Short-Physical Performance Battery (SPPB) score is associated with falls in older outpatients

  • Fulvio Lauretani
  • Andrea Ticinesi
  • Luciano Gionti
  • Beatrice Prati
  • Antonio Nouvenne
  • Claudio Tana
  • Tiziana Meschi
  • Marcello Maggio
Original Article



The capacity of Short-Physical Performance Battery (SPPB) test to discriminate between fallers and non-fallers is controversial, and has never been compared with fall risk assessment-specific tools, such as Performance-Oriented Mobility Assessment (POMA).


To verify the association of SPPB and POMA scores with falls in older outpatients.


451 older subjects (150 males, mean age 82.1 ± 6.8) evaluated in a geriatric outpatient clinic for suspected frailty were enrolled in this cross-sectional study. Self-reported history of falls and medication history were carefully assessed. Each participant underwent comprehensive geriatric assessment, including SPPB, POMA, Geriatric Depression Scale (GDS), mini-mental state examination (MMSE) and mini-nutritional assessment-short form (MNA-SF). Multivariate logistic regression and receiver-operating characteristic (ROC) analyses were performed to determine the factors associated with the status of faller.


245 (54.3%) subjects were identified as fallers. They were older and had lower SPPB and POMA test scores than non-fallers. At ROC analysis, SPPB (AUC 0.676, 95% CI 0.627–0.728, p < 0.001) and POMA (AUC 0.677, 95% CI 0.627–0.726, p < 0.001) scores were both associated with falls. At multivariate logistic regression models, SPPB total score (OR 0.83, 95% CI 0.76–0.92, p < 0.001), POMA total score (OR 0.94, 95% CI 0.91–0.98, p = 0.002) and SPPB balance score alteration (OR 2.88, 95% CI 1.42–5.85, p = 0.004), but not POMA balance subscale score alteration, were independently associated with recorded falls, as also GDS, MMSE and MNA-SF scores.


SPPB total score was independently associated with reported falls in older outpatients, resulting non-inferior to POMA scale. The use of SPPB for fall risk assessment should be implemented.


Comprehensive geriatric assessment Falls Frailty Balance 



No funds were received for this study.

Author contributions

FL and MM conceived and designed the study; FL, LG, AN and BP performed the investigation and collected data; FL and AT analyzed the data; AT wrote the paper; CT, TM and MM revised the manuscript for substantial content; TM and MM provided supervision.

Compliance with ethical standards

Conflict of interest

The authors declare no conflict of interest.

Ethical approval

The protocol of the TRIP (Traumatic Risk Identikit Parma) Study, which the analyses reported in this paper are part of, has been approved by the Ethics Committee of Parma province (ID 17262).

Informed consent

Written informed consent was obtained for all participants.


  1. 1.
    Blain H, Masud T, Dargent-Molina P et al (2016) A comprehensive fracture prevention strategy in older adults: the European union geriatric medicine society (EUGMS). Statement J Nutr Health Aging 20:647–652CrossRefPubMedGoogle Scholar
  2. 2.
    Tinetti ME (2003) Clinical practice. Preventing falls in elderly persons. N Engl J Med 348:42–49CrossRefPubMedGoogle Scholar
  3. 3.
    Gill TM, Murphy TE, Gahbauer EA et al (2013) Association of injurious falls with disability outcomes and nursing home admissions in community-living older persons. Am J Epidemiol 178:418–425CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Tricco AC, Thomas SM, Veroniki AA et al (2017) Comparisons of interventions for preventing falls in older adults. A systematic review and meta-analysis. JAMA 318:1687–1699CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Park SH (2018) Tools for assessing fall risk in the elderly: a systematic review and meta-analysis. Aging Clin Exp Res 30:1–16CrossRefPubMedGoogle Scholar
  6. 6.
    Neuls PD, Clark TL, Van Heuklon NC et al (2011) Usefulness of the Berg Balance Scale to predict falls in the elderly. J Geriatr Phys Ther 34:3–10PubMedGoogle Scholar
  7. 7.
    Palumbo P, Palmerini L, Bandinelli S et al (2015) Fall risk assessment tools for elderly living in the community: can we do better? PLoS One 10:e0146247CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Morley JE (2018) F3ALLS approach to preventing falls. J Nutr Health Aging 22:748–750CrossRefPubMedGoogle Scholar
  9. 9.
    Tinetti ME (1986) Performance-oriented assessment of mobility problems in elderly patients. J Am Geriatr Soc 34:119–126CrossRefPubMedGoogle Scholar
  10. 10.
    Raiche M, Hebert R, Prince F et al (2000) Screening older adults at risk of falling with the Tinetti balance scale. Lancet 356:1001–1002CrossRefPubMedGoogle Scholar
  11. 11.
    Guralnik JM, Simonsick EM, Ferrucci L et al (1994) A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. J Gerontol 49:M85–M94CrossRefPubMedGoogle Scholar
  12. 12.
    Guralnik JM, Ferrucci L, Simonsick EM et al (1995) Lower-extremity function in persons over the age of 70 years as a predictor of subsequent disability. N Engl J Med 332:556–561CrossRefPubMedGoogle Scholar
  13. 13.
    Penninx BW, Ferrucci L, Leveille SG et al (2000) Lower extremity performance in nondisabled older persons as a predictor of subsequent hospitalization. J Gerontol A Biol Sci Med Sci 55:M691–M697CrossRefPubMedGoogle Scholar
  14. 14.
    Volpato S, Cavalieri M, Sioulis F et al (2011) Predictive value of the Short Physical Performance Battery following hospitalization in older patients. J Gerontol A Biol Sci Med Sci 66:89–96CrossRefPubMedGoogle Scholar
  15. 15.
    Enderlin C, Rooker J, Ball S et al (2015) Summary of factors contributing to falls in older adults and nursing implications. Geriatr Nurs 36:397–406CrossRefPubMedGoogle Scholar
  16. 16.
    WHO Global Report on Fall Prevention in Older Age, World Health Organization (2007) Accessed 10 Sep 2018
  17. 17.
    Veronese N, Bolzetta F, Toffanello ED et al (2014) Association between short physical performance battery and falls in older people: the Progetto Veneto Anziani study. Rejuvenation Res 17:276–284CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Kim JC, Chon J, Kim HS et al (2017) The association between fall history and physical performance tests in the community-dwelling elderly: a cross-sectional analysis. Ann Rehabil Med 41:239–247CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Wang AY, Sherrington C, Toyama T et al (2017) Muscle strength, mobility, quality of life and falls in patients on maintenance hemodialysis: a prospective study. Nephrology 22:220–227CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Hars M, Audet MC, Herrmann F et al (2018) Functional performances on admission predict in-hospital falls, injurious falls, and fractures in older patients: a prospective study. J Bone Min Res 33:852–859CrossRefGoogle Scholar
  21. 21.
    Minneci C, Mello AL, Mossello E et al (2015) Comparative study of four physical performance measures as predictors of death, incident disability, and falls in unselected older persons: the Insufficienza Cardiaca negli Anziani Residenti a Dicomano Study. J Am Geriatr Soc 63:136–141CrossRefPubMedGoogle Scholar
  22. 22.
    Ward RE, Leveille SG, Beauchamp MK et al (2015) Functional performance as a predictor of injurious falls in older adults. J Am Geriatr Soc 63:315–320CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Zhou J, Habtemariam D, Iloputaife I et al (2017) The complexity of standing postural sway associates with future falls in community-dwelling older adults: the MOBILIZE Boston Study. Sci Rep 7:2924CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Lauretani F, Meschi T, Ticinesi A et al (2017) “Brain-muscle loop” in the fragility of older persons: from pathophysiology to new organizing models. Aging Clin Exp Res 29:1305–1311CrossRefPubMedGoogle Scholar
  25. 25.
    Morley JE (2016) Gait, falls, and dementia. J Am Med Dir Assoc 17:467–470CrossRefPubMedGoogle Scholar
  26. 26.
    Cederholm T, Nouvenne A, Ticinesi A et al (2014) The role of malnutrition in older persons with mobility limitations. Curr Pharm Des 20:3173–3177CrossRefPubMedGoogle Scholar
  27. 27.
    Afrin N, Honkanen R, Koivumaa-Honkanen H et al (2016) Multimorbidity predicts falls differentially according to the type of fall in postmenopausal women. Maturitas 91:19–24CrossRefPubMedGoogle Scholar
  28. 28.
    Ek S, Rizzuto D, Fratiglioni L et al (2018) Risk profiles for injurious falls in older people over 60: a population-based cohort study. J Gerontol A Biol Sci Med Sci 73:233–239CrossRefPubMedGoogle Scholar
  29. 29.
    Liu Z, Wang Q, Zhi T et al (2016) Frailty Index and its relation to falls and overnight hospitalizations in elderly Chinese people: a population-based study. J Nutr Health Aging 20:561–566CrossRefPubMedGoogle Scholar
  30. 30.
    Cesari M, Landi F, Calvani R et al (2017) Rationale for a preliminary operational definition of physical frailty and sarcopenia in the SPRINTT trial. Aging Clin Exp Res 29:81–88CrossRefPubMedGoogle Scholar
  31. 31.
    Lauretani F, Ceda GP, Pelliccioni P et al (2014) Approaching neurological diseases to reduce mobility limitations in older persons. Curr Pharm Des 20:3149–3164CrossRefPubMedGoogle Scholar
  32. 32.
    Balogun S, Winzenberg T, Willis K et al (2017) Prospective associations of low muscle mass and function with 10-year falls risk, incident fracture and mortality in community-dwelling older adults. J Nutr Health Aging 21:843–848CrossRefPubMedGoogle Scholar
  33. 33.
    Muir SW, Gopaul K, Montero-Odasso MM (2012) The role of cognitive impairment in fall risk among older adults: a systematic review and meta-analysis. Age Ageing 41:299–308CrossRefPubMedGoogle Scholar
  34. 34.
    Torres MJ, Féart C, Samieri C et al (2015) Poor nutritional status is associated with a higher risk of falling and fracture in elderly people living at home in France: the Three-City cohort study. Osteoporos Int 26:2157–2164CrossRefPubMedGoogle Scholar
  35. 35.
    Tyrovolas S, Koyanagi A, Lara E et al (2016) Mild cognitive impairment is associated with falls among older adults: findings from the Irish Longitudinal Study on Ageing (TILDA). Exp Gerontol 75:42–47CrossRefPubMedGoogle Scholar
  36. 36.
    Kojima R, Ukawa S, Ando M et al (2016) Association between falls and depressive symptoms or visual impairment among Japanese young-old adults. Geriatr Gerontol Int 16:384–391CrossRefPubMedGoogle Scholar
  37. 37.
    Kang L, Chen X, Han P et al (2018) A screening tool using five risk factors was developed for fall risk prediction in Chinese community-dwelling elderly individuals. Rejuvenation Res 21:416–422CrossRefPubMedGoogle Scholar
  38. 38.
    Yingyongyudha A, Saengsirisuwan V, Panichaporn W et al (2016) The mini-balance evaluation systems test (Mini-BESTest) demonstrates higher accuracy in identifying older adult participants with history of falls than do the BESTest, berg balance scale, or timed up and go test. J Geriatr Phys Ther 39:64–70CrossRefPubMedGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2018

Authors and Affiliations

  1. 1.Department of Medicine and SurgeryUniversity of ParmaParmaItaly
  2. 2.Geriatric-Rehabilitation DepartmentAzienda Ospedaliero-Universitaria di ParmaParmaItaly

Personalised recommendations