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J Gerontol A Biol Sci Med Sci. 2018 Nov 1. doi: 10.1093/gerona/gly248. [Epub ahead of print]

The relationships between physical performance, activity levels and falls in older men.

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Department of Medicine, Bone and Mineral Unit, Oregon Health & Science University, Portland, OR.
Department of Biostatistics, School of Public Health and the Biostatistics and Design Program, Oregon Health & Science University, Portland, OR.
Department of Medicine, Yale School of Medicine, New Haven, CT.
Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA.
Center for Chronic Disease Outcomes Research, Veterans Affairs Health Care System, Department of Medicine, University of Minnesota, Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN.
Department of Family Medicine and Public Health, University of California, San Diego School of Medicine, San Diego, CA.
Department of Medicine, University of California, San Francisco, CA.
California Pacific Medical Center Research Institute and Department of Epidemiology and Biostatistics, University of California, San Francisco, CA.



Physical performance and activity have both been linked to fall risk, but the way they are jointly associated with falls is unclear. We investigated how these two factors are related to incident falls in older men.


In 2741 men (78.8±5 years) we evaluated the associations between activity and physical performance and how they jointly contributed to incident falls. Activity was assessed by accelerometry. Physical performance was measured by gait speed, dynamic balance (narrow walk), chair stand time, grip strength and leg power. Falls were ascertained by tri-annual questionnaires.


Men were grouped into four categories based on activity and performance levels. The greatest number of falls (36-43%) and the highest fall rate (4.7-5.4/year among those who fell) (depending on the performance test) occurred in men with low activity/low performance, but most falls (57-64%) and relatively high fall rates (3.0-4.35/year) occurred in the other groups (low activity/high performance, high activity/high performance and high activity/low performance; 70% of men were in these groups). There were interactions between activity, performance (gait speed, narrow walk) and incident falls (p=0.001-0.02); predicted falls/yr. were highest in men with low activity/low performance, but there was also a peak of predicted falls in those with high activity.


In community-dwelling older men, many falls occur in those with the lowest activity/worst physical performance but fall risk is also substantial with better activity and performance. Activity/physical performance assessments may improve identification of older men at risk of falls, and allow individualized approaches to prevention.


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