CLINICAL-PARAMETERS ASSOCIATED WITH FALLS IN AN ELDERLY POPULATION

Eighty-one elderly residents of a hostel for the aged (mean age 83.3 y ears) underwent clinical medical assessments to examine susceptibility to falling. The medical examination was structured and followed a cli nical format with particular emphasis upon posture and gait, in additi on to routine examination of the cardiovascular, respiratory, neurolog ical, gastrointestinal, haemopoietic, genitourinary, musculoskeletal a nd visual systems. These subjects were then followed up for 1 year to assess whether these clinical measures were associated with falls. Sev enty-six residents were available for follow-up. Thirty-four subjects (44.7%) reported having no falls in the follow-up year, 10 (13.2%) fel l once only, 13 (17.1%) fell on two occasions whilst 19 (25.0%) fell t hree or more times. Seventy-two percent of all falls occurred in the h ostel building. Certain clinical factors showed high specificity (i.e. only a few non-fallers screened positive in the tests) but low sensit ivity (i.e. there were considerable numbers of residents who screened negatively, but fell in the 12-month follow-up period). Stepwise logis tic regression analysis revealed impaired cognition, abnormal reaction to any push or pressure, history of palpitations and abnormal steppin g as variables that independently and significantly predicted falling. The equation predicted falls with 70.7% sensitivity and 79.4% specifi city, with an overall predictive accuracy of 74.7%. It appears that a modified focussed clinical examination could provide the basis of a sh ort assessment for predicting falls and highlight possible interventio n strategies for reducing fall risk.