Intra-Individual Changes in Ambulation Associated with Falls in a Population of Vulnerable Older Adults in Long-Term Care

Publication date: Available online 11 June 2016
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Mary Elizabeth Bowen, Meredeth Rowe
ObjectivesThe aim of this pilot study is to examine how intra-individual changes in ambulation characteristics may be used to predict falls.DesignLongitudinal study design.SettingAssisted Living Facility (ALF).ParticipantsAmbulatory older adults (N=26, mean age 79).Main Outcome MeasuresContinuous measure of average weekly ambulation characteristics [time and distance walked, speed, path measures (e.g., path time and distance, number of paths (where at path is at least 60 seconds of uninterrupted walking separated by at least a 30 second stop)], accounting for weekly changes in these ambulation characteristics on an individual-level over time, along with falls (yes/no) and cognitive impairment (CI; measured by the Montreal Cognitive Assessment).ResultsIn Hierarchical Linear Models (HLM) accounting for intra-individual changes in ambulation characteristics over the eight month course of the study and level of CI, path distance (OR=1.02; p≤0.001) was associated with an increased risk for a fall. In the short term, intra-individual changes in path distance were associated with a fall within the 4-week interval the change was noted. Path distance had fair sensitivity (0.74) and specificity (0.66) to a fall (AUC=0.70).ConclusionStudy findings suggest that falls may have specific predictors - specifically that older adults with CI are more likely to fall when walking continuously with little/no breaks. Interventions focused on reducing path-associated fatigue may effectively reduce fall incidence in this population.



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