Functional Performance as a Predictor of Injurious Falls in Older Adults

Objectives To determine whether a performance battery and its components aid in predicting injurious falls. Design Longitudinal analysis; prospective cohort study. Setting Clinical site. Participants Boston‐area community‐dwelling adults (N = 755; mean age ±  SD 78.1 ± 5.4, 64.1% female, 77.6% white). Measurements Baseline functional performance was determined according to the Short Physical Performance Battery ( SPPB ), measuring balance, gait speed, and five repeated chair stands. Fall history (past year) and efficacy in performing 10 daily activities without falling were assessed. Falls were assessed using a daily calendar over 4 years. Injurious falls were defined as resulting in fractures, sprains, dislocations, pulled or torn muscles, ligaments, or tendons or seeking medical attention. Results Poorest chair stand performance (≥16.7 seconds) was associated with greater hazard of injurious falls than in all other chair stand performance groups (hazard ratio ( HR ) = 1.96, 95% confidence interval ( CI ) = 1.18–3.26 for ≥ 16.7 vs. 13.7–16.6 seconds; HR  = 1.65, 95% CI  = 1.07–2.55 for ≥ 16.7 vs. 11.2–13.6 seconds, HR  = 1.60, 95% CI  = 1.03–2.48 for ≥ 16.7 vs. <11.2 seconds). SPPB did not predict injurious falls. Fall history predicted injurious falls ( HR  = 1.82, 95% CI  = 1.39–2.39); falls efficacy did not. Fall history and a slow chair stand (<16.7 seconds) had a 2‐year cumulative incidence rate of an injurious fall of 46% (95% CI  = 0.34–0.58), nearly the combined rate of a positive fall history (0.29, 95% CI  = 0.25–0.34) and a slow chair stand alone (0.21, 95% CI  = 0.13–0.30). Conclusion An easily administered chair stand test may be sufficient for evaluating performance as part of a risk stratification strategy for injurious falls.