An assessment of falls in elderly men and women

Background. The assessment of falls in the elderly has moved from disease-oriented approaches, which attempt to identify single causative factors, to performance-oriented evaluations of functional deficits. This study examined the abilities of elderly fallers and nonfallers to perform various functional activities and to provide some rationale for performance differences by assessing the integrity of specific systems within the sensory, central processing control, and effector components of balance control. Methods. Twenty-two elderly subjects, aged 69-93 years, categorized as either a faller or a nonfaller, were assessed on their ability to perform the functional activities of static balance, walking, and stair descent. In addition, the balance control components of sensory input: vision, vestibular function, and proprioception; the central processing control system components: mental status, selective attention, perceptual style, and simple and choice reaction time; and the effector system: isometric strength were assessed. Results. The data indicated that fallers exhibited significantly reduced static balance, walking and stair descent performance than the nonfallers. The fallers exhibited significantly lower selective attention abilities and increased choice resisted reaction times, both measures of the central processing control system component. The nonfallers exhibited reduced proprioceptive function, suggesting that this is not a major contributor to the performance of balance and mobility skills. Conclusions. The data suggest that actual performance of mobility skills is an efficient means of identifying potential fallers. The decrements in functional activity performance appear to be related to central information processing control components, specifically selective attention and choice reaction time. The significant correlations between the sensory input, central processing control, and effector components with the functional activities suggest that the marginal declines in the sensory and effector components may have an additive effect, which may adversely affect the ability of fallers to perform the functional activities. The data suggest that selective attention and choice reaction time are the two most significant balance control components predictive of falls.