PHYS THER
Vol. 90, No. 3, March 2010, pp. 338-347
DOI: 10.2522/ptj.20090163
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Research Reports

Balance Impairment as a Risk Factor for Falls in Community-Dwelling Older Adults Who Are High Functioning: A Prospective Study

Susan W. Muir, Katherine Berg, Bert Chesworth, Neil Klar and Mark Speechley

S.W. Muir, BScPT, PhD, is Postdoctoral Fellow, Department of Medicine, Division of Geriatric Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, Parkwood Hospital, Room A-283, 801 Commissioners Rd East, London, Ontario, Canada N6C 5J1.
K. Berg, PT, PhD, is Chair and Associate Professor, Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada.
B. Chesworth, BScPT, MClScPT, PhD, is Assistant Professor, School of Physical Therapy, and Faculty of Health Sciences, Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, University of Western Ontario.
N. Klar, PhD, is Associate Professor, Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, University of Western Ontario.
M. Speechley, PhD, is Associate Professor, Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, University of Western Ontario.

Address all correspondence to Dr Muir at: susan.muir{at}uwo.ca.

Background: Screening should have simple and easy-to-administer methods that identify impairments associated with future fall risk, but there is a lack of literature supporting validation for their use.

Objective: The aim of this study was to evaluate the independent contribution of balance assessment on future fall risk, using 5 methods to quantify balance impairment, for the outcomes "any fall" and "any injurious fall" in community-dwelling older adults who are higher functioning.

Design: This was a prospective cohort study.

Methods: A sample of 210 community-dwelling older adults (70% male, 30% female; mean age=79.9 years, SD=4.7) received a comprehensive geriatric assessment at baseline, which included the Berg Balance Scale to measure balance. Information on daily falls was collected for 12 months by each participant's monthly submission of a falls log calendar.

Results: Seventy-eight people (43%) fell, of whom 54 (30%) sustained an injurious fall and 32 (18%) had recurrent falls (≥2 falls). Different balance measurement methods identified different numbers of people as impaired. Adjusted relative risk (RR) estimates for an increased risk of any fall were 1.58 (95% confidence interval [CI]=1.06, 2.35) for self-report of balance problems, 1.58 (95% CI=1.03, 2.41) for one-leg stance, and 1.46 (95% CI=1.02, 2.09) for limits of stability. An adjusted RR estimate for an increased risk of an injurious fall of 1.95 (95% CI=1.15, 3.31) was found for self-report of balance problems.

Limitations: The study was a secondary analysis of data.

Conclusions: Not all methods of evaluating balance impairment are associated with falls. The number of people identified as having balance impairment varies with the measurement tool; therefore, the measurement tools are not interchangeable or equivalent in defining an at-risk population. The thresholds established in this study indicate individuals who should receive further comprehensive fall assessment and treatment to prevent falls.


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