measuring balance performance in people with ID is challenging and needs to be adapted to the patients' requirements. Despite the difficulties in assessing some of these tests, the persons with ID who managed to get a score have on average lower performance than peers without ID (Bruckner and Herge 2003;Carmeli et al 2004;Carmeli et al 2005;Chiba et al 2009;Duncan et al 1990;Hale et al 2007;Isles et al 2004;Smith et al 2007;Smith and Ulrich 2008;Steffen et al 2002;Tinetti 1986;Tinetti et al 1986;Vereeck et al 2008;Verghese et al 2009). Carmeli et al (2003) underlined the necessity of evaluating balance with more than one test to reduce possible discrepancies between the patient's performance and the assessor's interpretation.…”

“…According to Chiba et al (2009), the Tinetti score could discriminate fallers with ID from non-fallers with ID. The Tinetti Test, or Performance Oriented Mobility Assessment (POMA) consists of two parts that evaluate components of static and dynamic balance, respectively ).…”

“…The sum of scores classifies the patient as low-, moderate-or high-risk for falls person. A score of 25 or lower could identify a faller from a non-faller with 88.9 % sensitivity and 91.9 % specificity (Chiba et al 2009). Contrary to the Tinetti Test, the TUG test was not sensitive enough to distinguish between fallers and non-fallers (Bruckner and Herge 2003).…”

Acceso y morbilidad hospitalaria en personas con trastornos del desarrollo intelectual

“…[5][6][7]10,17 El resultado más sorprendente que se puede observar en esta investigación es que a pesar de los muchos estudios que ponen de relevancia factores de riesgo como enfermedades cardiovasculares, sobrepeso, dislipemias, diabetes o bajos niveles de actividad física en TDI, se encuentra una prevalencia inferior de ingresos por esta causa. El mismo caso ocurre con enfermedades como la epilepsia, demencia, otitis, tapones de cerumen, caídas, fracturas, etcétera, 5,6,8,10,[22][23][24] que deberían llevar a pensar en una frecuencia de ingresos igual o mayor que en la población general por estas causas. Sin embargo, se halló una prevalencia menor de ingresos relacionados con problemas del sistema nervioso, otorrinolaringoló-gicos o musculoesqueléticos en los TDI.…”