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Falls, Walking Ability, and Physical Activity in the Elderly

Ulrike S. Trampisch, Department of Sports Medicine and Sports Nutrition, Faculty of Sports Sciences, Ruhr-University Bochum; Timo Hinrichs, Department of Sports Medicine and Sports Nutrition, Faculty of Sports Sciences, Ruhr-University Bochum, Germany; Heinz Endres, Ina Burghaus, Renate Klaassen-Mielke, Department of Medical Informatics, Biometry and Epidemiology, Ruhr-University Bochum, Germany; Margitta Lungenhausen, Department of Pain Management, BG-Kliniken Bergmannsheil, Ruhr-University Bochum, Germany; Petra Platen, Department of Sports Medicine and Sports Nutrition, Faculty of Sports Sciences, Ruhr-University Bochum, Germany

Introduction: The incidence of falls in people over 65 years of age who are living in the community is high. Falls often have serious consequences in older persons and may result in sustained disability and in loss of autonomy. The result can be a vicious cycle for the patient: On the one hand disability limits physical activity; on the other hand activity and exercise are essential to prevent further falls. This study reports on the associations between self-reported falls, walking ability, and physical activity in elderly people.

Methods: In a monitored prospective cohort study (German epidemiological trial on ankle brachial index, getABI), 6,880 unselected patients 65 years were followed up by 344 representative primary care physicians in Germany since November 2001. In the 5-year follow-up, 2,120 patients (median age 76; 70-94 years; 53.7% women) of the cohort were interviewed about their level of physical activity (activity of moderate intensity for at least 30 min per session): 1: no activities or active less than once per week, 2: active 1 time per week) and on the occurrence of a fall during the previous 3 months. Moreover, they were asked if they had been able to walk without a walking aid during the previous 4 weeks (2,111 of all patients answered these questions).

Results: 80.7% of the 2,111 patients reported to be active (level 2). 8.2% had experienced a fall during the previous 3 months, and 13.4% even suffered a fracture following their fall. 10.1% of patients were not able to walk without an aid in the 4 weeks before the interview. A log linear model concerning fall status, ability to walk, and the activity showed that there was no significant relation between activity level and fall status (7.8% of falls among level 1 versus 9.8% among level 2; p = .65), as well as no three-way interaction (p = .97). However, there was a strong association (p < .001) between activity level and walking ability, as well as between fall status and ability to walk (p < .001). 7.3% of the 1,897 patients without a walking aid had experienced a fall, whereas 16.4% of the 214 patients who were not able to walk without an aid had experienced a fall.

Conclusion: The incidence of self-reported falls and the prevalence of impairment measured by the inability to walk without an aid are high in elderly people. As expected, the ability to walk independently was associated with the level of physical activity. Furthermore, the frequency of falls seems to be reduced when a person is able to walk without an aid. There seems to be no relevant association between fall status and activity level. Considering the relevance of regular physical activity for health, the preservation of walking ability should be a major aim in elderly health care. The study has been conducted within the research cooperation PRISCUS ("Prerequisites for a new health care model for elderly people with multimorbidity"), which is funded by the German Federal Ministry of Education and Research (01ET0720).


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