Balance testing should start at 45, not 65: Emerging Evidence

Harmon KJ, et al. Inj Prev 2019;25:184–186. doi:10.1136/injuryprev-2018-042875.

Brief Summary

The study suggests that fall risk assessment and prevention activities should be initiated earlier than age 65, particularly for women, and recommends beginning these activities before age 45 for women, as the incidence rates of fall-related emergency department visits begin to increase in early middle age for women.

Key Takeaways

What is Known:

• Falls are a major cause of injury morbidity and mortality among adults. Fall screening and other prevention programs have been demonstrated to reduce fall morbidity and mortality; however, these activities are rarely initiated in adults under the age of 65

New Findings about Balance Testing:

• The study examined the incidence of fall-related emergency department visits across the lifespan

• Throughout the human lifespan, fall-related emergency department visits among women exceeded the rate of fall-related emergency department visits by men

• The incidence of fall-related emergency department visits started to increase in early middle age among women and later for men
  
  

Vital Fall Risk Information

• The epidemiology of falls may not be accurately reflected in available data,
  with likely higher rates of falls, especially in women, occurring earlier in
  life

• Tracking falls and implementing community measures to reduce falls may
  impact emerging trends in fall-related injuries and morbidity
  
   “Fall risk assessment should begin with middle-aged women, so that prevention
  strategies, including gait, balance, and strength training, can be initiated before
  fall risk accelerates.”

Relevant Data:

• Design: Descriptive epidemiological study
• Location: North Carolina state-wide surveillance system
• Time: 01/2010 - 12/2014
• Method: ICD 10 EMR analysis
• Rate: 18.5 ER visits, 986,024 fall-related (5.3%)

Summary

• The study challenges the commonly held belief that fall prevention should only
  begin at age 65. The authors argue that fall prevention should begin earlier, at
  age 45, for women. The study uses statewide population-based data to identify
  risk factors for falls in women and recommends specific interventions to prevent
  falls in this population. The study also acknowledges limitations in generalizability
  to other US jurisdictions.
• The study provides evidence that the incidence of fall-related emergency
  department visits among women exceeds the rate of fall-related emergency
  department visits among men throughout the entire adult lifespan. The study also
  shows that the incidence of fall-related emergency department visits starts to
  increase in early middle age among women and somewhat later for men. The
  authors recommend that fall risk assessment should begin with middle-aged
  women, so that prevention strategies, including gait, balance, and strength
  training, can be initiated before fall risk accelerates. The study suggests that
  waiting until age 60 or 65 to screen for fall risk is too late for women.
• The conclusion of the study is that fall risk assessment and prevention activities
  should be initiated earlier than age 65, particularly for women. The study
  recommends beginning these activities before age 45 for women, as the
  incidence rates of fall-related emergency department visits begin to increase in
  early middle age for women. The study suggests that fall prevention strategies,
  including gait, balance, and strength training, should be initiated before fall risk
  accelerates. The study also acknowledges that its results may not be
  generalizable to all US jurisdictions.
  
  Important Fact:
  Fall risk assessment and prevention should start earlier than age 65, especially for women. The incidence of fall-related emergency department visits increases in early middle age. Early balance screening can help you stay safe and prevent falls.