To examine how intraindividual changes in ambulation characteristics may be used to predict falls.
Longitudinal study design.
Assisted living facility.
Ambulatory older adults (N=26; mean age, 79y).
Main Outcome Measures
Continuous measure of average weekly ambulation characteristics (time and distance walked, speed, path measures [eg, path time and distance, number of paths (where a path is at least 60s of uninterrupted walking separated by at least a 30-s stop)]), accounting for weekly changes in these ambulation characteristics on an individual level over time along with falls (yes/no) and cognitive impairment (CI) (measured by the Montreal Cognitive Assessment).
In hierarchical linear models accounting for intraindividual changes in ambulation characteristics over the 8-month course of the study and level of CI, path distance (odds ratio, 1.02; P≤.001) was associated with an increased risk of a fall. In the short-term, intraindividual changes in path distance were associated with a fall within the 4-week interval the change was noted. Path distance had fair sensitivity (.74) and specificity (.66) to a fall (area under the curve, .70).
Study findings suggest that falls may have specific predictors, specifically that older adults with CI are more likely to fall when walking continuously with little/no breaks. Interventions focused on reducing path-associated fatigue may effectively reduce fall incidence in this population.
List of abbreviations:CI (cognitive impairment), IRB (Institutional Review Board), LTC (long-term care), MoCA (Montreal Cognitive Assessment), OR (odds ratio), RTLS (real-time location system)
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Published online: June 10, 2016
Supported by a Rehabilitation Research and Development Career Development Award (II) from the Department of Veterans Affairs (CDA E7503W). The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs.
© 2016 by the American Congress of Rehabilitation Medicine