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      The history of falls and the association of the timed up and go test to falls and near-falls in older adults with hip osteoarthritis

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      1 , , 2
      BMC Geriatrics
      BioMed Central

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          Abstract

          Background

          Falling accounts for a significant number of hospital and long-term care admissions in older adults. Many adults with the combination of advancing age and functional decline associated with lower extremity osteoarthritis (OA), are at an even greater risk. The purpose of this study was to describe fall and near-fall history, location, circumstances and injuries from falls in a community-dwelling population of adults over aged 65 with hip OA and to determine the ability of the timed up and go test (TUG) to classify fallers and near-fallers.

          Method

          A retrospective observational study of 106 older men and women with hip pain for six months or longer, meeting a clinical criteria for the presence of hip OA at one or both hips. An interview for fall and near-fall history and administration of the TUG were administered on one occasion.

          Results

          Forty-five percent of the sample had at least one fall in the past year, seventy-seven percent reported occasional or frequent near-falls. The majority of falls occurred during ambulation and ascending or descending steps. Forty percent experienced an injury from the fall. The TUG was not associated with history of falls, but was associated with near-falls. Higher TUG scores occurred for those who were older, less mobile, and with greater number of co-morbidities.

          Conclusion

          A high percentage of older adults with hip OA experience falls and near-falls which may be attributed to gait impairments related to hip OA. The TUG could be a useful screening instrument to predict those who have frequent near-falls, and thus might be useful in predicting risk of future falls in this population.

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          Most cited references41

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          Risk factors for falls among elderly persons living in the community.

          To study risk factors for falling, we conducted a one-year prospective investigation, using a sample of 336 persons at least 75 years of age who were living in the community. All subjects underwent detailed clinical evaluation, including standardized measures of mental status, strength, reflexes, balance, and gait; in addition, we inspected their homes for environmental hazards. Falls and their circumstances were identified during bimonthly telephone calls. During one year of follow-up, 108 subjects (32 percent) fell at least once; 24 percent of those who fell had serious injuries and 6 percent had fractures. Predisposing factors for falls were identified in linear-logistic models. The adjusted odds ratio for sedative use was 28.3; for cognitive impairment, 5.0; for disability of the lower extremities, 3.8; for palmomental reflex, 3.0; for abnormalities of balance and gait, 1.9; and for foot problems, 1.8; the lower bounds of the 95 percent confidence intervals were 1 or more for all variables. The risk of falling increased linearly with the number of risk factors, from 8 percent with none to 78 percent with four or more risk factors (P less than 0.0001). About 10 percent of the falls occurred during acute illness, 5 percent during hazardous activity, and 44 percent in the presence of environmental hazards. We conclude that falls among older persons living in the community are common and that a simple clinical assessment can identify the elderly persons who are at the greatest risk of falling.
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            Predicting the probability for falls in community-dwelling older adults using the Timed Up & Go Test.

            This study examined the sensitivity and specificity of the Timed Up & Go Test (TUG) under single-task versus dual-task conditions for identifying elderly individuals who are prone to falling. Fifteen older adults with no history of falls (mean age=78 years, SD=6, range=65-85) and 15 older adults with a history of 2 or more falls in the previous 6 months (mean age=86.2 years, SD=6, range=76-95) participated. Time taken to complete the TUG under 3 conditions (TUG, TUG with a subtraction task [TUGcognitive], and TUG while carrying a full cup of water [TUGmanual]) was measured. A multivariate analysis of variance and discriminant function and logistic regression analyses were performed. The TUG was found to be a sensitive (sensitivity=87%) and specific (specificity=87%) measure for identifying elderly individuals who are prone to falls. For both groups of older adults, simultaneous performance of an additional task increased the time taken to complete the TUG, with the greatest effect in the older adults with a history of falls. The TUG scores with or without an additional task (cognitive or manual) were equivalent with respect to identifying fallers and nonfallers. The results suggest that the TUG is a sensitive and specific measure for identifying community-dwelling adults who are at risk for falls. The ability to predict falls is not enhanced by adding a secondary task when performing the TUG.
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              Guideline for the prevention of falls in older persons. American Geriatrics Society, British Geriatrics Society, and American Academy of Orthopaedic Surgeons Panel on Falls Prevention.

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                Author and article information

                Journal
                BMC Geriatr
                BMC Geriatrics
                BioMed Central (London )
                1471-2318
                2007
                4 July 2007
                : 7
                : 17
                Affiliations
                [1 ]College of Kinesiology and School of Physical Therapy, University of Saskatchewan, Saskatoon, Canada
                [2 ]College of Kinesiology, University of Saskatchewan, Saskatoon, Canada
                Article
                1471-2318-7-17
                10.1186/1471-2318-7-17
                1936991
                17610735
                bcacf96a-91cb-4a0d-a7ad-e7ad66248785
                Copyright © 2007 Arnold and Faulkner; licensee BioMed Central Ltd.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 13 April 2007
                : 4 July 2007
                Categories
                Research Article

                Geriatric medicine
                Geriatric medicine

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