Self-report of missteps in older adults: a valid proxy of fall risk?

Jennifer M Srygley, Talia Herman, Nir Giladi, Jeffrey M Hausdorff
Archives of Physical Medicine and Rehabilitation 2009, 90 (5): 786-92

OBJECTIVE: To evaluate the relationship between missteps and falls and to identify factors associated with missteps, potentially to generate a broader picture of fall risk.

DESIGN: Prospective, observational cohort.

SETTING: General community.

PARTICIPANTS: A sample of healthy, community-living older adults (N=266; age, 70-90y) who were cognitively intact and walked independently.

INTERVENTIONS: Not applicable.

MAIN OUTCOME MEASURES: Baseline testing of gait, motor function, cognitive function, affect, and balance confidence was followed by a 12-month period in which subjects completed a daily log documenting the number of falls and missteps (defined as a trip, slip, or other loss of balance in which recovery occurred to prevent a fall).

RESULTS: Mean +/- SD participant age was 76.4+/-4.3 years. Of all the participants, 20.7% reported at least 1 misstep, and 25.6% of the participants reported at least 1 fall during the 12 months. Among subjects who had multiple falls, missteps were more common than falls by a ratio of 3:1 (P<.001). Subjects who reported multiple missteps were more likely to fall prospectively (relative risk=3.89). Missteps were associated with higher scores on the Geriatric Depression Scale (P=.009) and increased anxiety (P=.014), but were not associated with other known risk factors for falls, including gait and cognitive function.

CONCLUSIONS: The self-report of missteps may be a valuable tool in the research of falls and fall risk and may provide a way to identify patients at risk for falls before they fall.

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