AN ASSESSMENT OF FALLS IN ELDERLY MEN AND WOMEN

Background. The assessment of falls in the elderly has moved from dise ase-oriented approaches, which attempt to identify single causative fa ctors, to performance-oriented evaluations of functional deficits. Thi s study examined the abilities of elderly fallers and nonfallers to pe rform various functional activities and to provide some rationale for performance differences by assessing the integrity of specific systems within the sensory, central processing control, and effector componen ts of balance control. Methods. Twenty-two elderly subjects, aged 69-9 3 years, categorized as either a faller or a nonfaller, were assessed on their ability to perform the functional activities of static balanc e, walking, and stair descent. In addition, the balance control compon ents of sensory input: vision, vestibular function, and proprioception ; the central processing control system components: mental status, sel ective attention, perceptual style, and simple and choice reaction tim e; and the effector system: isometric strength were assessed. Results. The data indicated that fallers exhibited significantly reduced stati c balance, walking and stair descent performance than the nonfallers. The fallers exhibited significantly lower selective attention abilitie s and increased choice resisted reaction times, both measures of the c entral processing control system component. The nonfallers exhibited r educed proprioceptive function, suggesting that this is not a major co ntributor to the performance of balance and mobility skills. Conclusio ns. The data suggest that actual performance of mobility skills is an efficient means of identifying potential fallers. The decrements in fu nctional activity performance appear to be related to central informat ion processing control components, specifically selective attention an d choice reaction time. The significant correlations between the senso ry input, central processing control, and effector components with the functional activities suggest that the marginal declines in the senso ry and effector components may have an additive effect, which may adve rsely affect the ability of fallers to perform the functional activiti es. The data suggest that selective attention and choice reaction time are the two most significant balance control components predictive of falls.