physical function and fall risk among urban community dwelling elders arline bohannon, md pamela...

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