THE TIMED “UP & GO” TEST IS A USEFUL PREDICTOR OF FALLS IN COMMUNITY‐DWELLING OLDER PEOPLE

Field: Health Professions (Health Sciences)

To the Editor: Vellas et al. reported that one-leg balance is an important predictor of injurious falls in older persons.1 We now show in a cross-sectional study in 1991 and in a longitudinal cohort study with a follow up of 5 years from 1991 to 1996 in Kahoku, a rural Japanese town, that the timed "Up & Go" test2 is also a useful and easy to administer predictor of falls. The timed "Up & Go" test measures, in seconds, the time it takes the subject to stand up from an armchair, walk a distance of 3 meters, turn, walk back to the chair, and sit down again. This test is a simple measure of physical mobility and demonstrates the subject's balance, gait speed, and functional ability.2 The study population consisted of 328 subjects aged 75 years or older (151 men and 177 women; mean age in 1991, 80.3 years) who participated in the Kahoku Longitudinal Aging Study3 in 1991. Through the use of a self-administered questionnaire, the subjects were asked about their frequency of falls, medical history, antihypertensive drug use, activities of daily living (ADL), alcohol intake, and functions of sight and hearing. The following assessments were also carried out in 1991: 1 Neurobehavioral functions as determined by the following tests: "Up & Go" test, Button score,4 Mini-Mental State (MMS), and Visuospatial Cognitive Performance Test (VCP-test)4; 2 Body mass index and blood pressure measurements; 3 Geriatric Depression Scale (GDS)5; 4 blood chemistries. The subjects were divided into two groups, non-fallers and fallers, according to their frequency of falls in 1991. Nonfallers were defined as subjects who did not fall and fallers as subjects who fell occasionally or frequently in those days. In 1991 there were 278 nonfallers and 50 fallers. We adjusted odds ratios using multiple logistic regression analysis considering fallers as the dependent variable. Independent variables included in the model were those variables that were statistically significant in monovariate analysis ("Up & Go" test, Button score, depression, ADL dependency, hearing impairment, antihypertensive drug use, low total cholesterol, history of bone disease or arthropathy) along with age and sex. Cross-sectional independent predictors of falls in 1991 in multivariate analysis were "Up & Go" test score > 16 seconds (adjusted odds ratio: 2.6, 95% CI: 1.2-6.0), antihypertensive drug use (3.6, 1.7-7.6), and de-pression(GDS ≥ 10)(2.4, 1.1-5.2). We followed 278 nonfallers for 5 years, and the frequency of their falls was queried annually in the questionnaire. Thirty-five subjects dropped out of the study during the 5-year period, making the final sample size of the study 243 subjects, of whom 175 subjects remained nonfallers; 68 subjects became fallers during the follow-up period. Table 1 shows the longitudinal risk factors for falls obtained by monovariate analysis and multiple logistic regression analysis. Independent variables included in the model were those variables that were statistically significant in monovariate analysis ("Up & Go" test, Button score, history of stroke, depression, VCP-test, ADL dependency, low HDL cholesterol, high blood urea nitrogen, high fibrinogen, and alcohol intake) along with age and sex. The independent predictors of falls in the multivariate analysis were Up & Go test > 16 seconds (adjusted odds ratio: 2.7, 95% CI: 1.3-5.8), Button score > 17 seconds (2.2, 1.0-4.6), history of stroke (16.8, 1.5-189.4), and depression (GDS ≥ 10) (2.0, 1.0-4.1). The sensitivity of the abnormal "Up & Go" test (more than 16 seconds) at baseline to predict fallers during the follow-up period was 54%, specificity was 74%, and positive predictive value was 44%. There were eight subjects with a history of stroke in 1991, seven of whom became fallers during the 5-year follow-up period. History of stroke is the most potent predictor of falls in our study, as in Campbell et al.6 Falls are also associated with manual dexterity, assessed by Button score, and with depression, which was, strictly, not significant (P =.06) in our study, as suggested by Tinetti et al.7, 8 In conclusion, the "Up & Go" test, which was found to be improved by physical exercises in the older people living in the community in our recent study,4 was an independent predictor of falls both in our cross-sectional study and in longitudinal studies. The timed "Up & Go test", as well as the one-leg balance, may be useful and easy-to-administer predictors of falls in older people. Editors note: The above letter was referred to the authors of the original paper, and their reply follows.