FallScreen: The physiological profile approach for assessing falls risk in older people

Causes of Falls Trip 39.7% Slip 13.2% Unsure 14.3% Weak legs 5.5% Balance 20.8% Dizzy 5.2% Faint 1%

Conceptual model  Physiological, rather than disease-oriented  Involves functional assessment of sensorimotor abilities  Assumes that many disease processes will be manifest in impaired performances in one or more tests  Cataracts – poor vision  Neuropathy – poor sensation  Prior-polio – weakness  Stroke – weakness, incoordination, instability

Test characteristics  Provide quantitative, objective measures  Simple to administer  Short administration time  Feasible for older people to undertake – no ceiling or floor effects  Valid and reliable measures  Low-tech, robust and transportable

Contrast sensitivity - MET Melbourne Edge Test

Proprioception

Lower Limb Strength

Reaction Time- Hand

Sway on floor and on foam

1. EYES OPEN (FLOOR) 4. EYES CLOSED (FOAM) 2. EYES CLOSED (FLOOR) 3. EYES OPEN (FOAM) Example of body sway under four conditions

PPA Short form  Significant and independent predictors Coefficients  Visual contrast sensitivity  Proprioception 0.20  Quadriceps strength  Simple reaction time 0.47  Postural sway on the compliant surface 0.51  Percentage of subjects correctly classified: 75%.

Validation in multiple studies  Intermediate care residents (n=95 + n=70)  Randwick Falls and Fractures Study (n=341)  Dubbo Osteoporosis Epidemiology Study (n=1750)  Injurious falls study (n=100)  Prevention of Older People Injuries study (n=600)  Prospective validation over 1 year

FallScreen  Web-based physiological falls risk calculator  (FallScreen page)  Secure encoded transmission  De-identified data held on University of NSW server

Screening and assessment

Falls and Balance Research Group Prince of Wales Medical Research Institute Barker St, Randwick NSW 2031 Ph. (02) fax. (02)

Evaluating efficacy of interventions

Better Bones and Balance Study - 6 mth results  47.5%  57.3% Significant reductions in fall risk with Resistance & Agility Training. N = 98 Mean Age = 79 Liu-Ambrose et al, J Am Geriatr Soc, 2004

Falls risk score 79 yrs falls risk score normal population Resistance Training

Conclusions Physiological risk factors  Tests of vision, sensation, strength, speed and balance can accurately predict older people at risk of falls  Physiological profiles provide information about the causes of falls on an individual basis and provide information about potential intervention strategies Interventions  Increasing evidence that falls can be prevented  Effectiveness may be maximized if interventions are targeted and tailored to at-risk groups