Advertisement

Slip and Fall Risk Assessment

  • Feng Yang
Reference work entry

Abstract

The cumulative effect of falls on older adults and on the healthcare system is immense; the results are debilitating injuries, loss of independence, and transfer to a healthcare institution, or even death. Slip-related falls contribute up to 40% of all outdoor falls in seniors, which often cause serious injuries such as hip fractures and high economic burden. Therefore, it is pressing to develop fall prevention interventions to prevent falls from happening. To identify individuals with high risk of falls could be equivalently important to the development of fall prevention paradigms because it allows the limited resources assigned to fall prevention to be directed to those who truly need the interventions. It is thus essential to establish accurate and effective fall risk assessment tools to identify those with elevated risk of falls. This chapter intends to review the approaches which can be applied in research or clinics to evaluate one’s risk of falls after a slip. Dynamic gait stability and lower limb support have been identified as two key factors leading to slip-initiated falls. In addition, muscle weakness was associated with high risk of slips and falls. Other measures including dynamic stability based on linear and nonlinear dynamics and gait parameters could also play a certain role in predicting a fall initiated by a slip. These measurements provide some useful and objective tools for the early identification of individuals with a higher risk of falling, which is important for effective deployment of fall prevention interventions.

Keywords

Fall prevention Muscle strength Muscle power Dynamic stability Limb support Variability Balance loss 

References

  1. Bean JF, Leveille SG, Kiely DK, Bandinelli S, Guralnik JM, Ferrucci L (2003) A comparison of leg power and leg strength within the InCHIANTI study: which influences mobility more? J Gerontol Ser A: Biol Sci Med Sci 58:M728–M733CrossRefGoogle Scholar
  2. Berg WP, Alessio HM, Mills EM, Tong C (1997) Circumstances and consequences of falls in independent community-dwelling older adults. Age Ageing 26:261–268CrossRefGoogle Scholar
  3. Bhatt T, Espy D, Yang F, Pai Y-C (2011) Dynamic stability, clinical correlates, and prognosis of falls among community-dwelling older adults. Arch Phys Med Rehabil 92:799–805CrossRefGoogle Scholar
  4. Borelli GA (1680) De Motu Animalium (On the movement of animals). Springer, BerlinGoogle Scholar
  5. Bruijn SM, Kate WR, Faber GS, Meijer OG, Beek PJ, van Dieen JH (2010) Estimating dynamic gait stability using data from non-aligned inertial sensors. Ann Biomed Eng 38:2588–2593CrossRefGoogle Scholar
  6. Bruijn SM, Bregman DJJ, Meijer OG, Beek PJ, van Dieen JH (2011) The validity of stability measures: A modelling approach. J Biomech 44:2401–2408CrossRefGoogle Scholar
  7. Callisaya ML, Blizzard L, Schimidt MD, Martin KL, McGinley JL, Sanders LM, Srikanth VK (2011) Gait, gait variability and the risk of multiple incident falls in older people: a population-based study. Age Ageing 40:481–487CrossRefGoogle Scholar
  8. Cham R, Redfern MS (2001) Lower extremity corrective reactions to slip events. J Biomech 34:1439–1445CrossRefGoogle Scholar
  9. Ding L, Yang F (2016) Muscle weakness is related to slip-initiated falls among community-dwelling older adults. J Biomech 49:238–243CrossRefGoogle Scholar
  10. Dingwell JB, Cusumano JP (2000) Nonlinear time series analysis of normal and pathological human walking. Chaos 10:848–863CrossRefzbMATHGoogle Scholar
  11. Dingwell JB, Kang HG (2007) Differences between local and orbital dynamic stability during human walking. J Biomech Eng 129:586–593CrossRefGoogle Scholar
  12. Dingwell JB, Cusumano J, Cavanagh P, Sternad D (2001) Local dynamic stability versus kinematic variability of continuous overground and treadmill walking. J Biomech Eng 123:27–32CrossRefGoogle Scholar
  13. Dingwell JB, Gu KH, Marin LC (2007) The effects of sensory loss and walking speed on the orbital dynamic stability of human walking. J Biomech 40:1723–1730CrossRefGoogle Scholar
  14. Donelan JM, Shipman DW, Kram R, Kuo AD (2004) Mechanical and metabolic requirements for active lateral stabilization in human walking. J Biomech. 37:827–835CrossRefGoogle Scholar
  15. El-Khoury F, Cassou B, Charles M-A, Dargent-Molina P (2013) The effect of fall prevention exercise programmes on fall induced injuries in community dwelling older adults: systematic review and meta-analysis of randomised controlled trials. BMJ 2013:1–13Google Scholar
  16. England SA, Granata KP (2007) The influence of gait speed on local dynamic stability of walking. Gait Posture 25:172–178CrossRefGoogle Scholar
  17. Englander F, Hodson TJ, Terregrossa RA (1996) Economic dimensions of slip and fall injuries. J Forensic Sci 41:733–746CrossRefGoogle Scholar
  18. Evans WJ (2000) Exercise strategies should be designed to increase muscle power. J Gerontol Ser A: Biol Sci Med Sci 55:M309–M310CrossRefGoogle Scholar
  19. Feldman F, Robinovitch SN (2006) Recalling the mechanics of falls. Young adults cannot accurately describe the sites of impact immediately after a fall occurs. Osteoporos Int 17:955Google Scholar
  20. Foldvari M, Clark M, Laviolette LC, Bernstein MA, Kaliton D, Castaneda C, Pu CT, Hausdorff JM, Fielding RA, Singh MA (2000) Association of muscle power with functional status in community-dwelling elderly women. J Gerontol Ser A: Biol Sci Med Sci 55:M192–M199CrossRefGoogle Scholar
  21. Goodpaster BH, Park SW, Harris TB, Kritchevsky SB, Nevitt M, Schwartz AV, Simonsick EM, Tylavsky FA, Visser M, Newman AB (2006) The loss of skeletal muscle strength, mass, and quality in older adults: the health, aging and body composition study. J Gerontol Ser A: Biol Sci Med Sci 61:1059–1064CrossRefGoogle Scholar
  22. Graafmanc WC, Lips P, Wijlhuizen GJ, Pluijm SM, Bouter LM (2003) Daily physical activity and the use of a walking aid in relation to falls in elderly people in a residential care setting. Z Gerontol Geriatr 36:23–28CrossRefGoogle Scholar
  23. Granata KP, Lockhart TE (2008) Dynamic stability differences in fall-prone and healthy adults. J Electromyogr Kinesiol 18:172–178CrossRefGoogle Scholar
  24. Grisso JA, Kelsey JL, Strom BL, Chiu GY, Maislin G, O’Brien LA, Hoffman S, Kaplan F (1991) Risk factors for falls as a cause of hip fracture in women. N Engl J Med 324:1326–1331CrossRefGoogle Scholar
  25. Haines T, Kuys SS, Morrison G, Clarke J, Bew P (2008) Balance impairment not predictive of falls in geriatric rehabilitation wards. J Gerontol: Med Sci 63A:523–528CrossRefGoogle Scholar
  26. Hamacher D, Singh NB, Van Dieen JH, Heller MO, Taylor WR (2011) Kinematic measures for assessing gait stability in elderly individuals: a systematic review. J R Soc Interface 8:1682–1698CrossRefGoogle Scholar
  27. Han L-Z, Yang F (2015) Strength or power: which is more important to prevent slip-related falls? Hum Mov Sci 44:192–200CrossRefGoogle Scholar
  28. Hardy R, Cooper R, Shah I, Harridge S, Guralnik J, Kuh D (2010) Is chair rise performance a useful measure of leg power? Aging Clin Exp Res 22:412–418CrossRefGoogle Scholar
  29. Hausdorff JM, Edelberg HK, Mitchell SL, Goldberger AL, Wei J-Y (1997) Increased gait unsteadiness in community-dwelling elderly fallers. Arch Phys Med Rehabil 78:278–283CrossRefGoogle Scholar
  30. Hausdorff JM, Rios DA, Edelberg HK (2001) Gait variability and fall risk in community-living older adults: a 1-year prospective study. Arch Phys Med Rehabil 82:1050–1056CrossRefGoogle Scholar
  31. Hayes WC, Myers ER, Robinovitch SN, Van Den Kroonenberg A, Courtney AC, McMahon TA (1996) Etiology and prevention of age-related hip fractures. Bone 18:77s–86sCrossRefGoogle Scholar
  32. Hedlund R, Lindgren U (1987) Trauma type, age, and gender as determinants of hip fracture. J Orthop Res 5:242–246CrossRefGoogle Scholar
  33. Heinrich S, Rapp K, Rissmann U, Becker C, Kunig H-H (2010) Cost of falls in old age: a systematic review. Osteoporos Int 21:891–902CrossRefGoogle Scholar
  34. Hof AL, Gazendam MG, Sinke WE (2005) The condition for dynamic stability. J Biomech 38:1–8CrossRefGoogle Scholar
  35. Horlings CGC, van Engelen BGM, Allum JHH, Bloem BR (2008) A weak balance: the contribution of muscle weakness to postural instability and falls. Nat Clin Pract Neurol 4:504–515CrossRefGoogle Scholar
  36. Hurmuzlu Y, Basdogan C (1994) On the measurement of dynamic stability of human locomotion. J Biomech Eng 116:30–36CrossRefGoogle Scholar
  37. Jenkins P, Earle-Richardson G, Slingerland DT, May J (2002) Time dependent memory decay. Am J Ind Med 41:98–101CrossRefGoogle Scholar
  38. Kannus P, Parkkari J, Koskinen S, Niemi S, Palvanen M, Jarvinen M, Vuori I (1999) Fall-induced injuries and deaths among older adults. J Am Med Assoc 281:1895–1899CrossRefGoogle Scholar
  39. Kavanagh JJ, Menz HB (2008) Accelerometry: a technique for quantifying movement patterns during walking. Gait Posture 28:1–5CrossRefGoogle Scholar
  40. Koepsell TD, Wolf ME, Buchner DM, Kukull WA, LaCroix AZ, Tencer AF, Frankenfeld CL, Taulvydas M, Larson EB (2004) Footwear style and risk of falls in older adults. J Am Geriatr Soc 52:1495–1501CrossRefGoogle Scholar
  41. Kraemer WJ, Newton RU (2000) Training for muscular power. Phys Med Rehabil Clin N Am 11:341–368Google Scholar
  42. Labrador MA, Delahoz YS (2014) Survey on fall detection and fall prevention using wearable and external sensors. Sensors 14:19806–19842CrossRefGoogle Scholar
  43. Lajoie Y, Gallagher SP (2004) Predicting falls within the elderly community: comparison of postural sway, reaction time, the Berg balance scale and the Activities-specific Balance Confidence (ABC) scale for comparing fallers and non-fallers. Arch Gerontol Geriatr 38:11–26CrossRefGoogle Scholar
  44. Lockhart TE, Liu J (2008) Differentiating fall-prone and healthy adults using local dynamic stability. Ergonomics 51:1860–1872CrossRefGoogle Scholar
  45. Luukinen H, Herala M, Koski K, Honkanen R, Laippala P, Kivela SL (2000) Fracture risk associated with a fall according to type of fall among the elderly. Osteoporos Int 11:631–634CrossRefGoogle Scholar
  46. Maki BE, McIlroy WE (1997) The role of limb movements in maintaining upright stance: the “change-in-support” strategy. Phys Ther 77:488–507CrossRefGoogle Scholar
  47. Melzer I, Benjuya N, Kaplanski J (2004) Postural stability in the elderly: a comparison between fallers and non-fallers. Age Ageing 33:602–607CrossRefGoogle Scholar
  48. Mille ML, Rogers MW, Martinez K, Hedman LD, Johnson ME, Lord SR, Fitzpatrick RC (2003) Thresholds for inducing protective stepping responses to external perturbations of human standing. J Neurophysiol 90:666–674CrossRefGoogle Scholar
  49. Moreland JD, Richardson JA, Goldsmith CH, Clase CM (2004) Muscle weakness and falls in older adults: a systematic review and meta-analysis. J Am Geriatr Soc 52:1121–1129CrossRefGoogle Scholar
  50. Morley JE (2002) A fall is a major event in the life of an older person. J Gerontol Ser A Biol Sci Med Sci 57:M492–M495CrossRefGoogle Scholar
  51. Moyer BE, Chambers AJ, Redfern MS, Cham R (2006) Gait parameters as predictors of slip severity in younger and older adults. Ergonomics 49:329–343CrossRefGoogle Scholar
  52. Moyer BE, Redfern MS, Cham R (2009) Biomechanics of trailing leg response to slipping - Evidence of interlimb and intralimb coordination. Gait Posture 29:565–570CrossRefGoogle Scholar
  53. Muir SW, Berg KO, Chesworth B, Klar N, Speechley M (2010) Balance impairment as a risk factor for falls in community-dwelling older adults who are high functioning: a prospective study. Phys Ther 90:338–347CrossRefGoogle Scholar
  54. Muir SW, Gopaul K, Montero Odasso MM (2012) The role of cognitive impairment in fall risk among older adults: a systematic review and meta-analysis. Age Ageing 41:299–308CrossRefGoogle Scholar
  55. Nevitt MC, Cummings SR, Kidd S, Black D (1989) Risk factors for recurrent nonsyncopal falls. A prospective study. J Am Med Assoc 261:2663–2668CrossRefGoogle Scholar
  56. O’Sullivan SB (2007) Examination of motor function. In: O’Sullivan SB, Schmitz TJ (eds) Physical rehabilitation. F.A. Davis Company, Philadelphia, pp 249–253Google Scholar
  57. Orr R (2010) Contribution of muscle weakness to postural instability in the elderly. Eur J Phys Rehabil Med 46:183–220Google Scholar
  58. Orr R, de Vos NJ, Singh NA, Ross DA, Stavrinos TM, Fiatarone-Singh MA (2006) Power training improves balance in healthy older adults. J Gerontol Ser A: Biol Sci Med Sci 61A:78–85CrossRefGoogle Scholar
  59. Owings TM, Grabiner MD (2004) Step width variability, but not step length variability or step time variability, discriminates gait of healthy young and older adults during treadmill locomotion. J Biomech 37:935–938CrossRefGoogle Scholar
  60. Pai Y-C, Patton JL (1997) Center of mass velocity-position predictions for balance control. J Biomech 30:347–354CrossRefGoogle Scholar
  61. Pai Y-C, Yang F, Wening JD, Pavol MJ (2006) Mechanisms of limb collapse following a slip among young and older adults. J Biomech 39:2194–2204CrossRefGoogle Scholar
  62. Parkkari J, Kannus P, Palvanen M, Natri A, Vainio J, Aho H, Vuori I, Jarvinen M (1999) Majority of hip fractures occur as a result of a fall and impact on the greater trochanter of the femur: a prospective controlled hip fracture study with 206 consecutive patients. Calcif Tissue Int 65:183–187CrossRefGoogle Scholar
  63. Patton JL, Lee WA, Pai Y-C (2000) Relative stability improves with experience in a dynamic standing task. Exp Brain Res 135:117–126CrossRefGoogle Scholar
  64. Pavol MJ, Pai Y-C (2007) Deficient limb support is a major contributor to age differences in falling. J Biomech 40:1318–1325CrossRefGoogle Scholar
  65. Pijnappels M, Bobbert MF, van Dieen JH (2005) Control of support limb muscles in recovery after tripping in young and older subjects. Exp Brain Res 160:326–333CrossRefGoogle Scholar
  66. Redfern MS, Cham R, Gielo-Perczak K, Gronqvist R, Hirvonen M, Lanshammar H, Marpet M, Pai Y-C, Powers C (2001) Biomechanics of slips. Ergonomics 44:1138–1166CrossRefGoogle Scholar
  67. Riva F, Bisi MC, Stagni R (2013) Orbital stability analysis in biomechanics: a systematic review of a nonlinear technique to detect instability of motor tasks. Gait Posture 37:1–11CrossRefGoogle Scholar
  68. Rubenstein LZ (2006) Falls in older people: epidemiology, risk factors and strategies for prevention. Age Ageing 35(Suppl 2):ii37–ii41CrossRefGoogle Scholar
  69. Rubenstein LZ, Josephson KR (2006) Falls and their prevention in elderly people: what does the evidence show? Med Clin N Am 90:807–824CrossRefGoogle Scholar
  70. Rubenstein LZ, Josephson KR, Robbins AS (1994) Falls in the nursing home. Ann Intern Med 121:442–451CrossRefGoogle Scholar
  71. Skelton DA, Greig CA, Davies JM, Young A (1994) Strength, power and related functional ability of healthy people aged 65-89 years. Age Ageing 23:371–377CrossRefGoogle Scholar
  72. Skelton DA, Kennedy J, Rutherford OM (2002) Explosive power and asymmetry in leg muscle function in frequent fallers and non-fallers aged over 65. Age Ageing 31:119–125CrossRefGoogle Scholar
  73. Sleet DA, Moffett DB, Stevens J (2008) CDC’s research portfolio in older adults fall prevention: A review of progress, 1985 - 2005, and future research directions. J Safety Res 39:259–267CrossRefGoogle Scholar
  74. Smeesters C, Hayes WC, McMahon TA (2001) Disturbance type and gait speed affect fall direction and impact location. J Biomech 34:309–317CrossRefGoogle Scholar
  75. Stevens JA, Corso PS, Finkelstein EA, Miller TR (2006) The costs of fatal and non-fatal falls among older adults. Inj Prev 12:290–295CrossRefGoogle Scholar
  76. Tinetti ME (1986) Performance-oriented assessment of mobility problems in elderly patients. J Am Geriatr Soc 34:119–126CrossRefGoogle Scholar
  77. Tinetti ME (2003) Preventing falls in elderly persons. N Engl J Med 388:42–49CrossRefGoogle Scholar
  78. Toebes MJ, Hoozemans MJ, Furrer R, Dekker J, van Dieen JH (2012) Local dynamic stability and variability of gait are associated with fall history in elderly subjects. Gait Posture 36:527–531CrossRefGoogle Scholar
  79. Verghese J, Holtzer R, Lipton RB, Wang C (2009) Quantitative gait markers and incident fall risk in older adults. J Gerontol Med Sci 64:896–901CrossRefGoogle Scholar
  80. Wang T-Y, Bhatt T, Yang F, Pai Y-C (2011) Generalization of motor adaptation to repeated-slip perturbation across tasks. Neuroscience 180:85–95CrossRefGoogle Scholar
  81. Wang T-Y, Bhatt T, Yang F, Pai Y-C (2012) Adaptive control reduces trip-induced forward gait instability among young adults. J Biomech 45:1169–1175CrossRefGoogle Scholar
  82. Wijlhuizen GJ, Chorus AMJ, Hopman-Rock M (2010) The FARE: a new way to express FALLs Risk among older persons including physical activity as a measure of exposure. Prev Med 50:143–147CrossRefGoogle Scholar
  83. Woledge RC, Birtles DB, Newham DJ (2005) The variable component of lateral body sway during walking in young and older humans. J Gerontol Ser A: Biol Sci Med Sci 60:1463–1468CrossRefGoogle Scholar
  84. World Health Organization (2007) Global age-friendly cities: A guide. Geneva, Switzerland, pp 76Google Scholar
  85. Yang F, Pai Y-C (2010a) Reactive control and its operation limits in responding to a novel slip in gait. Ann Biomed Eng 38:3246–3256CrossRefGoogle Scholar
  86. Yang F, Pai Y-C (2010b) Role of individual lower limb joints in reactive stability control following a novel slip in gait. J Biomech 43:397–404CrossRefGoogle Scholar
  87. Yang F, Pai Y-C (2011) Automatic recognition of falls in gait-slip training: Harness load cell based criteria. J Biomech 44:2243–2249CrossRefGoogle Scholar
  88. Yang F, Pai Y-C (2014) Can stability really predict an impending slip-related fall among older adults? J Biomech 47:3876–3881CrossRefGoogle Scholar
  89. Yang F, Anderson FC, Pai Y-C (2007) Predicted threshold against backward balance loss in gait. J Biomech 40:804–811CrossRefGoogle Scholar
  90. Yang F, Anderson FC, Pai Y-C (2008a) Predicted threshold against backward balance loss following a slip in gait. J Biomech 41:1823–1831CrossRefGoogle Scholar
  91. Yang F, Passariello F, Pai Y-C (2008b) Determination of instantaneous stability against backward balance loss: Two computational approaches. J Biomech 41:1818–1822CrossRefGoogle Scholar
  92. Yang F, Bhatt T, Pai Y-C (2009) Role of stability and limb support in recovery against a fall following a novel slip induced in different daily activities. J Biomech 42:1903–1908CrossRefGoogle Scholar
  93. Yang F, Bhatt T, Pai Y-C (2011) Limits of recovery against slip-induced falls while walking. J Biomech 44:2607–2613CrossRefGoogle Scholar
  94. Yang F, Espy D, Bhatt T, Pai Y-C (2012) Two types of slip-induced falls among community dwelling older adults. J Biomech 45:1259–1264CrossRefGoogle Scholar
  95. Zijlstra GA, van Haastregt JC, van Rossum E, van Eijk JT, Yardley L, Kempen GI (2007) Interventions to reduce fear of falling in community-living older people: a systematic review. J Am Geriatr Soc 55:603–615CrossRefGoogle Scholar
  96. Zijlstra GA, van Haastregt JCM, Ambergen T, van Rossum E, van Eijk JTM, Tennstedt SL, Kempen GIJM (2009) Effects of a multicomponent cognitive behavioral group intervention on fear of falling and activity avoidance in community-dwelling older adults: Results of a randomized controlled trial. J Am Geriatr Soc 57:2020–2028CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of KinesiologyThe University of Texas at El PasoEl PasoUSA

Personalised recommendations