Mobility screening for fall prediction in the Canadian Longitudinal Study on Aging (CLSA): implications for fall prevention in the decade of healthy ageing

Abstract

Background Guidelines for fall prevention in older adults recommend mobility screening for fall risk assessment; however, there is no consensus on which test to use and at what cutoff. This study aimed to determine the accuracy and optimal cut-off values of commonly used mobility tests for predicting falls in the Canadian Longitudinal Study on Aging (CLSA). Methods Mobility tests at baseline included the Timed Up and Go (TUG), Single Leg Stance (SLS), chair-rise and gait speed. Inclusion criteria were: age ≥ 65 years and meeting first-level fall screening criteria (i.e. history of a fall or mobility problem) at baseline. Accuracy of fall prediction at 18-months for each test was measured by the area under the receiver operating curve (AUC). Results Of 1,121 participants that met inclusion criteria (mean age 75.2 ± 5.9 years; 66.6% women), 218 (19.4%) reported ≥one fall at 18 months. None of the tests achieved acceptable accuracy for identifying individuals with ≥one fall at follow-up. Among women 65–74 and 75–85 years, the TUG identified recurrent fallers (≥two falls) with optimal cut-off scores of 14.1 and 12.9 s (both AUCs 0.70), respectively. Among men 65–74 years, only the SLS showed acceptable accuracy (AUC 0.85) for identifying recurrent fallers with an optimal cutoff of 3.6 s. Conclusions Our findings indicate that commonly used mobility tests do not have sufficient discriminability to identify fallers in a population-based sample of community-dwelling older adults. The TUG and SLS can identify recurrent fallers; however, their accuracy and cut-off values vary by age and sex.

Low Physical Performance Could Be Associated with Adverse Health Outcomes over Time: Results from a Cohort of Older Adults

“…Our results showed that only low performance, as assessed by the TUG test time at baseline, was associated with a higher prevalence of falls. TUG is the most commonly used tool in studies assessing fall risk, precisely because it evaluates, in addition to walking ability, other dimensions such as balance and strength [ 22 ], while GS has shown inconsistent results for predicting falls [ 6 , 52 , 53 ]. The Canadian Longitudinal Study on Aging verified that neither of the commonly used PP tests (TUG and GS) achieved acceptable accuracy in identifying individuals with at least one fall at follow-up (18 months) [ 52 ].…”

“…TUG is the most commonly used tool in studies assessing fall risk, precisely because it evaluates, in addition to walking ability, other dimensions such as balance and strength [ 22 ], while GS has shown inconsistent results for predicting falls [ 6 , 52 , 53 ]. The Canadian Longitudinal Study on Aging verified that neither of the commonly used PP tests (TUG and GS) achieved acceptable accuracy in identifying individuals with at least one fall at follow-up (18 months) [ 52 ]. This is in agreement with previous studies in which the values of sensitivity and specificity ranged from weak to moderate for the TUG and 4 m GS tests [ 28 , 29 , 30 , 33 , 54 , 55 ].…”

Examination of the Increased Risk for Falls Among Individuals With Knee Osteoarthritis: A Canadian Longitudinal Study on Aging Population‐Based Study

“…The time (in seconds) that they were able to balance on 1 foot before their foot touches the ground or they lose balance and touch the wall was recorded with a maximum time of 60 seconds. A cutoff based on previous work published with this data set was chosen to be 4.5 seconds (18); a time of 4.5 seconds or less indicates impaired balance. The TUG was used to assess mobility.…”

“…The time (in seconds) was recorded for how long it takes the participant to stand up from the chair, walk 3 meters, turn around, walk back to the chair and sit down again at their normal pace. A cutoff of 14.2 seconds was used (18); a time of 14.2 seconds or more indicates impaired mobility. The chair‐rise test assesses balance and coordination.…”

“…The time (in seconds) was recorded for how long it takes the participant to stand up and sit back down 5 times as quickly as possible with no rest in between. A cutoff of 15.9 seconds was used (18); a time of 15.9 seconds or more indicates impaired balance and coordination.…”