Abstract
Current fall prevention guidelines are largely reactive to a history of falls and are thus an ineffective approach to primary fall prevention. This work aims to identify objective measures that predict fall risk to facilitate broader implementation in primary care settings. Longitudinal data were available from 952 men (48%) and women aged 60 to 97 enrolled in the Baltimore Longitudinal Study of Aging who had an index and subsequent visit approximately 2.5 years apart. Participants received objective measures at index visit and answered "yes" or "no" to the question "Have you fallen in the past 12 months?" at both visits. Main predictors included muscle strength (hamstrings/quadriceps), narrow walk, progressive static balance (semi-tandem, full tandem, single leg stance) tests and performance on conditions I and II of the modified Clinical Test of Sensory Interaction in Balance (mCTSIB). Each test was parameterized using validated methods. Logistic regression models adjusted for age, sex, race, and BMI were used to predict fall risk. Persons who failed the semi-tandem, full tandem, single leg stance, narrow walk, and condition II had, respectively, 2.59 (95% CI 1.51, 4.46), 1.57 (95% CI 1.06, 2.33), 1.54 (95% CI 1.15, 2.06), 2.21 (95% CI 1.37, 3.58), and 3.56 (95% CI 1.01, 12.57) times the odds of a future fall than persons who did not fail these tests. Observation of standing balance by assessing sway with eyes closed (condition II), ability to hold progressively challenging standing positions, or inability to traverse a narrow walk are all prognostic of a future fall. As these tests require no special equipment and take only 30 s to administer, identifying older persons at elevated risk of falling is feasible. Whether identifying persons at risk of falling can proactively prevent a future fall remains to be demonstrated.