Predicting Probability for Elderly Falls

TOPIC: TO PREDICT THE PROBABILITY FOR FALLS IN COMMUNITY – DWELLING OLDER ADULTS USING THE TIMED UP & GO TEST AND GAIT SPEED.

INTRODUCTION AND BACKGROUND: Ageing process is a biological reality which has its own dynamic, largely beyond human control. In most of the developed countries the age of 60 – 65 years equivalent to retirement ages is said to be the beginning of old age. While, in some parts it is the loss of roles accompanying physical decline which is significant in defining old age. Any event that led to an unplanned, unexpected contact with a supporting surface is termed as a fall. It is the top cause of accidents in people over the age of 65 and also is the main cause leading to serious injury and accidental deaths in older people. It is a marker of poor health and declining function. Increasing age, medication use, cognitive impairment and sensory deficits are the risk for falls in elderly. Treatment is directed at the underlying cause for fall and makes patient return to his baseline function. Gait impairment, balance disorders or weakness, vertigo, postural hypotension visual disorder are some of the common causes for falls in elderly. Some drugs that may increase the risk for falling are tricyclic antidepressants, major tranquilizers antihypertensive drugs and any medications that is likely to affect balance. Providing balance training, modification of medication, elimination of environmental hazards and improvement of home supports are few critical steps for reducing the falls in elderly. For the assessment of an elderly prone to falls there are many tools TUG, Gait Speed , Six – Minute Walk Test and BBS being few of them. The need of the present study was to predict the probability for falls in community – dwelling older adults using TUG and Gait Speed. The aim and objective was to predict the probability for fall in older adults using the TUG, TUG _manual and CGS as parameters. Research hypothesis was the risk for fall is same in both of the category of community – dwelling older adults with or without history of falls formed the null hypothesis and the alternative hypothesis was the risk for fall is higher in community – dwelling older adults who have the previous history of fall as compared to older adults who have no history of falls.^[1,2,3] Studies in relation to the present study have supported that the TUG and Gait Speed are effective tools in assessing the probability for falls in elderly^.[2,4,5,6,7] Another study concluded that there is statistical association between TUG times and history of falls , but the clinical relevance of this association is limited. Even, in a retrospective design there is hardly any association between TUG and fall risk. So, TUG may not be used as a test of fall risk in an ambulatory elderly population^.[8]

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METHODOLOGY: A one time experimental study was conducted on 40 community- dwelling older adults with 60 – 80 years of age. The sample size was selected by non- probability sampling. Older adults were grouped as fallers’ and non fallers’ on the basis of inclusion criteria ( older adults with age group of 60 – 80 years, older adults with no history of fall for non faller category, older adults with self report of 2 or more falls within the past 6 months for faller category, no history of dizziness ) and exclusion criteria (Visual impairments, older adults with fall resulting from unavoidable environmental hazards such as a chair collapsing, older adults with 1 fall within 6 months, presence of known neurological or musculoskeletal diagnosis that could account for possible imbalance and falls, such as cerebrovascular accident, Parkinson disease, cardiac problems, TIA, or lower-extremity joint replacements , joint pain in lower limbs). The subjects were invited to participate in the study. The study was explained in detail. After they fulfilled the inclusion & exclusion criteria they were asked to sign an informed consent form and were assigned into faller and non faller groups. Following this, the subjects were given verbal instructions regarding the test procedure with visual demonstration of the TUG, TUG) _(manual) and Comfortable Gait Speed (CGS). Then the patients were asked to perform in the said manner. During the test, subject were asked to wear their routine footwear .No physical assistance was permitted. The stopwatch was used to time each test. Assistive devices were not permitted at the time of TUG _(manual) test. The subject received no score if they were unable to complete the test or required assistance to refrain from falling during the rest.

RESULT: The data was analyzed using unpaired t- test.

TABLE 1

MEAN AND STANDARD DEVIATION OF THE TUG, TUG _MANUAL AND CGS SCORES OF THE FALLERS CATEGORY

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TABLE 2

MEAN AND STANDARD DEVIATION OF THE TUG, TUG _MANUAL AND CGS SCORES OF THE NON FALLERS CATEGORY

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TABLE 3

CALCULATED STANDARD ERROR AND t-VALUE FOR TUG, TUG _MANUAL AND CGS SCORES OF THE BOTH CATEGORY

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FIGURE 1

GRAPHICAL REPRESENTATION OF COMPARISON OF MEAN AND STANDARD DEVIATION SCORES OF TUG FOR FALLER AND NON FALLER CATEGORY

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FIGURE 2

GRAPHICAL REPRESENTATION OF COMPARISON OF MEAN AND STANDARD DEVIATION SCORES OF TUG _manual FOR FALLER AND NON FALLER CATEGORY

FIGURE 3

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GRAPHICAL REPRESENTATION OF COMPARISON OF MEAN AND STANDARD DEVIATION SCORES OF CGS FOR FALLER AND NON FALLER CATEGORY

DISCUSSION: The purpose of the study was to predict the probability for falls in community – dwelling older adults with history and without history of falls. In the study, TUG, TUG _manual and CGS were performed on older adults with and without history of falls. From the result it was observed that the mean scores for TUG assessment was greater in faller category (20.30sec) than in non faller category (14.82sec),that is, older adults with history of falls takes longer time to complete TUG than the older adults without any history of falls. From the result it was observed that the mean scores for TUG _manual assessment was greater in faller category (25.06sec) than in non faller category (15.72sec), that is, older adults with history of falls takes longer time to complete TUG _manual than the older adults without any history of falls. Also, it was observed that the mean scores for CGS assessment was greater in non faller category (1.18m/s)than in faller category (0.28m/s), that is, older adults with history of falls have slower comfortable gait speed than the older adults without history of falls. Hence, comparison between these all three scores shows that older adults with previous history of falls take longer time to complete TUG and TUG _manual while have a slower gait speed than the older adults with no history of falls. Thus, the results of the present study were coherent with the results of the study In the present study it was found that the mean scores for TUG as well as for TUG _manual was higher in older adults with previous history of falls and CGS mean score is higher in case of older adults without history of falls. So older adults with previous history of falls take longer time to complete TUG and TUG _manual and have slower gait speed.

CONCLUSION: It was concluded through the present study that the TUG and Gait Speed are simple tests that can predict the probability for falls in community- dwelling older adults and the risk for falls was higher in community – dwelling older adults with previous history of fall as compared to older adults with no history of fall.

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