Self-report of missteps in older adults: a valid proxy of fall risk?

Arch Phys Med Rehabil. 2009 May;90(5):786-92. doi: 10.1016/j.apmr.2008.11.007.


Objective: To evaluate the relationship between missteps and falls and to identify factors associated with missteps, potentially to generate a broader picture of fall risk.

Design: Prospective, observational cohort.

Setting: General community.

Participants: A sample of healthy, community-living older adults (N=266; age, 70-90y) who were cognitively intact and walked independently.

Interventions: Not applicable.

Main outcome measures: Baseline testing of gait, motor function, cognitive function, affect, and balance confidence was followed by a 12-month period in which subjects completed a daily log documenting the number of falls and missteps (defined as a trip, slip, or other loss of balance in which recovery occurred to prevent a fall).

Results: Mean +/- SD participant age was 76.4+/-4.3 years. Of all the participants, 20.7% reported at least 1 misstep, and 25.6% of the participants reported at least 1 fall during the 12 months. Among subjects who had multiple falls, missteps were more common than falls by a ratio of 3:1 (P<.001). Subjects who reported multiple missteps were more likely to fall prospectively (relative risk=3.89). Missteps were associated with higher scores on the Geriatric Depression Scale (P=.009) and increased anxiety (P=.014), but were not associated with other known risk factors for falls, including gait and cognitive function.

Conclusions: The self-report of missteps may be a valuable tool in the research of falls and fall risk and may provide a way to identify patients at risk for falls before they fall.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Accidental Falls / prevention & control
  • Accidental Falls / statistics & numerical data*
  • Activities of Daily Living*
  • Aged
  • Aged, 80 and over
  • Cognition Disorders / diagnosis
  • Cognition Disorders / epidemiology
  • Female
  • Gait / physiology*
  • Geriatric Assessment
  • Humans
  • Incidence
  • Male
  • Postural Balance / physiology*
  • Predictive Value of Tests
  • Probability
  • Prospective Studies
  • Reproducibility of Results
  • Risk Assessment
  • Sampling Studies
  • Self-Assessment
  • Sensitivity and Specificity