Orthostatic Hypotension is a Risk Factor for Falls Among Older Adults: 3-Year Follow-Up.

OBJECTIVES: To assess the prevalence of orthostatic hypotension (OH) and the association of OH with the risk of falls among community-dwelling older adults with a previous fall. DESIGN: Longitudinal study. SETTING AND PARTICIPANTS: The subjects (n = 561) were participants in fall prevention conducted in western Finland. METHODS: Blood pressure (BP) was measured in supine position and at 30 seconds and 3 minutes after standing. The participants were divided according to the consensus definition to an OH group (OHG) and a non-OH group (non-OHG). Falls were recorded by fall diaries during 12 months. Falls requiring treatment were gathered from health center and hospital registers during 12 and 36 months. RESULTS: The prevalence of OH was 23.4% (30 seconds) and 7.3% (3 minutes). The 30-second measurement showed that the incidence of falls and that of falls requiring treatment were significantly higher in OHG compared with non-OHG during 12 months. After adjustments, the incidence of falls remained higher in all 5 adjusted models whereas that of falls requiring treatment remained higher only after adjustment for functional balance. The 3-minute measurement showed that the incidence of falls was higher in OHG compared with non-OHG during 12 months and remained higher after adjustments for functional balance and for age and functional balance. During the 36-month follow-up, OH measured at 30 seconds or 3 minutes after standing was not associated with the occurrence of falls leading to treatment. CONCLUSIONS AND IMPLICATIONS: OH at 30 seconds or 3 minutes after standing is associated with a greater risk for falling within 12 months in older adults. The 30-second blood pressure measurement is more reliable to detect the risk than the 3-minute measurement. The results support the usability of 30-second measurement in determining OH and the risk for falling among older persons.

Predicting Value of Nine-Item Berg Balance Scale Among the Aged: A 3-Year Prospective Follow-Up Study.

BACKGROUND/STUDY CONTEXT: The aim was to assess the predicting value of the nine-item Berg Balance Scale (BBS-9) for falls among the community-dwelling aged. METHODS: The participants (N = 298) were divided according to BBS-9 (range: 0-36) into those scoring 0-32 sum points (risk group [RG]; n = 158) and those scoring 33-36 (non-risk group [non-RG]; n = 140). Falls were recorded by fall diaries, which subjects were asked to mail to the research assistants (RAs) monthly during the 12-month follow-up. The occurrences of falls requiring treatment were collected from the health center and hospital registers during the 12- and 36-month follow-ups. RESULTS: During the 12-month follow-up, 271 falls (171 in RG and 100 in non-RG) and 29 falls requiring treatment (22 in RG and 7 in non-RG) occurred. During 36 months, there were 98 falls that required treatment (72 in RG and 26 in non-RG). The incidence of falls was higher in RG compared with non-RG (incidence rate ratio [IRR]: 1.57, 95% confidence interval [CI]: 1.23-2.01) during the 12-month follow-up (p < .001). Also, the incidence of falls requiring treatment was significantly higher in RG than in non-RG during 12 months (IRR: 2.82, 95% CI: 1.20-6.59; p = .017) and 36 months (IRR: 2.56, 95% CI: 1.63-4.01; p < .001). CONCLUSION: BBS-9 with a cutoff score of 32/33 is an applicable tool for predicting risk of falls among the community-dwelling aged. Future studies are needed to assess the predicting value of BBS-9 among different age groups in the elderly population.

Short Berg Balance Scale, BBS-9, as a predictor of fall risk among the aged: a prospective 12-month follow-up study.

BACKGROUND AND AIMS: The aim of this study was to assess the adequacy of the short, 9-item Berg Balance Scale (BBS-9) to predict fall risk among the community-dwelling aged. METHODS: The subjects (n = 519) were derived from the participants in a multifactorial fall prevention intervention conducted in Pori, Finland. Receiver operating characteristic (ROC) analysis was used to determine the cut-off score for BBS-9 (range 0-36) to classify aged people with a fall risk during a 12-month follow-up. Logistic regression was used to analyse the relationship of potential confounders with fall risk. The association between the cut-off score for BBS-9 and fall risk was tested using the Chi-square test. RESULTS: In determining the cut-off score of BBS-9 to classify fall risk, the highest sensitivity (0.51) and specificity (0.57) (when both presumed to be above 0.50) sum score was within the limit range 32 scores or below. The area under curve (AUC) was significantly better in the model adjusted for significant confounders (vision and the number of regularly used drugs) (AUC = 0.64) than in the unadjusted model (AUC = 0.57) (p = 0.045). Among patients who scored 32 or below in BBS-9 the incidence of multiple falls was 20.0 %, whereas among those who scored 33-36 it was 15.7 %. CONCLUSIONS: BBS-9 with the cut-off score of 32/33 together with data on vision and the number of regularly used drugs predicted moderately the risk of falling among the community-dwelling aged.

Short Berg Balance Scale - correlation to static and dynamic balance and applicability among the aged.

BACKGROUND AND AIMS: To create a shorter version of the Berg Balance Scale (BBS) and to assess correlations between short BBS and static and dynamic aspects of balance among community-dwelling aged with a self-reported history of falling. METHODS: 519 (88%) subjects were included in the study, for whom BBS, and static and dynamic balance measurements were performed. Explanatory factor analysis was used to create a shorter version of the BBS. Static and dynamic balance was measured on a force platform. Correlations between the short BBS and static and dynamic balance were analysed by Spearman's correlation analysis. Cronbach's alpha was used to assess the internal consistency of the short BBS. RESULTS: Explanatory factory analysis produced two factors. Factor 1 consisted of nine items and factor 2 of four items of the BBS. One item of the original BBS was not loaded in these factors. The short BBS (BBS-9) was formed of factor 1. It correlated significantly with the original BBS, and had moderate correlations with static and dynamic aspects of balance (p<0.001). The high scores of BBS-9 were associated with better static and dynamic balance. BBS-9 demonstrated as good internal consistency reliability (Cronbach's alpha [α]=0.69) as the original BBS (α=0.74). CONCLUSIONS: Results support the applicability of BBS-9 in assessing functional balance among the aged with quite good physical function. However, more studies are needed to verify applicability to other samples and to assess cut-off scores for BBS-9, to predict the likelihood of falling.