Discriminative and Predictive Ability of Physical Performance Measures in Identifying Fall Risk among Older Adults

Abstract

Falls are a public health concern among older adults. There is a need to take significant measures such as screening for the risk of a fall as a means of prevention and management. A cross-sectional study was conducted to determine discriminative and predictive ability of physical performance measures in identifying the risk of fall among Malaysian community dwelling older adults. Three hundred twenty-five Malaysian community dwelling older adults aged 60 years and above (67.67+ 5.5 years) participated in this study. This study was a part of a larger longitudinal study 'LRGS TUA'. Physiological Profile Assessment (PPA), a comprehensive tool for quantifying risk of fall was used as a standard measure of comparison to 6 Meter Gait Speed (GS), Timed Up and Go (TUG) and Walking While Talking (WWT) tests to establish discriminative and predictive ability. Participants recorded incidence of falls in a 'falls diary' over a span of six months. To determine the optimum cut off scores of the test identified to classify fall risk, receiver operator curves (ROC) were used and its sensitivity and specificity were calculated. A significant mean difference between fallers and non-fallers was demonstrated only with TUG test (p<0.05). TUG test cut off score in discriminating older adults at risk of fall was established at eight seconds, with a sensitivity and specificity of 83.95% and 32.4%, respectively, in this study. Eighty-four percent older adults who experienced a fall in our study were identified to be at risk of fall when screened using this TUG cut off score. Our study results suggested TUG test to be an optimal screening tool for risk of fall among community dwelling older adults.

Predictive Validity of Motor Fitness and Flexibility Tests in Adults and Older Adults: A Systematic Review

“…There was strong evidence for worse TUG performance predicting falls (and fear of falling) in adults over 40 years old as a result of nine studies [31,35,36,73,74,82,83,85,87]. A systematic review (with three studies) [14] and a study did not find association between TUG and falls [78].…”

“…A total of 25 studies [6][7][8][9]31,[34][35][36][37]54,64,70,[72][73][74][75][76][77][78][79][82][83][84][85]87] and 2 systematic reviews [14,15] included falls or hip fracture as health outcomes (Tables 3 and S1).…”

“…Gait speed was reported in 13 studies [6][7][8][9]31,[34][35][36][37]54,64,70,82] and 2 systematic reviews [14,15], the 6m gait speed test being the most common. One study also included step length to assess gait variables [54].…”

“…There was strong evidence for slower gait predicting falls in adults over 60 years old, as a result of seven selected studies [6][7][8][9]35,38,64] plus seven studies derived from two systematic reviews [14,15]. Three studies did not found association between gait speed tests and falls [31,36,82]. There was limited evidence for a short step length (<0.45 m), assessed over 5m predicting risk of falling in older adults over 70 years [54].…”

Effectiveness of a 3-month antifalling program in the mobility, balance confidence, and muscle performance of older adults

“…The study of Motalebi et al (2018) on community-dwelling older adults in Malaysia revealed that 18.6% of such individuals had a history of falls associated with advanced age, especially those aged 75–84 years and ≥85 years and women. Older adults who experience recurrent falls demonstrate significantly reduced lower extremity strength, dynamic balance, endurance, balance confidence in daily activities, and physical activity levels ( Samah et al, 2018 ). Thus, to prevent fall incidences and optimize their daily functioning, older individuals require effective intervention.…”