Developing a multivariate prediction model of falls among older community-dwelling adults using measures of neuromuscular control and proprioceptive acuity: A pilot study.

OBJECTIVE: To examine whether measures of neuromuscular control and proprioceptive acuity were predictive of falls in an older community-dwelling population and to develop a multivariate prediction model. METHODS: Fifty-eight adults aged above 60 living independently in the community were recruited for a prospective falls study. On entry, they undertook a Sensory Organisation Test (SOT) and an Active Movement Extent Discrimination Assessment (AMEDA) and completed a short fall risk questionnaire. Participants were monitored for falls over the subsequent 12 months. Prior to analysis, falls were classified into three categories based on the difficulty of the activity being undertaken and the demands of the environment in which the fall occurred. Logistic regression was used to predict the probability of a fall. RESULTS: For falls occurring under the least challenging circumstances, the model fitted using the AMEDA score and two of the questions from the fall risk questionnaire, related to balance and confidence, achieved a specificity of 87% and sensitivity of 83%. Falls occurring in more challenging circumstances could not be predicted with any accuracy based on the variables recorded at inception. CONCLUSIONS: This study highlights the importance of considering the heterogeneous nature of falls. Poorer proprioceptive acuity appears to play a role in falls occurring where neither the environment nor the activity is challenging, but not in falls occurring in other circumstances. Falls in the least-challenging circumstances affected 15% of participants, but this group was considerably more likely to have multiple falls, increasing their vulnerability to adverse consequences.

Daily surveillance of falls is feasible and reveals a high incidence of falls among older adults.

OBJECTIVE: To ensure accurate data capture for a fall study through a system of daily contact with participants. METHODS: Fifty-eight adults older than 60 years of age and living independently in the community in Canberra, Australia, were recruited for a prospective fall study. We adopted a system of daily contact with study participants for at least 12 months, either by email or by text, asking whether they had suffered a fall in the previous 24 h. At the final testing session, we asked participants whether they had experienced a fall during the previous twelve months. RESULTS: We found no evidence that the daily reporting regime led to excess participant attrition. Only three participants withdrew over the course of the study, and the burden of responding was not cited as a factor in any of these cases. Of the 55 participants who completed the full twelve-month study period, 38 (69%) experienced at least one fall. We also identified inconsistencies between recall of falls occurring during the last twelve months of the study and the contemporaneously recorded data. CONCLUSIONS: Previous studies have found that increasing the reporting demands on fall study participants will lead to higher attrition. This study demonstrates that it is possible to maintain participant engagement and minimise attrition with appropriate design of reporting procedures. We confirm existing evidence regarding the unreliability of retrospective recall of falls. The study highlights the importance of comprehensive and accurate data capture and points to the possibility of under-reporting of fall incidence.

Discrimination of amount of spinal flexion for movements made with and without vision after lumbar disc replacement.

Discrimination of differences between small lumbar flexion movements made when standing may differ depending on whether vision is available. Dependence on general vision during trunk movements may be increased following surgery, in which an intervertebral disc is replaced with a prosthetic disc. This study investigated whether the availability of vision changed discrimination of small differences in lumbar forward flexion movement when standing for patients with lumbar disc replacement and healthy peers. 20 volunteers without a history of back pain and 20 with disc replacement undertook a 100-trial sequence of forward flexion movements to a set of physical stops, making an absolute judgement as to the position after each movement. General (nontarget) vision during the movement was available or removed randomly trial by trial. Availability of vision did not affect discrimination of flexion movements of the lumbar spine either in normal healthy individuals or those with disc replacement.

Perceptions of embarrassment for men with and without urinary incontinence.

There is little information available about the impact incontinence has on men. Using photographs, men were asked to rate the perceived embarrassment of the wearer. Embarrassment ratings rose with the size of the visible wet area, but were lower from those who had experienced the problem themselves. Knowing how to deal with the feelings of embarrassment seems to be critical when dealing with incontinent males.

The Relationship Between Subjective Falls-Risk Assessment Tools and Functional, Health-Related, and Body Composition Characteristics.

We sought to explore the relationship between two subjective falls-risk assessment tools (Falls Efficacy Scale-International [FES-I] and Activities-Specific Balance Confidence [ABC] Scale) and functional, health-related, and body composition characteristics. A total of 245 community-dwelling people aged 60 to 88 years underwent assessments for subjective falls risk (using the FES-I and ABC Scale), health-related (cognitive; Short-Form Health Survey [SF-12]), functional (physical activity and physical function), and body composition characteristics (measured by dual X-ray absorptiometry). The FES-I and ABC Scale are strongly correlated with each other for females and males ( r = -.70, p < .001; r = -.65, p < .001), respectively. There are substantial differences between males and females when they self-assess their risk of falling as well as what characteristics contribute to explaining these self-assessments. Females are potentially more self-aware of their functional, body composition and health-related characteristics to better estimate their own risk of falling. FES-I correlates better with functional, body composition, and health-related characteristics, and thus may be more appropriate for use than the ABC in community-dwelling older adults.