Physical Function and Fall Risk among Urban Community Dwelling Elders Arline Bohannon, MD Pamela Parsons, PhD Department of Internal Medicine Section of Geriatrics

Falls in Elderly Common feature of frailty Increased morbidity Restricted mobility Increased risk of nursing home placement

Predictors of Fall Risk Intrinsic Factors –Advanced age –Sensory deficits –Musculoskeletal Disorders –Neurologic Disorders

Predictors of Fall Risk Environmental Factors –Use of multiple medications –Cluttered hallways –Slippery floors

Physical Performance Measures Lower extremity weakness Gait assessment Balance

Objectives To describe physical function and fall risk among community dwelling minority elders To evaluate the relationships between self-reported physical function and physical performance among minority elders

Study Design Cross sectional Study sample – 50 volunteers Exclusion criteria: Unable to understand English Moderate-severe cognitive impairment

Short Portable Mental Status Questionnaire Cognitive Function –10 item survey –5 or more errors = cognitive impairment

Late Life Function and Disability Instrument (LLFDI) Self report physical function instrument Administered by trained reviewer 48 item questionnaire –Disability component (16 items) –Functional component (32 items)

Scoring of LLDFI Overall functioning Physical functioning upper extremity basic lower advanced lower Disability functioning limitation frequency

LLFDI (mean ± SEM) Characteristic Mobility Limited n=34 Non-Mobility Limited n=67 P-value Overall48.2 ± ± 1.3 <.001 Basic lower57.2 ± ± 1.7 <.001 Disability Limitation58.6 ± ± 1.2 <.001 Frequency48.9 ±

Modified Timed Get Up and Go Measures physical mobility Measured in seconds Test –Stand from a standard armchair –Walk three meters –Turn 180° –Walk back to chair –Sit down

Modified Timed Get Up and GO Independent Mild impairment Requires Assistance Time (seconds)< >30

Tinetti Assessment Tool Measures gait and balance Balance test –14 maneuvers –Scored on a three point ordinal scale –Range from 0 to 2 for each task –Maximum score is 16

Tinetti Assessment Tool Gait test –10 components –Ranges form 0 to 16 –Maximum score = 12 Total score –Balance + Gait –Maximum score = 28 –Higher functioning = better mobility

Tinetti Assessment Tool Low Risk –Total score > 24 Moderate Risk –Total score High Risk – Total score < 19

Fall Risk Stratification High risk Medium Low risk

Stratification Methods Tinetti Assessment Tool – Total Score Modified Timed Get Up and Go Combination

Analyses – Objective 1 Demographic characteristics Compare risk factors between groups ANOVA t tests Logistic regression

Analyses – Objective 2 Correlation –LLDFI and Modified Timed Get Up and Go –LLDFI and Tinetti Assessment Tool – Total score –LLDFI – composite or combination score taking into account both measures