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Screening for Balance and Mobility Impairment in Elderly Individuals Living in Residential Care Facilities

N Harada, PhD, PT, is Health Services Research Associate, Geriatric Research, Education, and Clinical Center (11G), Veterans Administration Medical Center-West Los Angeles, and Assistant Professor, School of Medicine, University of California, Los Angeles, Los Angeles, CA 90073 (USA). She is also Associate Director, UCLA/MEDTEP Outcomes Research Center for Asians and Pacific Islanders.
V Chiu, is Research Associate, UCLA/MEDTEP Outcomes Research Center for Asians and Pacific Islanders.
J Damron-Rodriguez, PhD, is Associate Chief of Evaluation and Education, Geriatric Research, Education, and Clinical Center, Veterans Administration Medical Center-West Los Angeles, and Assistant Professor, School of Public Policy and Social Research, University of California, Los Angeles.
E Fowler, PhD, PT, is Adjunct Associate Professor, School of Medicine, and Director, Functional Assessment Laboratory, Department of Rehabilitation Services, University of California, Los Angeles.
A Siu, MD, MSPH, is Deputy Commissioner for Clinical Affairs, New York State Department of Health, Empire State Plaza, Corning Tower, Albany, NY 12220.
DB Reuben, is Chief, Division of Geriatrics; Director, Multicampus Program in Geriatric Medicine and Gerontology; and Associate Professor, School of Medicine, University of California, Los Angeles.

Background and Purpose. The rapid growth of the elderly population has resulted in a corresponding rise in the number of elderly individuals who experience disability during their lifetimes. The purpose of this study was to test the usefulness of four established clinical measures of balance, gait, and subjective perceptions of fear of falling as screening methods for referring community-dwelling elderly individuals living in residential care facilities for detailed physical therapy evaluation and possible intervention. Subjects. The subjects were a convenience sample of 53 elderly individuals living in two residential care facilities for the elderly. Methods. Subjects were tested on each of four clinical measures of balance and mobility. Their performance on these measures was compared with a physical therapist's brief evaluation of disability and appropriateness for more detailed evaluation. The usefulness of these tools as screening methods was determined by calculating sensitivity and specificity levels using the physical therapist's evaluation as a standard. Results. The sensitivity and specificity levels of the four clinical measures in their application as screening tests for referral to physical therapy were as follows: Berg Balance Scale, 84% and 78%; balance subscale of the Tinetti Performance-Oriented Mobility Assessment, 68% and 78%; gait speed, 80% and 89%; and Tinetti Fall Efficacy Scale, 59% and 82%. The combination of two tests, Berg Balance Scale and gait speed, yielded the highest sensitivity of 91% and the highest specificity of 70% when a subject tested positive on at least one test. Conclusion and Discussion. These findings indicate the feasibility of developing screening methods for referring community-dwelling elderly individuals for a detailed physical therapy evaluation based on established clinical assessment measures, with a combination of tests measuring balance and gait demonstrating the most promising results.

Key Words: Balance • Disability • Elderly • Gait • Screening

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