Relative risk for a future fall among community-dwelling older adults

Includes bibliographical references (pages 34-44)The purpose of this study was to examine the level of relative risk for a future fall associated with difficulties with performing various tasks related to normal daily functioning among community-dwelling adults 70 years and older. Functional status is often defined by cumulative scores across indices of independence in performing basic and instrumental activities of daily living (ADL/IADL). However, little is known about the unique relationship of each item with the fall outcome. In this study, risk analysis was performed on 6 ADLs, 7 IADLs and 10 items related to mobility limitations. Furthermore, the items were compared across a subsample of older adults who had a single fall and reported difficulty with walking and/or balance (FRAIL), as well as to a subsample with a history of a single fall and no difficulty with walking or dizziness. The items that had the strongest relationships and highest risk ratios for the FRAIL group, which had the highest probabilities for a future fall, included difficulties with eating (73%); managing money (70%); biting or chewing food (66%); walking a quarter of a mile (65%); using fingers to grasp (65%); and difficulty with dressing without help (65%). For the NDW+ND group, the most noteworthy items included difficulty with bathing or showering (79%); managing money (77%); shopping for personal items (75%); Walking up 10 steps without rest (72%); difficulty with walking a quarter of a mile (72%); and difficulty with stooping/crouching/kneeling (70%). These findings suggest that individuals??? ADLs and IADLs have substantive relationship with the fall outcome among older adults who have difficulty with walking and balance, but these indices do not effectively capture the fall risk associated with older adults who are high-functioning. Moreover, the relationship between items that are related to more challenging activities and the fall outcome revealed, that higher functioning older adults who report difficulties with the 6 items that yielded the highest risk ratios may also be at elevated risk for a fall. This study explored a relatively new perspective of fall-related item analysis and may have future research and clinical implications