Embargoed until May 11, 2001
Contact: Kenneth S. Satterfield760-776-8502 (5/11-5/16) 703- 519-1563[email protected]
Balance Testing Is a Valuable Aid in Identifying Elderly At-Risk of Multiple Falls
No single illness or vestibular disorder is linked to an increased likelihood of falls
Palm Desert, CA -- Each year, it is estimated that 25-35 percent of healthy adults, 65 to 75 years old, report a significant fall. This rate rises to 35-42 percent of those individuals over age 75. Falling is currently the single leading cause of accidental death and disability in the US population over age 65, and fall-related injuries result in annual health care costs that exceed $20 billion dollars. As the population ages, falls will become a greater public health concern as fall-related morbidity, mortality, and expenses increase. Medical expenditures are only one consequence of falling. Additional health care related issues include pain, disability, lawsuits, impact on other family members, and deterioration of the patientâs general well being.
Falls have multiple causes, and those who fall have multiple risk factors, which increase the likelihood of falling. The first step in preventing falls is to determine which individuals are at higher risk of falling. A thorough history and physical examination as well as ancillary testing are important in the identification of elderly individuals at increased risk of falling. This study was designed to determine which elements of a patientâs history, physical examination, and ancillary testing correlated highest with a risk of falls.
The authors of the study, Medical Profile of a Group of Elderly Fallers, are Marian Girardi, MA, Horst R. Konrad, MD, and Larry F. Hughes, PhD, from the Division of Otolaryngology, Department of Surgery, Southern Illinois University School of Medicine, Springfield, Illinois; and Manali Amin, MD, Lynette Hock, MA, and Kathryn Jones, MS, PT, from the Department of Otolaryngology, University of Nebraska Medical Center, Omaha, NE. Their findings were presented May 12, 2001, at the spring meeting of the American Otological Society, being held in Palm Desert, CA.
Methodology: Patients were recruited from the Southern Illinois University School of Medicine (SIU-SOM)/St. Johnâs Hospital Balance Disorders and Falls Prevention Clinic. All patients seen in the clinic between July 1999 and June 2000 who were at least 65 years of age and reported at least one significant fall in the previous 12 months were included in the study.
Following history and physical examination, all subjects underwent computerized dynamic posturography (or CDP, used to test balance control in situations intended to isolate the factors that affect balance in everyday experience). In addition, each received a comprehensive physical therapy assessment including the Tinetti Balance and Mobility Assessment and the Berg Balance Scale. Finally, patients were further assessed with electronystagmography (ENG) and underwent limits of stability (LOS) testing. Patients taking medications known to suppress vestibular or CNS function (i.e. antihistamines, anxiolytics, narcotics, some anti-depressants, etc.) were excluded from the study. All patients were asked to refrain from use of alcohol or caffeine 48 hours prior to ENG testing.
The data obtained was divided into three groups: diagnostic tests (ENG and CDP parameters), functional measurements (Tinetti and Berg Assessments), and comorbidities (different medical diagnoses and number of prescription and non-prescription medications.Results: Thirty-six patients met the inclusion criteria of age 65 or greater and one or more significant falls in the year prior to presentation at the clinic. The age of patients ranged from 65 years to 96 years and included 13 men and 23 women. The number of significant falls, as defined by at least one knee and/or both hands hitting the ground, ranged from one to 20 with a median of two.
The mean number of medications taken by these patients was 5.8 for prescriptions and 1.6 for over-the-counter drugs. Computer Dynamic Posturography was the most sensitive of the items examined with 83.3 percent of the elderly fallers demonstrating abnormal results. The Tinetti and Berg assessments ranked next with 63.9 percent patients having sub-threshold scores for both tests. ENG results were significantly abnormal for 55.6 percent of the patients. Other medical factors, ranked in decreasing order were: musculo-skeletal complaints 69.4 percent; cardiovascular problems 61.1 percent; hypertension 58.3 percent; hearing loss, anxiety and depression, each 44.4 percent; vision difficulty 36.1 percent; tinnitus 30.6 percent; cancer and closed head trauma, each 16.7 percent; panic attacks 13.9 percent; diabetes and stroke, each 11.1 percent; and knee replacement surgery 8.3 percent.
Comorbidities were analyzed. Cardiovascular disease, hypertension, arthritis and panic attacks were assessed. None of these diseases were associated with multiple falls. The relative risks of cancer and knee surgery for falls could not be assessed due to zero cancer patients reporting one fall and zero patients with multiple falls reporting knee surgery.
Abnormal limits of stability scores solely were associated with multiple falls. Individuals with an abnormal LOS score were 13.5 times more likely to sustain multiple falls.
Conclusions: The study has shown that diagnostic tests such as the Limits of Stability posturography subtest and functional tests such as the Tinetti Gait test appear to be useful in identifying individuals at risk for falling. Of particular importance, the study also shows that ENG abnormalities do not necessarily correlate with an increased risk of falling. Not all fallers have vestibular dysfunction, and not all patients with vestibular abnormalities are at risk of falling. Furthermore, while disease processes may exacerbate balance dysfunction, no single diagnosis is in and of itself a strong predictor of falls.
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