Environmental Health and Preventive Medicine

, Volume 15, Issue 6, pp 386–391 | Cite as

Predicting the probability of falls in community-dwelling elderly individuals using the trail-walking test

Short Communication

Abstract

Background

Falling is a common problem in the fast-growing elderly population. Multitasking or engaging in two or more activities at the same time is common in daily living.

Objective

To determine the usefulness of the trail-walking test (TWT) for predicting a fall in community-dwelling elderly individuals.

Methods

This was a prospective study in which the TWT was used to evaluate the risk of falling among a group of community-dwelling elderly individuals (n = 171) with a mean age of 80.5 ± 5.6 years. The following tests were conducted: TWT, trail-making test (TMT), timed-up-and-go test (TUG), functional reach (FR) test, one-leg standing (OLS) test, and 10-m walking time test. Test–retest reliability was assessed by repeating the TWT within 2 weeks of the first trial, and there was a 1-year follow-up. Stepwise logistic regression analysis was used to analyze whether the TWT, TMT, TUG, FR, OLS, or 10-m walking tests predicted falling.

Results

The test–retest reliability of TWT was high (intraclass correlation coefficient 0.945, p < 0.001). Fifty-nine participants (34.5%) had reported a fall during the year preceding the 1-year follow-up. The stepwise logistic regression analysis revealed that only the TWT was significantly related to falling (odds ratio 1.160, 95% confidence interval 1.107–1.214; p < 0.001). In total, 77.8% of cases were correctly classified.

Conclusion

When reliability and validity were considered, the TWT was most useful test of those evaluated for assessing the risk of fall among our elderly cohort.

Keywords

Fall Elderly Trail-walking test Predictor Complex-task condition 

References

  1. 1.
    Tinetti ME, Speechley M. Prevention of falls among the elderly. N Engl J Med. 1989;320:1055–9.CrossRefPubMedGoogle Scholar
  2. 2.
    Tinetti ME, Speechley M, Ginter SF. Risk factors for falls among elderly persons living in the community. N Engl J Med. 1988;319:1701–7.CrossRefPubMedGoogle Scholar
  3. 3.
    Scuffham P, Chaplin S, Legood R. Incidence and costs of unintentional falls in older people in the United Kingdom. J Epidemiol Community Health. 2003;57:740–4.CrossRefPubMedGoogle Scholar
  4. 4.
    Menz HB, Lord SR, Fitzpatrick RC. Age-related differences in walking stability. Age Ageing. 2003;32:137–42.CrossRefPubMedGoogle Scholar
  5. 5.
    Tinetti ME, Doucette J, Claus E, Marottoli R. Risk factors for serious injury during falls by older persons in the community. J Am Geriatr Soc. 1995;43:1214–21.PubMedGoogle Scholar
  6. 6.
    St George RJ, Fitzpatrick RC, Rogers MW, Lord SR. Choice stepping response and transfer times: effects of age, fall risk, and secondary tasks. Gerontol A Biol Sci Med Sci. 2007;62:537–42.Google Scholar
  7. 7.
    Chen HC, Schultz AB, Ashton-Miller JA, Giordani B, Alexander NB, Guire KE. Stepping over obstacles: dividing attention impairs performance of old more than young adults. J Gerontol A Biol Sci Med Sci. 1996;51:M116–22.PubMedGoogle Scholar
  8. 8.
    Podsiadlo D, Richardson S. The timed “Up & Go”: a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc. 1991;39:142–8.PubMedGoogle Scholar
  9. 9.
    Vellas BJ, Wayne SJ, Romero L, Baumgarther RN, Rubenstein LZ, Garry PJ. One-leg balance is an important predictor of injurious fall in older persons. J Am Geriatr Soc. 1997;45:735–8.PubMedGoogle Scholar
  10. 10.
    Duncan PW, Studenski S, Chandler J, Prescott B. Functional reach: a new clinical measure of balance. J Gerontol. 1990;45:M192–7.PubMedGoogle Scholar
  11. 11.
    Tinetti ME. Performance-oriented assessment of mobility problems in elderly patients. J Am Geriatr Soc. 1986;34:119–26.PubMedGoogle Scholar
  12. 12.
    Nevitt MC, Cummings SR, Hudes ES. Risk factors for recurrent nonsyncopal falls. JAMA. 1989;261:2663–8.CrossRefPubMedGoogle Scholar
  13. 13.
    Beauchet O, Dubost V, Allali G, Gonthier R, Hermann FR, Kressig RW. ‘Faster counting while walking’ as a predictor of falls in older adults. Age Ageing. 2007;36:418–23.CrossRefPubMedGoogle Scholar
  14. 14.
    Faulkner KA, Redfern MS, Cauley JA, Landsittel DP, Studenski SA, Rosano C, et al. Multitasking: association between poorer performance and a history of recurrent falls. J Am Geriatr Soc. 2007;55:570–6.CrossRefPubMedGoogle Scholar
  15. 15.
    Baddeley AD. Working memory. Science. 1992;255:556–9.CrossRefPubMedGoogle Scholar
  16. 16.
    Lundin-Olsson L, Nyberg L, Gustafson Y. “Stops walking when talking” as a predictor of falls in elderly people. Lancet. 1997;349:617.CrossRefPubMedGoogle Scholar
  17. 17.
    Beauchet O, Allali G, Annweiler C, Berrut G, Maarouf N, Herrmann FR, et al. Does change in gait while counting backward predict the occurrence of a first fall in older adults? Gerontology. 2008;54:217–23.CrossRefPubMedGoogle Scholar
  18. 18.
    Bootsma-van der Wiel A, Gussekloo J, de Craen AJ, van Exel E, Bloem BR, Westendorp RG. Walking and talking as predictors of falls in the general population: the Leiden 85-Plus Study. J Am Geriatr Soc. 2003;51:1466–71.CrossRefPubMedGoogle Scholar
  19. 19.
    Zilstra A, Ufkes T, Skelton DA, Lundin-Olsson L, Zilstra W. Do dual tasks have an added value over single tasks for balance assessment in fall prevention programs? A mini-review. Gerontology. 2008;54:40–9.CrossRefGoogle Scholar
  20. 20.
    Bloem BR, Valkenburg VV, Slabbekoorn M, Willemsen MD. The multiple tasks test: development and normal strategies. Gait Posture. 2001;14:191–202.CrossRefPubMedGoogle Scholar
  21. 21.
    Alexander NB, Ashton-Miller JA, Giordani B, Guire K, Schultz AB. Age differences in timed accurate stepping with increasing cognitive and visual demand: a walking trail making test. J Gerontol A Biol Sci Med Sci. 2005;60:1558–62.PubMedGoogle Scholar
  22. 22.
    War Department Adjutant General’s Office. Army individual test battery. Manual of directions and scoring. Washington, DC: War Department, Adjutant General’s Office; 1944.Google Scholar
  23. 23.
    Folstein MF, Folstein SE, McHugh PR. “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12:189–98.CrossRefPubMedGoogle Scholar
  24. 24.
    Duncan PW, Studenski S, Chandler J, Prescott B. Functional reach: predictive validity in a sample of elderly male veterans. J Gerontol. 1992;47:M93–8.PubMedGoogle Scholar
  25. 25.
    Lopopolo RB, Greco M, Sullivan D, Craik RL, Mangione KK. Effect of therapeutic exercise on gait speed in community-dwelling elderly people: a meta-analysis. Phys Ther. 2006;86:520–40.PubMedGoogle Scholar
  26. 26.
    Koski K, Luukinen H, Laippala P, Kivela SL. Physiological factors and medications as predictors of injurious falls by elderly people: a prospective population-based study. Age Ageing. 1996;25:29–38.CrossRefPubMedGoogle Scholar
  27. 27.
    Blake AJ, Morgan K, Bendall MJ, Dallosso H, Ebrahim SB, Arie TH, Fentem PH, Bassey EJ. Falls by elderly people at home: prevalence and associated factors. Age Ageing. 1988;17:365–72.CrossRefPubMedGoogle Scholar
  28. 28.
    Tinetti ME, Doucette JT, Claus EB. The contribution of predisposing and situational risk factors to serious fall injuries. J Am Geriatr Soc. 1995;43:1207–13.PubMedGoogle Scholar
  29. 29.
    Nevitt MC, Cummings SR, Hudes ES. Risk factors for injurious falls: a prospective study. J Gerontol. 1991;46:M164–70.PubMedGoogle Scholar
  30. 30.
    Lord SR, Fitzpatrick RC. Choice stepping reaction time: a composite measure of falls risk in older people. J Gerontol A Biol Sci Med Sci. 2001;56:M627–32.PubMedGoogle Scholar
  31. 31.
    Shumway-Cook A, Brauer S, Woollacott M. Predicting the probability for falls in community-dwelling older adults using the Timed Up & Go Test. Phys Ther. 2000;80:896–903.PubMedGoogle Scholar

Copyright information

© The Japanese Society for Hygiene 2010

Authors and Affiliations

  1. 1.Department of Human Health SciencesKyoto University Graduate School of MedicineSakyo-ku, KyotoJapan

Personalised recommendations