Purpose: To determine whether combined performance-based models could exert better predictive values toward discriminating community-dwelling elderly with high risk of any-falls or recurrent-falls.
Participants and Methods: This prospective cohort study included a total of 875 elderly participants (mean age: 67.10± 5.94 years) with 513 females and 362 males, recruited from Hangu suburb area of Tianjin, China. All participants completed comprehensive assessments.
Methods: We documented information about sociodemographic information, behavioral characteristics and medical conditions. Three functional tests—timed up and go test (TUGT), walking speed (WS), and grip strength (GS) were used to create combined models. New onsets of any-falls and recurrent-falls were ascertained at one-year follow-up appointment.
Results: In total 200 individuals experienced falls over a one-year period, in which 66 individuals belonged to the recurrent-falls group (33%). According to the receiver operating characteristic curve (ROC), the cutoff points of TUGT, WS, and GS toward recurrent-falls were 10.31 s, 0.9467 m/s and 0.3742 kg/kg respectively. We evaluated good performance as “+” while poor performance as “–”. After multivariate adjustment, we found “TUGT > 10.31 s” showed a strong correlation with both any-falls (adjusted odds ratio (OR)=2.025; 95% confidence interval (CI)=1.425– 2.877) and recurrent-falls (adjusted OR=2.150; 95%CI=1.169– 3.954). Among combined functional models, “TUGT > 10.31 s, GS < 0.3742 kg/kg, WS > 0.9467 m/s” showed strongest correlation with both any-falls (adjusted OR=5.499; 95%CI=2.982– 10.140) and recurrent-falls (adjusted OR=8.260; 95%CI=3.880– 17.585). And this combined functional model significantly increased discriminating abilities on screening recurrent-fallers than a single test (C-statistics=0.815, 95%CI=0.782– 0.884, P < 0.001), while not better than a single test in predicting any-fallers (P =0.083).
Conclusion: Elderly people with poor TUGT performance, weaker GS but quicker WS need to be given high priority toward fall prevention strategies for higher risks and frequencies. Meanwhile, the combined “TUGT–, GS–, WS+” model presents increased discriminating ability and could be used as a conventional tool to discriminate recurrent-fallers in clinical practice.
Keywords: recurrent-falls, elderly, physical functional performance, increased predictive value