A new longitudinal study suggested that balance-testing protocols for older adults should be lengthened from the conventional 10 seconds to at least 23 seconds to better detect subtle balance deficits and predict fall risk. The researchers followed 153 community-dwelling older adults for 6 months and found that mediolateral amplitude of Center of Pressure displacement and sustained balance times in challenging positions were significant predictors of future falls.
The study, published in BMC Geriatrics, demonstrated that maintaining tandem and single-leg stance positions for longer durations served as protective factors against falls. "An increase of 1 s in the duration of these maintenance positions decreases the odds of an older adult falling in the next 6 months by 5%," Daniela Cristina Carvalho de Abreu, of the Department of Health Sciences, Rehabilitation and Functional Performance Program, Ribeirão Preto Medical School, University of São Paulo in Brazil, and colleagues reported.
The investigation revealed marked differences between fallers and nonfallers in their ability to maintain challenging positions. Nonfallers maintained the single-leg stance for 17.2 seconds and tandem stance for 24.8 seconds, while fallers averaged only 10.4 seconds and 17.5 seconds respectively.
"In clinical practice in which only stance time is recorded, it is possible to interchangeably use the double-leg or semi-tandem stance. To identify early signs of imbalance, we suggest setting a time limit for the balance test equal to or greater than 23 s, as 10 s appear to be insufficient to detect subtle balance deficits," the researchers wrote.
The study utilized sophisticated force platform measurements to assess anteroposterior and mediolateral Center of Pressure (CoP) displacements across four increasingly challenging positions: double-leg, semi-tandem, tandem, and single-leg stances. Notable sex differences emerged: males demonstrated greater CoP displacement but longer stance maintenance times compared with females.
The research cohort consisted predominantly of females (78%), and participants' ages ranged from 60 to 89 years old. Of the 55 participants (36%) who experienced falls during the 6-month follow-up period, 87.27% were female. Common comorbidities included arterial hypertension (93%), dyslipidemia (61%), hypothyroidism (35%), and osteoarthritis (23%).
The findings have direct implications for clinical assessment protocols, and suggest that current standard testing durations may be insufficient for detecting early balance deficits in community-dwelling older adults. The researchers concluded: "assessing the time an individual can maintain tandem and single-leg stances can help identify older adults at risk of falling within the next six months."
The researchers declared no competing interests.