Background Falls in older adults precipitate hospitalisation, frailty and premature mortality and are a growing health concern. The standing balance test is a simple, cost effective tool used to screen for fall risk in adults aged 65+, however the association between standing balance and fall risk has not been examined in individuals younger than 65. To assess whether balance tests could be utilised to screen for fall risk at younger ages, we investigated if balance at ages 53 and 60–64 was associated with prevalence and frequency of subsequent falls.
Methods Data from the MRC National Survey of Health and Development, a British birth cohort study, were utilised (n=2571). Standing balance time (eyes closed) was assessed at ages 53 and 60–64 (max: 30 seconds). Fall history within the last year was self-reported at ages 60–64 and 68 and categorised to indicate fall prevalence (yes, no) and frequency (0, 1–2, 3+). Binary and multinomial logistic regressions were used to assess associations of balance time (per 1 second increase) with fall prevalence and frequency, respectively. Adjustments were made for sex, height, BMI, socioeconomic position, physical activity, smoking, knee pain, diabetes, cardiovascular events and respiratory and depressive symptoms.
Results Women reported higher prevalence of falls than men at ages 60–64 (23% vs 14%) and 68 (26% vs 18%). Longer balance time at age 53 was associated with reduced odds of falling at age 60–64 [OR: 0.98 (95% CI: 0.97,1.00)]; similar associations were found between balance at age 60–64 and falls at age 68 [0.96 (0.93,0.99)]. Better balance at age 53 was associated with lower risk of 3 or more falls (vs no falls) at ages 60–64 [RRR: 0.88 (0.80,0.98)] and 68 [0.93 (0.88,0.97)]. Better balance at age 60–64 was also associated with lower risk of 3+ falls at age 68 [RRR: 0.92 (0.85,0.98)] and in addition was associated with lower risk of 1–2 falls [0.97 (0.94,1.00)]. These associations remained after adjustments.
Discussion Poorer balance at ages 53 and 60–64 was associated with subsequent fall risk. Balance at age 53 was most strongly associated with 3 or more falls, while balance at age 60–64 was associated with both 1–2 and 3+ falls. Whether this is due to stronger associations at age 60–64 or a shorter time between balance and falls assessments requires further investigation. Balance tests in middle age may help identify high risk individuals who would benefit from earlier interventions to prevent future recurrent falls.
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