Postural stability in the elderly: Fallers versus non-fallers

Objectives(1) To compare static and dynamic balance alterations in recurrent fallers and non-fallers elderly patients. (2) To assess the functional repercussions of balance disorders and falls in these subjects.Patients and methodsRetrospective, observational, case-control study. The patients examined were 226 community-dwelling elderly people aged over 65 years, 113 of whom had suffered more than two falls in the past 6 months, and a further 113 who had not fallen in the past 6 months. All subjects had received primary care (at one of Madrid's Area 7 Healthcare Centres) and/or had been outpatients of the Geriatrics Unit and were subjected to an exhaustive examination including the collection of demographic data, geriatric assessment, physical examination, tests of gait and balance and balance control assessment using the Balance Master®. This last assessment included the tests: (1) modified clinical test for sensory interaction on balance (mCTSIB), which estimates sensory balance by measuring the centre of gravity (COG) sway velocity and alignment relative to the centre of the patient's base of support with open then closed eyes, and on a firm then unstable surface; (2) weight-bearing squat (WBS); (3) rhythmic weight shift; (4) sit to stand (SS); (5) walk across (WA); and (6) step up/over (SUO). Statistical analysis was performed using SPSS v.12.0 software.ResultsRecurrent fallers showed greater postural instability when visual and proprioceptive conditions changed than non-fallers, especially when both sensory inputs were simultaneously abolished. The speed of displacement of the centre of gravity on a foam surface was increased in the fallers both with open (p < 0.001) or closed eyes (p = 0.001). In the SS test, fallers took longer to stand from sitting without help (p < 0.001). The WA test results indicated a higher gait speed for the non-fallers (p = 0.001).ConclusionsAssessing postural control systems and identifying neurological fall risk factors in patients who undergo recurrent falls is the key to adopting appropriate measures to prevent subsequent falls and thus minimize their physical, psychological and social consequences.