Physical Function and Fall Risk among Urban Community Dwelling

Elders

Arline Bohannon, MDPamela Parsons, PhD

Department of Internal MedicineSection of Geriatrics

Falls in Elderly

• Common feature of frailty

• Increased morbidity

• Restricted mobility

• Increased risk of nursing home placement

Predictors of Fall Risk

• Intrinsic Factors

– Advanced age

– Sensory deficits

– Musculoskeletal Disorders

– Neurologic Disorders

Predictors of Fall Risk

• Environmental Factors

– Use of multiple medications

– Cluttered hallways

– Slippery floors

Physical Performance Measures

• Lower extremity weakness

• Gait assessment

• Balance

Objectives

• To describe physical function and fall risk among community dwelling minority elders

• To evaluate the relationships between self-reported physical function and physical performance among minority elders

Study Design

• Cross sectional

• Study sample – 50 volunteersExclusion criteria:

Unable to understand English

Moderate-severe cognitive impairment

Short Portable Mental Status Questionnaire

• Cognitive Function

– 10 item survey

– 5 or more errors = cognitive impairment

Late Life Function and Disability Instrument (LLFDI)

• Self report physical function instrument

• Administered by trained reviewer

• 48 item questionnaire– Disability component (16 items)– Functional component (32 items)

Scoring of LLDFI

• Overall functioning

• Physical functioningupper extremity

basic lower

advanced lower

• Disability functioning

limitation

frequency

LLFDI (mean ± SEM)

Characteristic

Mobility

Limited

n=34

Non-Mobility Limited

n=67P-value

Overall 48.2 ±1.1 59.8 ± 1.3 <.001

Basic lower 57.2 ± 1.3 71.6 ± 1.7 <.001

Disability

Limitation 58.6 ± 1.6 67.7 ± 1.2

<.001

Frequency 48.9 ± 0.9 52.7 0.9 .008

Modified Timed Get Up and Go

• Measures physical mobility

• Measured in seconds

• Test– Stand from a standard armchair– Walk three meters– Turn 180°– Walk back to chair – Sit down

Modified Timed Get Up and GO

Independent

Mild

impairment

Requires

Assistance

Time

(seconds) <20 20-29 >30

Tinetti Assessment Tool

• Measures gait and balance

• Balance test– 14 maneuvers– Scored on a three point ordinal scale– Range from 0 to 2 for each task– Maximum score is 16

Tinetti Assessment Tool

• Gait test– 10 components– Ranges form 0 to 16– Maximum score = 12

• Total score– Balance + Gait– Maximum score = 28– Higher functioning = better mobility

Tinetti Assessment Tool

• Low Risk– Total score > 24

• Moderate Risk– Total score 19-24

• High Risk– Total score < 19

Fall Risk Stratification

• High risk

• Medium

• Low risk

Stratification Methods

• Tinetti Assessment Tool – Total Score

• Modified Timed Get Up and Go

• Combination

Analyses – Objective 1

Demographic characteristics

Compare risk factors between groups• ANOVA• t tests• Logistic regression

Analyses – Objective 2

• Correlation – LLDFI and Modified Timed Get Up and Go– LLDFI and Tinetti Assessment Tool – Total

score– LLDFI – composite or combination score

taking into account both measures