Abstract
Objectives
Evaluate fall risk with the Short Physical Performance Battery (SPPB) and examine
its application within the Stopping Elderly Accidents, Deaths, and Injuries (STEADI)
tool advocated by the Centers for Disease Control and Prevention.
Design
Prospective longitudinal cohort study.
Setting and Participants
417 community-dwelling adults aged ≥65 years at risk for mobility decline, recruited
from 9 primary care practices.
Methods
The SPPB, a 3-part performance-based test (gait time, chair stand, and balance), was
assessed at baseline. Previously established cutpoints were used to categorize participant
scores into 3 groups: low, middle, and best performers. Self-reported falls were assessed
in-person at baseline and via phone interviews quarterly for 4 years. Multivariable
negative binomial regression models were used to evaluate the relationship of the
SPPB and each of its 3 components with fall rates over 1 and 4 years of follow-up.
Additional analysis were stratified by fall risk screen status (+/−) based on self-reported
fall history and balance self-efficacy using an adapted STEADI model.
Results
Participants had median age 76 years (interquartile range 70-82) and were 67.2% female
with mean baseline SPPB 8.7 ± 2.3. Poor performance on the SPPB and on each of its
3 components independently predicted higher fall risk in the first year. After 4 years,
the low total baseline SPPB [rate ratio (RR) 1.53, confidence interval (CI) 1.09-2.17]
and gait time performances (RR 1.61, CI 1.07-2.41) predicted higher fall risk. After
stratifying the sample according to the STEADI model, we observed the highest 1-year
fall risk among those with a (+) fall risk screen who also scored lowest on the SPPB.
Conclusions and Implications
The SPPB is a performance measure with clinical utility for fall risk stratification
over 1 and 4 years of follow-up among older adults. It shows promise as a complement
to the STEADI guidelines, but its full benefits should be confirmed within a larger
study.
Keywords
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Article info
Publication history
Published online: November 13, 2020
Footnotes
Funding Sources: This work was supported by the National Institute on Aging (R01 AG032052-03) and the National Center for Research Resources in a grant to the Harvard Clinical and Translational Science Center (1 UL1 RR025758-01) and in part by a National Institutes of Health K24 award (4K24HD070966-05).
The authors declare no conflicts of interest.
Identification
Copyright
Published by Elsevier Inc. on behalf of AMDA - The Society for Post-Acute and Long-Term Care Medicine.
