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Postural stability, falls and fractures in the elderly: results from the Dubbo Osteoporosis Epidemiology Study.

Lord SR, Sambrook PN, Gilbert C, Kelly PJ, Nguyen T, Webster IW, Eisman JA

To assess measures of postural stability in a large population of persons aged over 60 years in order to compare performance between fallers and non-fallers and relate postural stability to fracture prevalence. Tests of postural stability can identify, independently of age, individuals living in the community who are at risk of falls and fall-related fractures.

Physiological factors associated with falls in older community-dwelling women.

Lord SR, Ward JA, Williams P, Anstey KJ

To determine the prevalence of impaired vision, peripheral sensation, lower limb muscle strength, reaction time, and balance in a large community-dwelling population of women aged 65 years and over, and to determine whether impaired performances in these tests are associated with falls. These findings support previous results conducted in retirement village and institutional setting and indicate that the test procedure aids in the identification of older community-dwelling women at risk of falls.

Simple physiological and clinical tests for the accurate prediction of falling in older people.

Lord SR, Clark RD

A 1-year prospective study was conducted in an intermediate care institution to determine whether a combined assessment of physiological and clinical measures discriminates between elderly fallers and elderly nonfallers. Seventy persons aged between 72 and 96 years (mean 85.6), who were generally independent in activities of daily living, took part in the study, and 66 were available to follow-up. In the follow-up year, 24 subjects experienced no falls, 20 subjects fell one time only and 22 residents fell on two or more occasions. Discriminant analysis identified reaction time, body sway, quadriceps strength, tactile sensitivity, gait impairment, cognitive impairment, psychoactive drug use and age as the variables that significantly discriminated between subjects who experienced falls and those who did not. This procedure correctly classified 86% of subjects into faller and nonfaller groups. These findings suggest that an assessment that combines physiological and clinical factors provides excellent discrimination between elderly fallers and nonfallers.

Physiological factors associated with injurious falls in older people living in the community.

Lord SR, McLean D, Stathers G

Performance in six tests of sensorimotor function was measured in 50 subjects who were admitted to an acute hospital because of a fall (ICD codes E880-888), but who did not suffer a fracture of the lower limbs as a result. Performances in these tests were compared with 50 subjects of the same age and sex who had not fallen in the previous 12 months. It was found that those admitted to hospital because of a fall had decreased tactile sensation, reduced quadriceps strength and increased body sway on firm and compliant surfaces. The fallers also performed poorly in clinical tests of static and dynamic balance. Psychoactive-drug use was associated with falling and a number of test measures, including body sway, static balance, dynamic balance and quadriceps strength. Twenty-seven percent of fallers had poor outcomes, in that 1 year after testing, they had either suffered three or more additional falls, been readmitted to hospital, been transferred to nursing homes or died.

Postural stability and associated physiological factors in a population of aged persons.

Lord SR, Clark RD, Webster IW

A battery of 13 visual, vestibular, sensorimotor, and balance tests was administered to 95 elderly persons (mean age 82.7 years) to examine the relationships between specific sensorimotor functions and measures of postural stability. When subjects stood on a firm surface, increased body sway was associated with poor tactile sensitivity and poor joint position sense. When subjects stood on a compliant surface (which reduced peripheral sensation) with their eyes open, increased body sway was associated with poor visual acuity and contrast sensitivity, reduced vibration sense, and decreased ankle dorsiflexion strength as well as reduced joint position sense. Increased body sway with eyes closed on the compliant surface was associated with poor tactile sensation, reduced quadriceps and ankle dorsiflexion strength, and increased reaction time. Poor performance in two clinical measures of postural stability was associated with reduced sensation in the lower limbs as measured by joint position sense, tactile sensitivity and vibration sense, reduced quadriceps and ankle dorsiflexion strength, and slow reaction times. The prevalence of vestibular impairments was high in this group, but vestibular function was not significantly associated with sway under any of the test conditions. The results suggest that reduced sensation, muscle weakness in the legs, and increased reaction time are all important factors associated with postural instability. An analysis of the percentage increases in sway under conditions where visual and peripheral sensation systems are removed or diminished, compared with sway under optimal conditions, indicated that peripheral sensation is the most important sensory system in the maintenance of static postural stability.