- Original article
- Open access
- Published:
Assessment of clinical and laboratory tests in predicting risks of fall in the elderly
The Egyptian Journal of Otolaryngology volume 28, pages 189–195 (2012)
En
Abstract
Introduction
Falls and unstable balance are multifactorial problems and rank high among serious clinical problems faced by the elderly. They are a cause of substantial rates of mortality and morbidity as unintentional injuries.
Aim of the work
The aim of the study was to explore the most common risk factors for falls in the elderly and to construct the most specific test battery including clinical and laboratory tests capable of determining risk for falls in the elderly.
Materials and methods
A 6-month prospective study was carried out on a sample of 30 elderly persons of age at least 60 years, reporting more than one fall within last 6 months. Detailed history on neuro-otological symptoms, previous falls, dizziness episodes, and symptoms of systemic disease or osteoarthritis was taken. Visual acuity, musculoskeletal examination, complete neurological examination, and a complete vestibular test battery in the form of the videonystagmography (VNG) test battery, vestibular-evoked myogenic potentials, and computerized dynamic posturography was performed. All participants underwent radiological diagnosis and grading of the osteoarthritic knee and hip. The mobility and gait screening protocol was used, which includes the timed up and go test (TUG), fall risk assessment screening tool (FRAST), and Dynamic Gait Index (DGI).
Results
Most patients suffered from peripheral vestibular dysfunction and the most frequent VNG abnormality was unilateral vestibular lesion. Radiological assessment of knee and hip osteoarthritis revealed 36.76% with grades II and III. Significant impairment of vision was found in 40% of the elderly. TUG test revealed high risk of falls in those elderly. In total, 20 participants revealed moderate or high risk for falls by FRAST. There was significant correlation between the number of falls and SOT tests (C5 and C6) together with adaptation tests reflecting vestibular pattern of dysfunction. Functional test of dynamic posturography revealed a highly significant correlation between limits of stability reaction time, movement velocity, and tandem of gait step and the number of falls. TUG showed a highly significant correlation in elderly people who experienced falls, whereas DGI showed only significant correlation and FRAST showed nonsignificant correlation. A highly significant correlation was found between SOT C5 and C6 scores and TUG and DGI with a weak correlation with FRAST. Vestibular-evoked myogenic potential asymmetry and unilateral canal paresis revealed nonsignificant results with all functional tests except DGI, which revealed a weak correlation with them. Analysis of variance test revealed that the vestibular dysfunction group is more vulnerable to falls than other groups.
Conclusion
The VNG test battery and computerized dynamic posturography in conjunction with stance tests in the elderly who complain of dizziness can identify those with high risk of a fall.
References
Rubenstein LZ. Falls in older people: epidemiology, risk factors and strategies for prevention. Age Ageing. 2006;35(Suppl 2):ii37–ii41
Rubenstein LZ, Josephson KR. The epidemiology of falls and syncope. Clin Geriatr Med. 2002; 18: 141–158
MacIntosh G, Joy J. Assessing falls in older people. Nurs Older People. 2007; 19: 33–36 quiz 37
Peeters GM, de Vries OJ, Elders PJ, Pluijm SM, Bouter LM, Lips P. Prevention of fall incidents in patients with a high risk of falling: design of a randomised controlled trial with an economic evaluation of the effect of multidisciplinary transmural care. BMC Geriatr. 2007; 7: 15
Oliver D, Daly F, Martin FC, McMurdo ME. Risk factors and risk assessment tools for falls in hospital in-patients: a systematic review. Age Ageing. 2004; 33: 122–130
Kellgren JH, Lawrence JS. Radiological assessment of rheumatoid arthritis. Ann Rheum Dis. 1957; 16: 485–493
Petersson IF, Boegård T, Saxne T, Silman AJ, Svensson B. Radiographic osteoarthritis of the knee classified by the Ahlback and Kellgren and Lawrence systems for the tibiofemoral joint in people aged 35–54 years with chronic knee pain. Ann Rheum Dis. 1997; 56: 493–496
Podsiadlo D, Richardson S. The timed ‘Up and Go’: a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc. 1991; 39: 142–148
Shumway Cook A, Baldwin M, Polissar NL, Gruber W. Predicting the probability for falls in community-dwelling older adults. Phys Ther. 1997;77:812–819
Woollacott MH, Tang PF. Balance control during walking in the older adult: research and its implications. Phys Ther. 1997; 77: 646–660
Harwood RH, Foss AJE, Osborn F, Gregson RM, Zaman A, Masud T. Falls and health status in elderly women following first eye cataract surgery: a randomised controlled trial. Br J Ophthalmol. 2005; 89: 53–59
Barak Y, Wagenaar RC, Holt KG. Gait characteristics of elderly people with a history of falls: a dynamic approach. Phys Ther. 2006; 86: 1501–1510
Tinetti ME. Clinical practice. Preventing falls in elderly persons. N Engl J Med. 2003; 348: 42–49
Murray KJ, Hill K, Phillips B, Waterston J. A pilot study of falls risk and vestibular dysfunction in older fallers presenting to hospital emergency departments. Disabil Rehabil. 2005; 27: 499–506
Jahn K, Zwergal A, Schniepp R. Gait disturbances in old age: classification, diagnosis and treatment from a neurological perspective. Dtsch Arztebl Int. 2010; 107: 306–315 quiz 316
Imbaud Genieys S. Vertigo, dizziness and falls in the elderly. Ann Otolaryngol Chir Cervicofac. 2007;124:189–196
Serrador JM, Lipsitz LA, Gopalakrishnan GS, Black FO, Wood SJ. Loss of otolith function with age is associated with increased postural sway measures. Neurosci Lett. 2009; 465: 10–15
Whitney SL, Marchetti GF, Morris LO, Sparto PJ. The reliability and validity of the four square step test for people with balance deficits secondary to a vestibular disorder. Arch Phys Med Rehabil. 2007; 88: 99–104
Ortuño Cortés MA, MartÃn Sanz E, Barona de Guzmán R. Value of dynamic postural control tests on elderly people with vestibulopathy. Acta Otorrinolaringol Esp. 2009;60:149–154
Graafmans WC, Ooms ME, Hofstee HMA, Bezemer PD, Bouter LM, Lips P. Falls in the elderly: a prospective study of risk factors and risk profiles. Am J Epidemiol. 1996; 143: 1129–1136
Lawlor DA, Patel R, Ebrahim S. Association between falls in elderly women and chronic diseases and drug use: cross sectional study. Br Med J. 2003; 327: 712–715
Hale LA, Waters D, Herbison P. A randomized controlled trial to investigate the effects of water-based exercise to improve falls risk and physical function in older adults with lower-extremity osteoarthritis. Arch Phys Med Rehabil. 2012; 93: 27–34
Lord SR, Smith ST, Menant JC. Vision and falls in older people: risk factors and intervention strategies. Clin Geriatr Med. 2010; 26: 569–581
Chew FLM, Yong CK, Mas Ayu S, Tajunisah I. The association between various visual function tests and low fragility hip fractures among the elderly: a Malaysian experience. Age Ageing. 2010; 39: 239–245
Whitney SL, Marchetti GF, Schade A, Wrisley DM. The sensitivity and specificity of the Timed ‘Up & Go’ and the Dynamic Gait Index for self-reported falls in persons with vestibular disorders. J Vestib Res. 2004; 14: 397–409
Bischoff HA, Stähelin HB, Monsch AU, Iversen MD, Weyh A, von Dechend M, et al. Identifying a cut–off point for normal mobility: a comparison of the timed ‘up and go’ test in community–dwelling and institutionalised elderly women. Age Ageing. 2003; 32: 315–320
Nordin E, Rosendahl E, Lundin Olsson L. Timed ‘Up & Go’ test: reliability in older people dependent in activities of daily living–focus on cognitive state. Phys Ther. 2006; 86: 646–655
Tromp AM, Pluijm SMF, Smit JH, Deeg DJH, Bouter LM, Lips P. Fall-risk screening test: a prospective study on predictors for falls in community-dwelling elderly. J Clin Epidemiol. 2001; 54: 837–844
González Ravé JM, Sánchez Gómez A, Santos GarcÃa DJ. Efficacy of two different stretch training programs (passive vs. proprioceptive neuromuscular facilitation) on shoulder and hip range of motion in older people. J Strength Cond Res. 2012;26:1045–1051
Girardi M, Konrad HR, Amin M, Hughes LF. Predicting fall risks in an elderly population: computer dynamic posturography versus electronystagmography test results. Laryngoscope. 2001; 111: 1528–1532
Whitney SL, Hudak MT, Marchetti GF. The dynamic gait index relates to self-reported fall history in individuals with vestibular dysfunction. J Vestib Res. 2000; 10: 99–105
Author information
Authors and Affiliations
Corresponding author
Additional information
Conflicts of interest
There are no conflicts of interest.
Rights and permissions
This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
About this article
Cite this article
Taha, H.M.O., Shafik, A.G. & Saber, N.Z. Assessment of clinical and laboratory tests in predicting risks of fall in the elderly. Egypt J Otolaryngol 28, 189–195 (2012). https://doi.org/10.7123/01.EJO.0000418007.87507.ca
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.7123/01.EJO.0000418007.87507.ca