Self-Report of Missteps in Older Adults: A Valid Proxy of Fall Risk?

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 +/- SID participant age was 76.4 +/- 4.3 years. Of all the participants, 20.7% reported at least I 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.