The Physical Performance Test as a predictor of frequent fallers: a prospective community-based cohort study

Abstract

Objective: To construct a risk model in order to identify elderly individuals at risk of frequent falling. Design: Prospective community-based cohort study over 12 months. Setting: Baseline measures were performed at a local community centre. Subjects: Two hundred and sixty-three community-dwelling elderly people (mean age 72 years). Measurements: A variety of variables were evaluated, including medical, psychological, sensory, physical and postural control measurements. Fall incidence was monitored retrospectively and during one-year follow-up. Results: Logistic regression analysis showed that polypharmacia was the most prominent medical fall predictor with an odds ratio (OR) of 1.29 (P =0.005), poor visual acuity the best sensory predictor (OR=0.84; P =0.009) and general fear of falling the most crucial psychological predictor (OR=3.25; P B=0.001). Increased postural sway in near-tandem stance with eyes open was selected as the best balance predictor for falls (OR=5.60; P =0.010), followed by delayed anteroposterior movement velocity during rhythmic weight shifts (OR=0.42; P =0.004). The best physical predictor was a low score on the Physical Performance Test (OR=4.16; P <0.001), followed by decreased maximal handgrip strength (OR=0.87; P <0.001) and increased timed chair-stands (OR=1.13; P <0.003). Step-by-step regression analysis revealed a risk model for the prediction of future falls, as a combination of the Physical Performance Test and maximal handgrip strength. Conclusion: This study confirms the multicausality of falls, since medical, psychological, sensory, postural control as well as physical variables provides a predictive value. The composed fall risk model was mainly physically oriented.