Circumstances and consequences of falls in independent community-dwelling older adults

A randomized controlled pilot study assessing the feasibility of combined motor-cognitive training and its effect on gait characteristics in the elderly

OBJECTIVE

(1) To develop a motor-cognition training programme; (2) to evaluate the ability to recruit and retain elderly people; (3) to assess the effects of the interventions.

DESIGN

Pilot randomized controlled trial.

SETTING

Assisted living facility.

PARTICIPANTS

Sixteen subjects (11 female) living in an assisted living facility were randomized to a motor or motor-cognition group.

INTERVENTIONS

Both groups received machine-driven strength training and balance exercises for 45 minutes, twice weekly, for 12 weeks. In addition, the motor-cognition group received computerized training for attention 3-5 times per week for 10 weeks.

MAIN OUTCOME MEASURES

Baseline and post-intervention (12 weeks) assessments focused on recruitment, attrition and adherence. Secondary outcome measures assessed dual-task costs of gait (velocity, cadence, step time, step length), expanded timed get-up-and-go, falls efficacy and reaction time.

RESULTS

Of 35 subjects initially approached, 16 started and 14 completed the study, resulting in 46% recruitment, 19% attrition and >80% adherence rates. There is more evidence of altered levels in the motor-cognitive treatment group with significant differences in average change for fear of falling (P = 0.017) and foot reaction time (P = 0.046). No statistical significance was reached for gait parameters.

CONCLUSIONS

Motor-cognition training is feasible and shows trends to stronger improvement in walking and reaction time. The application in a main study is deemed feasible. A minimum of ± 55 subjects per group are required to achieve a power of 80% at the 5% level of significance based on step length and considering the expectable attrition rate in a required larger scale study.

Prevalência de quedas e de fatores associados em idosos segundo etnia

A característica histórico-cultural brasileira reflete a população. Idosos negros apresentam desvantagens nos aspectos socioeconômicos e demográficos, clínico-funcionais e psicossociais, reduzindo a autonomia social e a independência funcional. O declínio na condição funcional devido a idade e a variáveis associadas à etnia pode contribuir em eventos incapacitantes, como quedas. Foram coletados dados sociodemográficos, clínicos-funcionais, aspectos relacionados às quedas; Avaliou-se mobilidade, condição funcional e cognição. Estatística assumindo significância de p < 0,05. Amostra de 196 idosos sendo 48,5% brancos, 28% pardos, 23,5% negros. Média de 69,9 anos. Mobilidade reduzida classificando médio risco a quedas para 60% (p < 0,013) dos idosos. Referente aos grupos, significância entre variáveis para renda familiar (p < 0,029), ocorrência (p < 0,006) e medo de quedas (p < 0,023) e quase-quedas (p < 0,000). Negros caem com maior frequência (p < 0,03). Significância estatística entre etnia autodeclarada e ocorrência de quedas, medo de cair e ocorrência de quase-quedas, limitação funcional e risco médio a quedas por mobilidade reduzida, frequência maior de quedas aos idosos negros.

Cognitive demand and predictive adaptational responses in dynamic stability control

We studied the effects of a concurrent cognitive task on predictive motor control, a feedforward mechanism of dynamic stability control, during disturbed gait in young and old adults. Thirty-two young and 27 elderly male healthy subjects participated and were randomly assigned to either control or dual task groups. By means of a covered exchangeable element the surface condition on a gangway could be altered to induce gait perturbations. The experimental protocol included a baseline on hard surface and an adaptation phase with twelve trials on soft surface. After the first, sixth and last soft surface trial, the surface condition was changed to hard (H1-3), to examine after-effects and, thus, to quantify predictive motor control. Dynamic stability was assessed using the 'margin of stability (MoS)' as a criterion for the stability state of the human body (extrapolated center of mass concept). In H1-3 the young participants significantly increased the MoS at touchdown of the disturbed leg compared to baseline. The magnitude and the rate of these after-effects were unaffected by the dual task condition. The old participants presented a trend to after-effects (i.e., increase of MoS) in H3 but only under the dual task condition.In conclusion, the additional cognitive demand did not compromise predictive motor control during disturbed walking in the young and old participants. In contrast to the control group, the old dual task group featured a trend to predictive motor adjustments, which may be a result of a higher state of attention or arousal due to the dual task paradigm.

Does the attentional demands of walking differ for older men and women living independently in the community?

BACKGROUND AND PURPOSE

Walking has been shown to be an attentionally demanding task. For older adults, gender-specific differences in gait and falling reported in the literature could arise as a result of the attentional demands of walking. However, differences in how older men and women allocate attention to walking have not been investigated. The purpose of this study was to use a dual-task voice reaction time paradigm to examine gender-specific differences in the attentional demands of walking in older adults who are independent in community ambulation.

METHODS

A dual-task paradigm was used to measure voice reaction time (VRT) in older community-dwelling men (n = 29; mean age = 78.40, SD = 6.17 years) and women (n = 33; mean age = 77.01, SD = 6.07 years) under 3 task conditions: sitting in a chair, standing, and walking on a level surface. Between- and within-group differences in dual-task VRT were examined using a 2 (men vs women) by 3 (task condition) repeated-measures analysis of variance. The level of statistical significance was set at 0.05, and a Bonferroni procedure was used for post hoc analyses.

RESULTS

Sitting VRT was similar for men (mean = 454.90, SD = 140.05 milliseconds) and women (mean = 454.49, SD = 94.27 milliseconds). While standing, men had a slightly faster VRT (mean = 444.90, SD = 125.31 milliseconds vs mean = 452.09, SD = 92.82 milliseconds). When walking, VRT increased for both groups in comparison to sitting and standing and older men (mean = 509.11, SD = 142.19 milliseconds) responded faster than older women (mean = 537.55, SD = 122.43). However, the main effect of gender (P = .665) and interaction of gender with task (P = .433) were both not statistically significant. A statistically significant main effect for task (P < .001) indicated that walking VRT (mean = 524.25, SD = 131.71 milliseconds) was significantly longer than both sitting (P < .001, mean = 454.68, SD = 116.89 milliseconds) and standing (P < .001, mean = 448.36, SD = 108.37 milliseconds) VRT.

DISCUSSION

The results demonstrate that the attentional demands of walking are not different for older adult men and women who are independent in community mobility. However, support was provided for the idea that walking is an attentionally demanding activity. In comparison with sitting and standing, walking was more attentionally demanding for both men and women. CONCLUSIONS.: A dual-task voice reaction time paradigm revealed that walking is not more attentionally demanding on the basis of gender when comparing community-dwelling older adult men with women.

Design and evaluation of a new mechatronic platform for assessment and prevention of fall risks

Background

Studying the responses in human behaviour to external perturbations during daily motor tasks is of key importance for understanding mechanisms of balance control and for investigating the functional response of targeted subjects. Experimental platforms as far developed entail a low number of perturbations and, only in few cases, have been designed to measure variables used at run time to trigger events during a certain motor task.

Methods

This work introduces a new mechatronic device, named SENLY, that provides balance perturbations while subjects carry out daily motor tasks (e.g., walking, upright stance). SENLY mainly consists of two independently-controlled treadmills that destabilize balance by suddenly perturbing belts movements in the horizontal plane. It is also provided with force sensors, which can be used at run time to estimate the ground reaction forces and identify events along the gait cycle in order to trigger the platform perturbation. The paper also describes the customized procedures adopted to calibrate the platform and the first testing trials aimed at evaluating its performance.

Results

SENLY allows to measure both vertical ground reaction forces and their related location more precisely and more accurately than other platforms of the same size. Moreover, the platform kinematic and kinetic performance meets all required specifications, with a negligible influence of the instrumental noise.

Conclusion

A new perturbing platform able to reproduce different slipping paradigms while measuring GRFs at run time in order to enable the asynchronous triggering during the gait cycle was designed and developed. Calibration procedures and pilot tests show that SENLY allows to suitably estimate dynamical features of the load and to standardize experimental sessions, improving the efficacy of functional analysis.

A comparison of treadmill and overground walking effects on step cycle asymmetry in young and older individuals

Although lower limb strength becomes asymmetrical with age, past studies of aging effects on gait biomechanics have usually analyzed only one limb. This experiment measured how aging and treadmill surface influenced both dominant and nondominant step parameters in older (mean 74.0 y) and young participants (mean 21.9 y). Step-cycle parameters were obtained from 3-dimensional position/time data during preferred-speed walking for 40 trials along a 10 m walkway and for 10 minutes of treadmill walking. Walking speed (young 1.23 m/s, older 1.24 m/s) and step velocity for the two age groups were similar in overground walking but older adults showed significantly slower walking speed (young 1.26 m/s, older 1.05 m/s) and step velocity on the treadmill due to reduced step length and prolonged step time. Older adults had shorter step length than young adults and both groups reduced step length on the treadmill. Step velocity and length of older adults' dominant limb was asymmetrically larger. Older adults increased the proportion of double support in step time when treadmill walking. This adaptation combined with reduced step velocity and length may preserve balance. The results suggest that bilateral analyses should be employed to accurately describe asymmetric features of gait especially for older adults.

Biomechanical characteristics of stepping in older Tai Chi practitioners

This study compared the biomechanical characteristics of stepping in 10 older (aged 55+ years) Tai Chi (TC) practitioners and 10 age-matched non-TC (NTC) controls. Subjects were asked to take a step on an auditory cue as fast as possible, in the forward and backward directions, and with and without mental distractions, respectively. Stepping characteristics included step initiation time, preparation time for foot off, foot contact time, and step length and width. The results showed that both groups had similar step initiation time, step length and forward step width (p>0.466). Although mental distraction significantly delayed step initiation time and foot contact time, and shortened step length in both groups (p<0.003), TC practitioners had significantly shorter preparation and foot contact time, and wider backward step width than controls regardless of mental distraction (p<0.024). These group differences are in favor of TC practitioners in situations of postural recovery from potential falls, even with mental distractions, and may explain the positive effect of TC practice on fall reduction in older adults.

Evidence for age-related decline in visuomotor function and reactive stepping adjustments

This study investigated age-related and fall-risk-related differences in the ability to make visually guided reactive stepping adjustments during locomotion. Participants were asked to walk towards and step accurately onto a visual target which, during the step towards it, moved to an unpredictable location at an unpredictable time. We measured lower limb kinematics and eye movement characteristics of young adults and two groups of older adults deemed to be either at a low- or high-risk of falling. High-risk older adults produced significant deviations in foot trajectory with latencies of ∼300 ms, compared to 280 ms in low-risk older adults and ∼200 ms in young adults. Furthermore, high-risk older adults were unable to generate adjustments with the same magnitude and consistency as low-risk older adults and young adults. Saccadic reaction latencies also were doubled in high-risk older adults compared to young. Analysis of covariance showed that the significant between group differences in final foot placement error could be accounted for by differences in saccadic response times. We propose that age-related delays in visuomotor processing times may disrupt the timing and magnitude of stepping adjustments, possibly contributing to an increased likelihood of falls.

A shoe sole-based apparatus and method for randomly perturbing the stance phase of gait: test-retest reliability in young adults

Walking on an irregular surface is associated with an elevated risk for a fall at any age. Yet, relatively little is known about how a human responds to an unexpected underfoot perturbation during gait. This is partly due to the difficulty of generating an intermittent but repeatable, unexpected, underfoot perturbation whose size and location are precisely known. So we developed a shoe sole-embedded apparatus for randomly perturbing the stance phase of gait. Medial and lateral flaps were concealed in the soles of pairs of sandals, along with their actuators. Either flap could be deployed within 400ms in the parasagittal plane under a swing foot; this altered the resulting sagittal and frontal plane orientations of the foot during the next stance phase, whereafter the flap was retracted following toe-off for the rest of that gait trial. We tested six healthy young subjects by randomly presenting a single medial or lateral perturbation in 12 of 30 gait trials. Traditional step kinematic measures were used to evaluate the test-retest reliability of the response to the stimulus at two different walking speeds in 60 randomized trials conducted 1 week apart. The method was effective in systematically inducing an alteration in gait, reproducible across visits, as evidenced by acceptable intraclass correlation coefficients for step width, time and length. We conclude that the apparatus and method has potential for measuring the ability of humans to reject one or more unexpected underfoot perturbations during gait.

Meta-analysis of type and complexity of a secondary task during walking on the prediction of elderly falls

AIM

Dual-tasking probes divided attention and causes performance changes that are associated with an increased risk for falls in the elderly. There is no systematic review investigating the effect of task type and complexity on the prediction of elderly falls. This article synthesizes research evidence regarding this issue on the contents of dual-tasking walking.

METHODS

Relevant studies were systematically identified from electronic databases of Medline, PubMed, CINAHL, Cochrane CENTRAL and PsycINFO, and the reference lists of identified articles. The selection criteria were defined a priori. Two independent reviewers classified task types based on properties for cognitive demand, assessed the methodological quality with a customized checklist, and calculated the odds ratio of fall prediction.

RESULTS

There was one study of reaction time, one of discrimination and decision-making, 10 of mental tracking, three of verbal fluency and five of manual tasks. The methodological heterogeneity was manifested in the selection criteria, faller classification, tasks and measures, resulting in substantial heterogeneity (I(2) 87-92%). Meta-analyses resulted in a significant pooled odds ratio 1.33 (95% CI 1.18-1.50). The mental tracking task was the only type that yielded a significant odds ratio 3.30 (95% CI 2.00-5.44). Running meta-analyses separately for simple and difficult mental tracking task showed similar odds ratios.

CONCLUSION

The mental tracking task yielded significant dual-task-related changes for fall prediction. Most studies successively used an appropriate level of task complexity specific to the specified population of interest. More research is required for definite conclusions regarding the effect of task type and complexity.

Effectiveness of a multifactorial intervention program to reduce falls incidence among community-living older adults: a randomized controlled trial

OBJECTIVE

To determine the effectiveness of a multifactorial intervention program to prevent falls among older adults as compared with a brief intervention.

DESIGN

Randomized controlled trial.

SETTING

Eleven health centers located in Córdoba, Spain.

PARTICIPANTS

People over 70 years old (N=404), who are residents in the community.

INTERVENTIONS

The centers were randomized to either 1 of the 2 groups: intervention group (IG), of a multifactorial nature (individual advice, information leaflet, physical exercise workshop, and home visits), or control group (CG) (brief individual advice and information leaflet).

MAIN OUTCOME MEASURES

Fall rates and time until the fall; estimates of the relative and absolute risk of falls; and survival analysis and Cox regression.

RESULTS

Of the patients recruited, 133 were in the IG and 271 were in the CG. Around 33% in the IG and 30.25% in the CG had had a fall in the previous year (P=.56). After 12 months, the fall incidence rate was 17.29% in the IG and 23.61% in the CG (relative risk=0.73; 95% confidence interval [CI], 0.48-1.12; P=.146). Around 60% of the IG patients said they had increased the time spent on physical activity. In the IG, the incidence of falls at home was 27.5% compared with 49.3% in the CG (P=.04). Being a woman (odds ratio [OR]=1.62; 95% CI, 1.03-2.54), having a history of falls (OR=1.15; 95% CI, 1.05-1.26), suffering acute health problems (OR=2.19; 95% CI, 1.09-4.40), and doing moderate exercise (OR=1.91; 95% CI, 1.08-3.38) were found as factors associated with a higher risk of falls.

CONCLUSIONS

Although the reduction of falls in the IG was nearly halved, and after the intervention there was a significant reduction in the number of falls at these patients' homes, the multifactorial intervention program is no more effective than the brief intervention to reduce the overall risk of falls.

Enhanced somatosensory information decreases postural sway in older people

The somatosensory system plays an important role in balance control and age-related declines in somatosensory function have been implicated in falls incidence. Different types of insole devices have been developed to enhance somatosensory information and improve postural stability. However, they are often too complex and expensive to integrate into daily life and textured insole surfaces may provide an inexpensive and accessible means to enhance somatosensory input. This study investigated the effects of textured insole surfaces on postural sway in ten younger and seven older participants performing standing balance tests on a force plate under three insole surface conditions: (1) barefoot; (2) with hard; and (3), soft textured insole surfaces. With each insole surface, participants were tested under two vision conditions (eyes open, closed) on two standing surfaces (firm, foam). Four 30s trials were collected for different combinations of insole surface, standing surface and vision. Centre of pressure measurements included the range and standard deviation of anterior-posterior and medial-lateral displacement, path length and the 90% confidence elliptical area. Results revealed a significant Group*Surface*Insole interaction for five of the dependent variables. Compared to younger individuals, postural sway was greater in older people on both standing surfaces in the barefoot condition. However, both textured insole surfaces reduced postural sway for the older group especially in the eyes closed condition on a foam surface. These findings suggest that textured insole surfaces can reduce postural sway in older people, particularly during more challenging balance tasks. Textured insole surfaces may afford a low-cost means of decreasing postural sway, providing an important intervention in falls prevention.

Adaptive control reduces trip-induced forward gait instability among young adults

A vital functional plasticity of humans is their ability to adapt to threats to posture stability. The purpose of this study was to investigate adaptation to repeated trips in walking. Sixteen young adults were recruited and exposed to the sudden (electronic-mechanical) release of an obstacle, 11-cm in height, in the path of over ground walking during the mid-to-late left swing phase. Although none of the subjects fell on the first of eight unannounced, consecutive trips, all of them had to rely on compensatory step with a step length significantly longer than their regular to reduce their instability. In the subsequent trials, they were able to rapidly make adaptive adjustments in the control of their center-of-mass (COM) stability both proactively and reactively (i.e., before and after hitting or crossing the obstacle), such that the need for taking compensatory step was substantially diminished. The proactive adaptations included a reduced forward COM velocity that lessened forward instability in mid-to-late stance and an elevated toe clearance that reduced the likelihood of obstacle contact. The reactive adjustments were characterized by improved trunk control (by reducing its forward rotation) and limb support (by increasing hip height), and reduced forward instability (by both the posterior COM shift and the reduction in its forward velocity). These findings suggest that young adults can adapt appropriately to repeated trip perturbations and to reduce trip-induced excessive instability in both proactive and reactive manners.

Reliability of Impact Forces, Hip Angles and Velocities during Simulated Forward Falls Using a Novel Propelled Upper Limb Fall ARrest Impact System (PULARIS)

Previous forward fall simulation methods have provided good kinematic and kinetic data, but are limited in that they have started the falls from a stationary position and have primarily simulated uni-directional motion. Therefore, a novel Propelled Upper Limb fall ARest Impact System (PULARIS) was designed to address these issues during assessments of a variety of fall scenarios. The purpose of this study was to present PULARIS and evaluate its ability to impact the upper extremities of participants with repeatable velocities, hand forces and hip angles in postures and with vertical and horizontal motion consistent with forward fall arrest. PULARIS consists of four steel tubing crossbars in a scissor-like arrangement that ride on metal trolleys within c-channel tracks in the ceiling. Participants are suspended beneath PULARIS by the legs and torso in a prone position and propelled horizontally via a motor and chain drive until they are quick released, and then impact floor-mounted force platforms with both hands. PULARIS velocity, hip angles and velocities and impact hand forces of ten participants (five male, five female) were collected during three fall types (straight-arm, self-selected and bent-arm) and two fall heights (0.05 m and 0.10 m) to assess the reliability of the impact conditions provided by the system. PULARIS and participant hip velocities were found to be quite repeatable (mean ICC = 0.81) with small between trial errors (mean = 0.03 m/s). The ratio of horizontal to vertical hip velocity components (∼0.75) agreed well with previously reported data (0.70-0.80). Peak vertical hand impact forces were also found to be relatively consistent between trials with a mean ICC of 0.73 and mean between trial error of 13.4 N. Up to 83% of the horizontal hand impact forces displayed good to excellent reliability (ICC > 0.6) with small between trial differences. Finally, the ICCs for between trial hip angles were all classified as good to excellent. Overall, PULARIS is a reliable method and is appropriate for studying the response of the distal upper extremity to impact loading during non-stationary, multi-directional movements indicative of a forward fall. This system performed well at different fall heights, and allows for a variety of upper and lower extremity, and hip postures to be tested successfully in different landing scenarios consistent with elderly and sport-related falls.

Swing limb mechanics and minimum toe clearance in people with knee osteoarthritis

OBJECTIVE

Knee osteoarthritis (OA) has been shown to be a risk factor for falls. Reductions in foot clearance during the swing phase of walking can cause a trip and potentially lead to a fall. This study examined the swing phase mechanics of people with and without knee OA during walking.

DESIGN

Minimum toe clearance (MTC) height, joint angles at the time of MTC and the influence of the angular changes of the hip, knee and ankle of the swing leg on foot clearance using sensitivity analysis were investigated in 50 knee OA participants and 28 age-matched asymptomatic controls.

RESULTS

Although both groups had a similar MTC height (controls: 12.8±6.7 mm, knee OA: 13.4±7.0 mm), the knee OA group used a different strategy to achieve the same foot clearance, as evidenced by greater knee flexion (52.5±5.3° vs 49.4±4.8°, p=0.007), greater hip abduction (-3.6±3.3° vs -1.8±3.3°, p=0.03) and less ankle adduction (2.8±1.9° vs 4.2±2.1°, p=0.01).

CONCLUSION

MTC height was comparable between the groups, however a different swing phase mechanism was used by the knee OA. Although adequate MTC is an important component of safe locomotion, it does not appear to be impaired in people with knee OA. Other factors, such as inadequate responses to postural perturbation, may be responsible for falls in this group.

Stability of gait and interlimb coordination in older adults

Most falls in older adults occur when walking, specifically following a trip. This study investigated the short- and longer term responses of young (n = 24, 27.6 ± 4.5 yr) and older adults (n = 18, 69.1 ± 4.2 yr) to a trip during gait at comfortable speed and the role of interlimb coordination in recovery from tripping. Subjects walked on a self-paced treadmill when forward movement of their dominant leg was unexpectedly arrested for 250 ms. Recovery of center of mass (COM) movements and of double-support duration following perturbation was determined. In addition, the disruption and recovery of interlimb coordination of the arms and legs was evaluated. Although young and older subjects used similar lower limb strategies in response to the trip, older adults had less stable COM movement patterns before perturbation, had longer transient destabilization (>25%) after perturbation, required more gait cycles to recover double-support duration (older, 3.48 ± 0.7 cycles; young, 2.88 ± 0.4 cycles), and had larger phase shifts that persisted after perturbation (older, -83° to -90°; young, -39° to -42°). Older adults also had larger disruptions to interlimb coordination of the arms and legs. The timing of the initial disruption in coordination was correlated with the disturbance in gait stability only in young adults. In older adults, greater initial COM instability was related to greater longer term arm incoordination. These results suggest a relationship between interlimb coordination and gait stability, which may be associated with fall risk in older adults. Reduced coordination and gait stability suggest a need for stability-related functional training even in high-functioning older adults.

Randomized controlled trial comparing tailoring methods of multimedia-based fall prevention education for community-dwelling older adults

OBJECTIVE

We attempted to determine whether multimedia fall prevention education using different instructional strategies increases older adults' knowledge of fall threats and their fall prevention behaviors.

METHOD

Fifty-three community-dwelling older adults were randomized to iwo educational groups or a control group. Multimedia-based educational interventions to increase fall threats knowledge and encourage fall prevention behaviors had two tailoring strategies: (1) improve content realism for individual learners (authenticity group) and (2) highlight program goals and benefits while using participants' content selections (motivation group). Knowledge was measured at baseline and 1-mo follow-up. Participants recorded prevention behaviors for 1 mo.

RESULTS

Intervention group participants showed greater knowledge gains and posttest knowledge than did control group participants. The motivation group engaged in more prevention behaviors over 1 mo than did the other groups.

CONCLUSION

Tailoring fall prevention education by addressing authenticity and motivation successfully improved fall threats knowledge. Combining motivational strategies with multimedia education increased the effectiveness of the intervention in encouraging fall prevention behaviors.

A qualitative review of balance and strength performance in healthy older adults: impact for testing and training

A continuously greying society is confronted with specific age-related health problems (e.g., increased fall incidence/injury rate) that threaten both the quality of life of fall-prone individuals as well as the long-term sustainability of the public health care system due to high treatment costs of fall-related injuries (e.g., femoral neck fracture). Thus, intense research efforts are needed from interdisciplinary fields (e.g., geriatrics, neurology, and exercise science) to (a) elucidate neuromuscular fall-risk factors, (b) develop and apply adequate fall-risk assessment tools that can be administered in clinical practice, and (c) develop and design effective intervention programs that have the potential to counteract a large number of fall-risk factors by ultimately reducing the number of falls in the healthy elderly. This paper makes an effort to present the above-raised research topics in order to provide clinicians, therapists, and practitioners with the current state-of-the-art information.

A review of balance and gait capacities in relation to falls in persons with intellectual disability

Limitations in mobility are common in persons with intellectual disabilities (ID). As balance and gait capacities are key aspects of mobility, the prevalence of balance and gait problems is also expected to be high in this population. The objective of this study was to critically review the available literature on balance and gait characteristics in persons with ID. Furthermore, the consequences of balance and gait problems in relation to falls were studied, as well as the trainability of balance and gait in persons with ID. The systematic literature search identified 48 articles to be included in this review. The literature consistently reports that balance and gait capacities are affected in persons with ID compared to their age-matched peers. These problems start at a young age and remain present during the entire lifespan of persons with ID, with a relatively early occurrence of age-related decline. From these results a conceptual model was suggested in which the development of balance and gait capacities in the ID population across the life span are compared to the general population. Regarding the second objective, our review showed that, although the relationship of balance and gait problems with falls has not yet been thoroughly investigated in persons with ID, there is some preliminary evidence that these aspects are also important in the ID population. Finally, this review demonstrates that balance and gait are potentially trainable in persons with ID. These results suggest that falls might be prevented with ID-specific exercise interventions.

Fatores associados a quedas em idosos residentes em um bairro de Fortaleza, Ceará

A queda é uma das consequências mais graves do envelhecimento, sendo reconhecida como importante problema de saúde pública. A pesquisa teve como objetivo investigar aspectos relacionados à ocorrência de quedas em idosos. Participaram do estudo 50 idosos, do bairro Cidade 2000, em Fortaleza-CE, sendo 64% do gênero feminino. Para a coleta de dados foi utilizado um questionário. Observou-se que 42% dos idosos apresentaram, no mínimo, um episódio de queda nos últimos dois anos, dos quais 19% se encontravam entre 60 e 69 anos, 24% entre 70 e 79 anos e 57% entre 80 e 89 anos. As causas foram principalmente relacionadas ao ambiente doméstico inadequado (57%). Dentre os fatores relacionados ao ambiente doméstico que favorecem as quedas, o mais citado foi a existência de superfícies escorregadias (33%). A maioria dos participantes (80%) fazia uso de algum tipo de medicação prescrita por médicos, sendo os anti-hipertensivos utilizados por 42% do grupo. A consequência mais comum das quedas foi a fratura, indicada por 43% dos idosos, tendo sido mais frequente a fratura de rádio (56%). Outras consequências citadas foram trauma craniano (19%), depressão (19%) e ansiedade (19%). Necessitaram de internação hospitalar 33% dos idosos vítimas de quedas. A pesquisa aponta que 60% do grupo praticam atividade física regular e, dentre os sedentários, encontravam-se 90% dos idosos que haviam sido acometidos por quedas. Conclui-se que as quedas podem ser entendidas como eventos que podem, em parte, ser evitados através da adoção de programas e medidas preventivas simples.

Falls in multiple sclerosis

OBJECTIVE

To examine incidence, associated factors, and health care provider (HCP) response to falls in persons with multiple sclerosis (MS).

DESIGN

Cross-sectional retrospective design.

SETTING

Community setting.

PARTICIPANTS

Four hundred seventy-four persons with MS.

METHODS

Mailed survey questionnaire examined incidence, risk factors, and HCP response to falls in persons with MS who were dwelling in the community. Univariate and multiple ordinal regression analysis identified variables associated with single and multiple falls.

MAIN OUTCOME MEASUREMENTS

Falls, causes and perceived reasons for falls, and HCP response.

RESULTS

A total of 265 participants (58.2%) reported one or more falls in the previous 6 months, and 58.5% of falls were medically injurious. Trips/slips while walking accounted for 48% of falls. Factors associated with falls included use of a cane or walker (odds ratio [OR] 2.62; 95% confidence interval [CI] 1.66-4.14), income <$25,000 (OR 1.85; 95% CI 1.13-3.04), balance problems (OR 1.28; 95% CI 1.11-1.49), and leg weakness (OR 1.26; 95% CI 1.09-1.46). Fifty-one percent of those who fell (135/265) reported speaking to an HCP about their falls; recommended strategies included safety strategies (53.2%), use of gait assistive devices (42.1%), exercise/balance training (22.2%), and home modifications (16.6%).

CONCLUSIONS

Factors associated with falls in persons with MS are similar to those in other populations with neurologic diseases. Despite the high incidence of falls, fewer than 50% of people with MS receive information about prevention of falls from an HCP.

Kinematic measures for assessing gait stability in elderly individuals: a systematic review

Falls not only present a considerable health threat, but the resulting treatment and loss of working days also place a heavy economic burden on society. Gait instability is a major fall risk factor, particularly in geriatric patients, and walking is one of the most frequent dynamic activities of daily living. To allow preventive strategies to become effective, it is therefore imperative to identify individuals with an unstable gait. Assessment of dynamic stability and gait variability via biomechanical measures of foot kinematics provides a viable option for quantitative evaluation of gait stability, but the ability of these methods to predict falls has generally not been assessed. Although various methods for assessing gait stability exist, their sensitivity and applicability in a clinical setting, as well as their cost-effectiveness, need verification. The objective of this systematic review was therefore to evaluate the sensitivity of biomechanical measures that quantify gait stability among elderly individuals and to evaluate the cost of measurement instrumentation required for application in a clinical setting. To assess gait stability, a comparative effect size (Cohen's d) analysis of variability and dynamic stability of foot trajectories during level walking was performed on 29 of an initial yield of 9889 articles from four electronic databases. The results of this survey demonstrate that linear variability of temporal measures of swing and stance was most capable of distinguishing between fallers and non-fallers, whereas step width and stride velocity prove more capable of discriminating between old versus young (OY) adults. In addition, while orbital stability measures (Floquet multipliers) applied to gait have been shown to distinguish between both elderly fallers and non-fallers as well as between young and old adults, local stability measures (λs) have been able to distinguish between young and old adults. Both linear and nonlinear measures of foot time series during gait seem to hold predictive ability in distinguishing healthy from fall-prone elderly adults. In conclusion, biomechanical measurements offer promise for identifying individuals at risk of falling and can be obtained with relatively low-cost tools. Incorporation of the most promising measures in combined retrospective and prospective studies for understanding fall risk and designing preventive strategies is warranted.

Balance assessment practices and use of standardized balance measures among Ontario physical therapists

BACKGROUND

Balance impairment is a significant problem for older adults, as it can influence daily functioning. Treating balance impairment in this population is a major focus of physical therapist practice.

OBJECTIVE

The purpose of this study was to document current practices in clinical balance assessment and compare components of balance assessed and measures used across practice areas among physical therapists.

DESIGN

This was a cross-sectional study.

METHODS

A survey questionnaire was mailed to 1,000 practicing physical therapists in Ontario, Canada.

RESULTS

Three hundred sixty-nine individuals completed the survey questionnaire. More than 80% of respondents reported that they regularly (more than 60% of the time) assessed postural alignment, static and dynamic stability, functional balance, and underlying motor systems. Underlying sensory systems, cognitive contributions to balance, and reactive control were regularly assessed by 59.6%, 55.0%, and 41.2% of the respondents, respectively. The standardized measures regularly used by the most respondents were the single-leg stance test (79.1%), the Berg Balance Scale (45.0%), and the Timed "Up & Go" Test (27.6%). There was considerable variation in the components of balance assessed and measures used by respondents treating individuals in the orthopedic, neurologic, geriatric, and general rehabilitation populations.

LIMITATIONS

The survey provides quantitative data about what is done to assess balance, but does not explain the factors influencing current practice.

CONCLUSIONS

Many important components of balance and standardized measures are regularly used by physical therapists to assess balance. Further research, however, is needed to understand the factors contributing to the relatively lower rates of assessing reactive control, the component of balance most directly responsible for avoiding a fall.

The discriminant capabilities of stability measures, trunk kinematics, and step kinematics in classifying successful and failed compensatory stepping responses by young adults

This study evaluated the discriminant capability of stability measures, trunk kinematics, and step kinematics to classify successful and failed compensatory stepping responses. In addition, the shared variance between stability measures, step kinematics, and trunk kinematics is reported. The stability measures included the anteroposterior distance (d) between the body center of mass and the stepping limb toe, the margin of stability (MOS), as well as time-to-boundary considering velocity (TTB(v)), velocity and acceleration (TTB(a)), and MOS (TTB(MOS)). Kinematic measures included trunk flexion angle and angular velocity, step length, and the time after disturbance onset of recovery step completion. Fourteen young adults stood on a treadmill that delivered surface accelerations necessitating multiple forward compensatory steps. Thirteen subjects fell from an initial disturbance, but recovered from a second, identical disturbance. Trunk flexion velocity at completion of the first recovery step and trunk flexion angle at completion of the second step had the greatest overall classification of all measures (92.3%). TTB(v) and TTB(a) at completion of both steps had the greatest classification accuracy of all stability measures (80.8%). The length of the first recovery step (r ≤ 0.70) and trunk flexion angle at completion of the second recovery step (r ≤ -0.54) had the largest correlations with stability measures. Although TTB(v) and TTB(a) demonstrated somewhat smaller discriminant capabilities than trunk kinematics, the small correlations between these stability measures and trunk kinematics (|r| ≤ 0.52) suggest that they reflect two important, yet different, aspects of a compensatory stepping response.

Living with falls: house-bound older people's experiences of health and community care

Despite world-wide emphasis on falls prevention, falls and their consequences remain a major health issue for older people, and their health care providers. Many systematic reviews have been undertaken to evaluate the impact of intervention programmes on falls reduction, however, relatively little research provides a voice for older people's own perceptions of such programmes. To readdress this imbalance the current research utilized a purposive sampling method to recruit a hard to reach group of older people who had received a post-fall health and social-care programme to investigate their experiences of the programme. Semi-structured interviews with eight housebound people aged over 65 who had fallen were undertaken, and data analysed using interpretative phenomenological analysis. Four themes were identified: losing independence; losing confidence; losing social identity; managing a changed self. Despite a tailored intervention programme minimal improvement in participants' psychological adjustment to falls was noted. Outcomes from this study are of interest to health and social-care staff who deliver falls prevention programmes. Staff need to enhance constructive adjustment to the older person's altered circumstances and ensure behaviours do not exacerbate their clients' loss of independence. This should assist older people's ability to positively manage their sense of self, allowing them to find continuing meaning in their daily lives.

Effects of ramp negotiation, paving type and shoe sole geometry on toe clearance in young adults

Trips are a major cause of falls and result from involuntary contact of the foot with the ground during the swing phase of gait. Adequate toe clearance during swing is therefore crucial for safe locomotion. To date, little is known about the effects of environmental factors and footwear on toe clearance. This study reports on modulation of toe clearance and toe clearance variability in response to changes in ground inclination, paving type, and shoe sole geometry. Toe clearance and toe clearance variability for ten healthy young adults were calculated two-fold: a) for the commonly-used position on the foremost part of the sole of the shoe and b) for the lowest of a total of 7 sole positions, located between the metatarsals and the toe tip across the entire width of the sole. Utilizing a full-factorial design we found that toe clearance was affected by ground inclination, paving type, and sole geometry regardless of the computational method used (with p-values<0.01) but the use of the foremost part of the sole for toe clearance calculation results is an overestimation of this value. Our findings highlight the importance of considering footwear and environmental factors when assessing the risk of tripping. Future work needs to investigate to which extent the same factors affect toe clearance in more vulnerable parts of the population.

Patterns of comorbidity in community-dwelling older people hospitalised for fall-related injury: a cluster analysis

BACKGROUND

Community-dwelling older people aged 65+ years sustain falls frequently; these can result in physical injuries necessitating medical attention including emergency department care and hospitalisation. Certain health conditions and impairments have been shown to contribute independently to the risk of falling or experiencing a fall injury, suggesting that individuals with these conditions or impairments should be the focus of falls prevention. Since older people commonly have multiple conditions/impairments, knowledge about which conditions/impairments coexist in at-risk individuals would be valuable in the implementation of a targeted prevention approach. The objective of this study was therefore to examine the prevalence and patterns of comorbidity in this population group.

METHODS

We analysed hospitalisation data from Victoria, Australia's second most populous state, to estimate the prevalence of comorbidity in patients hospitalised at least once between 2005-6 and 2007-8 for treatment of acute fall-related injuries. In patients with two or more comorbid conditions (multicomorbidity) we used an agglomerative hierarchical clustering method to cluster comorbidity variables and identify constellations of conditions.

RESULTS

More than one in four patients had at least one comorbid condition and among patients with comorbidity one in three had multicomorbidity (range 2-7). The prevalence of comorbidity varied by gender, age group, ethnicity and injury type; it was also associated with a significant increase in the average cumulative length of stay per patient. The cluster analysis identified five distinct, biologically plausible clusters of comorbidity: cardiopulmonary/metabolic, neurological, sensory, stroke and cancer. The cardiopulmonary/metabolic cluster was the largest cluster among the clusters identified.

CONCLUSIONS

The consequences of comorbidity clustering in terms of falls and/or injury outcomes of hospitalised patients should be investigated by future studies. Our findings have particular relevance for falls prevention strategies, clinical practice and planning of follow-up services for these patients.

Influences of state anxiety on gaze behavior and stepping accuracy in older adults during adaptive locomotion

OBJECTIVES

Older adults deemed to be at a high risk of falling transfer their gaze from a stepping target earlier than their low-risk counterparts. The extent of premature gaze transfer increases with task complexity and is associated with a decline in stepping accuracy. This study tests the hypothesis that increased anxiety about upcoming obstacles is associated with (a) premature transfers of gaze toward obstacles (i.e., looking away from a target box prior to completing the step on it in order to fixate future constraints in the walkway) and (b) reduced stepping accuracy on the target in older adults.

METHODS

High-risk (9) and low-risk (8) older adult participants walked a 10-m pathway containing a stepping target area followed by various arrangements of obstacles, which varied with each trial. Anxiety, eye movements, and movement kinematics were measured.

RESULTS

Progressively increasing task complexity resulted in associated statistically significant increases in measures of anxiety, extent of early gaze transfer, and stepping inaccuracies in the high-risk group.

DISCUSSION

These results provide evidence that increased anxiety about environmental hazards is related to suboptimal visual sampling behavior which, in turn, negatively influences stepping performance, potentially contributing to increased falls risk in older adults.

Age-related striatal dopaminergic denervation and severity of a slip perturbation

BACKGROUND

Striatal dopamine activity declines with normal aging. Age-related striatal dopaminergic denervation (SDD) has been implicated in standing balance and unperturbed gait. The goal of this study was to analyze the association between the degree of SDD and the magnitude of an unexpected slip perturbation induced during gait.

METHODS

Fifty healthy participants aged 20-86 years old underwent dopamine transporter positron emission tomography to classify SDD severity as mild, moderate, or severe. Participants also walked on a floor that was unexpectedly contaminated with a glycerol solution for gait testing. The magnitude of a slip was quantified using the peak slip velocity (PSV), measured at the slipping foot. Data were analyzed for both fast (greater than 1.2 m/s) and slow walkers as gait speed correlated with slip severity. All data analyses were age adjusted.

RESULTS

Greater severity of dopaminergic denervation in the caudate nucleus was correlated with higher PSV (p < .01) but only in the fast speed walking group. The relationship between SDD in the putamen and slip severity was not statistically significant in fast and slow walkers.

CONCLUSIONS

Age-related SDD may impact the ability to recover from large perturbations during walking in individuals who typically walk fast. This effect, prominent in the caudate nucleus, may implicate a role of cognitive frontostriatal pathways in the executive control of gait when balance is challenged by large perturbations. Finally, a cautious gait behavior present in slow walkers may explain the apparent lack of involvement of striatal dopaminergic pathways in postural responses to slips.

Dynamic gait stability, clinical correlates, and prognosis of falls among community-dwelling older adults

OBJECTIVE

To establish an accurate measure for prognostic assessment of fall risk in community-dwelling older adults, this study examined the prediction accuracy of a dynamic gait stability measure and common clinical tests for slip-related falls among these adults.

DESIGN

Participants were tested for their fall-risk likelihood on a slip-test.

SETTING

Biomechanics research laboratory.

PARTICIPANTS

Community-dwelling older adults (N=119; ≥65y).

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Participants performed a battery of clinical tests, including Berg Balance Scale, Timed Up & Go (TUG) test, static posturography, isometric muscle strength, and bone density. They were then exposed to an unannounced slip during gait. The dynamic stability during unperturbed gait was measured based on the center of mass position and velocity relative to the limits of stability against backward falling. Accuracy of each measure was examined for prediction of slip outcome (fall or recovery).

RESULTS

On the slip, 59 participants fell, 56 recovered their balance, and 4 were harness-assisted. Dynamic stability predicted fall outcome with 69% accuracy. Except for TUG and bone density, no other measure could differentiate fallers from nonfallers; TUG predicted 56% of fall outcomes.

CONCLUSIONS

Reproduction of actual falls provides a new benchmark for evaluating the prognostic power of different performance-based assessment tools. The TUG was able to better predict fall outcome than other clinical measures; however, the new dynamic gait stability measure was more sensitive than TUG in its prediction of falls. Ultrasound bone scan could be used to screen older adults for fall risk.

High yield research opportunities in geriatric emergency medicine: prehospital care, delirium, adverse drug events, and falls

Emergency services constitute crucial and frequently used safety nets for older persons, an emergency visit by a senior very often indicates high vulnerability for functional decline and death, and interventions via the emergency system have significant opportunities to change the clinical course of older patients who require its services. However, the evidence base for widespread employment of emergency system-based interventions is lacking. In this article, we review the evidence and offer crucial research questions to capitalize on the opportunity to optimize health trajectories of older persons seeking emergency care in four areas: prehospital care, delirium, adverse drug events, and falls.

Consequências das quedas em idosos vivendo na comunidade

As quedas em idosos são um problema frequente, com importantes consequências físicas, psicológicas e sociais. O objetivo deste estudo foi realizar uma revisão sistematizada da literatura sobre as consequências das quedas em idosos vivendo na comunidade. A busca foi realizada entre junho a outubro de 2008 nas bases de dados eletrônicas Medline, Lilacs, PEDro e SciELO. Apenas artigos em inglês, português e espanhol foram considerados para esta revisão. Foram identificados inicialmente 114 artigos potencialmente relevantes. Após análise do título e dos resumos, considerando-se critérios de inclusão e exclusão predeterminados, foram selecionados para esta revisão dez artigos. Foram identificadas as seguintes consequências: fraturas, imobilização, lesões de tecidos moles, contusões, entorses, feridas e abrasões, lesões musculares e neurológicas, surgimento de outras doenças, dor, declínio funcional e da atividade física, atendimento médico, hospitalização, reabilitação, medo de cair, abandono de atividades, tristeza, mudança na vida/comportamentos, sentimento de impotência, declínio em atividade social, perda de autonomia e da independência, mudança de domicílio/ ambiente, rearranjo familiar e morte. As fraturas e o medo de uma nova queda ficaram dentre as consequências mais citadas. O conhecimento das consequências físicas, psicológicas e sociais das quedas em idosos é de extrema importância, pois ele auxiliará no delineamento das estratégias preventivas e de reabilitação de tais repercussões.

Prevalence and Risk Factors for Falls Among the Elderly in Primary Healthcare Centers (PHC) in Qatar

Falling is the primary cause of accidental death in those aged 65 years and above. To determine the prevalence and risk factors for falls among the elderly in Qatar a cross-sectional study was made to 355 elderly persons attending 12 of the Primary Health Centers in Qatar. A questionnaire elicited socio-demographic data, and histories of falls in the previous 1 2 months, chronic disease, medication, and functional disabilities affecting daily life. One hundred and nineteen (34%) had fallen in the previous 12 months, half of it happened more than once, mostly inside the house, although most (87.6%) were still independent with little effect upon daily activities; women fell more than men; Qataris more than non-Qataris; there were significantly more falls in married and illiterate persons. Living alone was not a significant factor but those using walking aids and/ or not exercising were at significant risk. Some chronic diseases were significant, others not, and some medications showed a significant relationship. Environmental risk factors did not appear to be significant. This study makes some recommendations to reduce the frequency of falls in elderly persons. An extensive bibliography is appended. Key words: Elderly, Falls, PHC

Testing the sensitivity, specificity and feasibility of four falls risk assessment tools in a clinical setting

AIM

This paper reports on a study undertaken to test the sensitivity, specificity and feasibility of four fall risk assessment tools.

BACKGROUND

Falls risk assessment tools have been developed based on literature and findings from empirical studies, but the instruments often lack further testing in the clinical setting.

METHOD

Four falls risk assessment tools were tested simultaneously in this study. The data was collected in May-June 2006. All assessment tools were completed on a total of 1546 patients. Descriptive statistics were used for data analysis.

RESULTS

The use of the instruments was moderately consistent among registered nurses, but the education provided did not entirely eliminate problems with accuracy. The sensitivity of the instruments was 57.1-100% and specificity was 24.9-69.3%.

CONCLUSION

The sensitivity and specificity of the instruments are important factors to consider when choosing an instrument. However, the strategies to educate staff and to intervene appropriately are equally important for an organization undertaking a proactive stance in mitigating the risk of falls.

IMPLICATIONS FOR NURSING MANAGEMENT

It is important for managers to test instruments in their own organizations and specific populations. It is also critical to carefully assess that the chosen instrument is easy and accurate in use.

Using canonical commonality analysis to examine the predictive quality of aging and falls efficacy on balance functioning in older adults

PURPOSE

The effects of important variables measuring the psychobiological aspects of falls among older adults were considered to determine their utility in predicting balance functioning among older adults. To partition the effects of aging and falls efficacy on balance and leg strength simultaneously, canonical commonality analysis (CCA) was used.

METHODS

CCA is a multivariate technique which decomposes squared semipartial correlation effect sizes into constituent, nonoverlapping segments that describe unique and common explanatory powers of predictor variables. Data from a study conducted to examine the psychobiological and aging influences on unintended falls among physically active older adults were analyzed.

FINDINGS

CCA showed balance confidence as measured by the Activities-Specific Balance Confidence Scale (ABC) and age to be noteworthy predictors of balance; yet, age was determined to be more important than balance confidence when predicting balance and leg strength (i.e., balance functioning) simultaneously. In addition, results suggest that data obtained from the ABC better predicted balance functioning among active older adults as compared to the Tinetti Falls Efficacy Scale (FES), a traditional measure used to assess the construct.

CONCLUSION

The ABC stands as a viable alternative to consider when assessing falls efficacy among dynamic older adults. Future research would benefit from using CCA to understand how various psychobiological constructs predict fall-related outcomes.

Age-related differences in locomotor targeting performance under structural interference

OBJECTIVE

to determine if there are age-related differences in locomotor targeting (LT) performance and step length (SL) regulatory behaviour under structural interference.

METHODS

forty older (n = 20, mean age = 77.9) and younger (n = 20, mean age = 25.2) participants walked 11.6 m while stepping on a target positioned at the 9.5 m point. Participants completed seven trials under each of three conditions, including the control (C) (no structural interference), low structural interference (L) and high structural interference (H). The structural interference conditions required participants to engage in LT while simultaneously verbally identifying letters that were visually presented on one of two monitors. One monitor was located near the target (low interference), while the other monitor was elevated to require participants to direct their gaze further away from the target to identify a letter (high interference). Outcome measures included LT error, SL, SL variability and the distribution of SL adjustment.

RESULTS

structural interference had a detrimental effect on the LT accuracy of the older group (2.75 cm mean increase in absolute error) but not on the younger group (1.05 cm mean increase in absolute error), even though the interference caused the older group alone to adopt a more conservative gait pattern involving shorter SLs. The older participants exhibited shorter mean SL with each increase in structural interference (conditions C vs. L, P = 0.004; conditions L vs. H, P = 0.050), whereas the younger participants' mean SL did not differ across conditions. The manner in which older and younger participants distributed SL adjustment across the steps in advance of the target did not differ.

CONCLUSIONS

the results confirmed that LT demands more attention from older adults than it does from younger adults, and revealed that a consequence of this age difference is a decline in LT accuracy among older adults. The study implicates age-related impaired visual attention switching as a potential source of impaired walking performance among older adults.

Effect of stroke on fall rate, location and predictors: a prospective comparison of older adults with and without stroke

Background

The literature suggests that stroke is a major risk factor for falls, but there is a lack of prospective, controlled studies which quantify fall-risk after stroke. The purpose of this study was to compare the rates, location and predictors among individuals recently discharged home from stroke rehabilitation to age and sex matched controls.

Methodology/Principal Findings

A sample of 80 people with stroke and 90 controls received baseline assessments of balance, mobility and balance confidence. Falls were recorded prospectively over 13 months for both groups. Group differences in fall rates and contribution of clinical measures to falls were determined using negative binomial regression. Fall location was compared between groups using χ² statistics. The rate of falls for individuals with stroke was 1.77 times the rate for the control group. People with stroke were more likely to fall at home. Poorer balance (Berg Balance Scale) was associated with greater falls for both stroke and control groups (incidence rate ratio [IRR]: 0.908 and IRR: 0.877 respectively). A faster Timed Up and Go Test was associated with greater falls for the stroke group (IRR: 0.955) while better walking endurance (Six Minute Walk Test) was associated with greater falls for the controls (IRR: 1.004). Balance confidence was not an independent predictor in either group.

Conclusions

Individuals recently discharged home are at greater risk of falling than individuals without stroke. Attention to home environment is warranted. Balance function can predict falls for both people with stroke and age and sex matched controls. Increased mobility may increase exposure to fall opportunities.