A multivariate logistic regression model for fall risk prediction based on physical performance in community-dwelling elderly
DOI:
https://doi.org/10.47197/retos.v75.117848Keywords:
Fall Risk Prediction, Elderly, Lower Limb Strength, Timed Up and Go Test, Power Sit-to-Stand Test, Multivariate Logistic RegressionAbstract
Introduction: Falls among older adults lead to significant morbidity and increased healthcare costs. Physical performance measures like strength, mobility, and balance are crucial for fall risk prediction, but existing assessments often rely on single measures, which may not fully capture fall risk.
Objective: To develop a multivariate logistic regression model for fall risk prediction, integrating the lower limb muscle strength-to-body weight (LS/BW) ratio, the Timed Up and Go Test (TTUGT), and the Power Sit-to-Stand Test (PSTS).
Methodology: Data from 108 community-dwelling elderly individuals (mean age 65.59 ± 4.32 years) were analyzed. Participants underwent physical performance assessments, including TTUGT, MVIC of lower limb strength, LS/BW ratio, and PSTS. A binary logistic regression model was used to analyze the relationship between these variables and fall risk, with model performance evaluated using AUC of the receiver operating characteristic (ROC).
Results: The model, incorporating LS/BW ratio, TTUGT, and PSTS, explained 70.6% of the variance in fall risk. Significant predictors included lower LS/BW ratio (adj.OR = 0.980), longer TTUGT times (adj.OR = 1.617), and lower PSTS values (adj.OR = 0.953). The Fall Risk Score equation provides a practical tool for identifying high-risk individuals.
Conclusion: The multivariate model effectively predicts fall risk, offering a reliable tool for fall risk screening and prevention in older adults, supporting personalized interventions to reduce fall incidence.
References
Alcazar, J., Alegre, L. M., Van Roie, E., Magalhães, J. P., Nielsen, B. R., González-Gross, M., Júdice, P. B., Casajús, J. A., Delecluse, C., Sardinha, L. B., Suetta, C., & Ara, I. (2021). Relative sit-to-stand power: aging trajectories, functionally relevant cut-off points, and normative data in a large European cohort. Journal of Cachexia, Sarcopenia and Muscle, 12(4), 921-932. https://doi.org/https://doi.org/10.1002/jcsm.12737
Andrade, L. C. A., Costa, G. L. d. A., Diogenes, L. G. B., & Pimentel, P. H. R. (2021). Timed Up and Go test in the assessment of the risk of falls in the elderly: a literature review. Research, Society and Development, 10(13), e321101321615. https://doi.org/10.33448/rsd-v10i13.21615
Asavamongkolkul, A., Adulkasem, N., Chotiyarnwong, P., Vanitcharoenkul, E., Chandhanayingyong, C., Laohaprasitiporn, P., Soparat, K., & Unnanuntana, A. (2024). Prevalence of osteoporosis, sarcopenia, and high falls risk in healthy community-dwelling Thai older adults: a nationwide cross-sectional study. JBMR Plus, 8(2), ziad020. https://doi.org/10.1093/jbmrpl/ziad020
Beauchet, O., Fantino, B., Allali, G., Muir, S. W., Montero-Odasso, M., & Annweiler, C. (2011). Timed Up and Go test and risk of falls in older adults: a systematic review. J Nutr Health Aging, 15(10), 933-938. https://doi.org/10.1007/s12603-011-0062-0
Camp, M., Chiriboga, L., Murphy, K., & Voit, J. (2024). Fall Risk and Prevention: A Guide for the Geriatric Mental Health Workforce. The American Journal of Geriatric Psychiatry, 32(4), S25-S26. https://doi.org/10.1016/j.jagp.2024.01.085
Campitelli, A., Paulson, S., Vincenzo, J., Glenn, J. M., Gills, J. L., Jones, M. D., Powers, M., & Gray, M. (2022). Sit-to-Stand Power Across the Lifespan: A Cross-Sectional Analysis. Journal of Aging and Physical Activity, 30(4), 678-688. https://doi.org/10.1123/japa.2021-0066
Cebolla, E. C., Rodacki, A. L. F., & Bento, P. C. B. (2015). Balance, gait, functionality and strength: comparison between elderly fallers and non-fallers. Brazilian Journal of Physical Therapy, 19.
Chan, W. L. S., Pin, T. W., Chan, J. Y. H., Siu, G. C. H., & Tsang, S. M. H. (2024). The Ability of Physical Performance Measures to Identify Fall Risk in Older Adults Living With Dementia: A Systematic Review and Meta-Analysis. J Am Med Dir Assoc, 25(8), 105100. https://doi.org/10.1016/j.jamda.2024.105100
Colón-Emeric, C. S., McDermott, C. L., Lee, D. S., & Berry, S. D. (2024). Risk Assessment and Prevention of Falls in Older Community-Dwelling Adults: A Review. JAMA, 331(16), 1397-1406. https://doi.org/10.1001/jama.2024.1416
Daneshjoo, A., Sadeghi, H., Yaali, R., & Behm, D. G. (2023). Comparison of unilateral and bilateral strength ratio, strength, and knee proprioception in older male fallers and non-fallers. Experimental Gerontology, 175, 112161. https://doi.org/https://doi.org/10.1016/j.exger.2023.112161
Dashner, J., Espín-Tello, S. M., Chen, S.-W., Hollingsworth, H., Bollinger, R., Morgan, K. A., & Stark, S. Influence of falls, fall-related injuries, and fear of falling on social participation in people aging with long-term physical disability: a cross-sectional study. Disability and Rehabilitation, 1-9. https://doi.org/10.1080/09638288.2023.2293990
Esposito, G., Ceruso, R., & Raiola, G. (2025). The impact of gentle physical activity on psychophysical well-being in older adults: a longitudinal study [Article]. Retos, 67, 509-521. https://doi.org/10.47197/retos.v67.112757
Ferragut, C., Suarez, H. V., Lima, M., Rodrigues, L. P., Bezerra, P., & Cancela, J. M. (2023). Age-dependent changes in physical performance in community dwelling elderly women. A cross-sectional study [Article]. Retos, 48, 527-531. https://doi.org/10.47197/RETOS.V48.97070
Gronbech Jorgensen, M., Andersen, S., Ryg, J., & Masud, T. (2015). Novel Use of the Nintendo Wii Board for Measuring Isometric Lower Limb Strength: A Reproducible and Valid Method in Older Adults. PLoS One, 10(10), e0138660. https://doi.org/10.1371/journal.pone.0138660
Ibeneme, S. C., Eze, J. C., Okonkwo, U. P., Ibeneme, G. C., & Fortwengel, G. (2022). Evaluating the discriminatory power of the velocity field diagram and timed-up-and-go test in determining the fall status of community-dwelling older adults: a cross-sectional observational study. BMC Geriatrics, 22(1), 658. https://doi.org/10.1186/s12877-022-03282-2
Ishigaki, E. Y., Ramos, L. G., Carvalho, E. S., & Lunardi, A. C. (2014). Effectiveness of muscle strengthening and description of protocols for preventing falls in the elderly: a systematic review. Braz J Phys Ther, 18(2), 111-118. https://doi.org/10.1590/s1413-35552012005000148
Jalayondeja, C. (2014). Falls screening by Timed Up and Go (TUG). Journal of medical technology, 26(1), 5-16.
Kear, B. M., Guck, T. P., & McGaha, A. L. (2017). Timed Up and Go (TUG) Test: Normative Reference Values for Ages 20 to 59 Years and Relationships With Physical and Mental Health Risk Factors. J Prim Care Community Health, 8(1), 9-13. https://doi.org/10.1177/2150131916659282
Kim, T., Yu, X., & Xiong, S. (2024). A multifactorial fall risk assessment system for older people utilizing a low-cost, markerless Microsoft Kinect. Ergonomics, 67(1), 50-68. https://doi.org/10.1080/00140139.2023.2202845
Lage, I., Braga, F., Almendra, M., Meneses, F., Teixeira, L., & Araújo, O. (2023). Older People Living Alone: A Predictive Model of Fall Risk. International Journal of Environmental Research and Public Health, 20(13), 6284. https://www.mdpi.com/1660-4601/20/13/6284
Lewis, S. R., & Griffin, X. L. (2023). Preventing falls in older people: the evidence for environmental interventions and why history matters. Cochrane Database of Systematic Reviews(3). https://doi.org/10.1002/14651858.ED000162
Nguyen, K. T., Brooks, D., Macedo, L. G., Ellerton, C., Goldstein, R., Alison, J. A., Dechman, G., Harrison, S. L., Holland, A. E., Lee, A. L., Marques, A., Spencer, L., Stickland, M. K., Skinner, E. H., Haines, K. J., & Beauchamp, M. K. (2024). Balance measures for fall risk screening in community-dwelling older adults with COPD: A longitudinal analysis. Respir Med, 230, 107681. https://doi.org/10.1016/j.rmed.2024.107681
Nurdin, F., Subadi, I., Wardhani, I., & Utomo, B. (2025). Effect of Exergame boxing addition on appendicular muscle mass index in elderly women. Retos, 67, 1102-1109. https://doi.org/10.47197/retos.v67.111564
Oliveira-Zmuda, G., Soldera, C., Jovanov, E., & Bós, A. (2022). Timed Up and Go test phases as predictors of future falls in community-dwelling older adults. Fisioterapia em Movimento, 35. https://doi.org/10.1590/fm.2022.35142
Paredes, A. N. M., Monzon, D. G. R., Mansilla, M. R., Ochavano, R. E. C., Espejo, Y. M., & Boza, A. A. P. (2024). Physical activity at home to improve strength and balance in the elderly to prevent the risk of falls. Bibliographic Review [Review]. Retos, 53, 305-315. https://doi.org/10.47197/RETOS.V53.99567
Poncumhak, P., Srithawong, A., Duangsanjun, W., & Amput, P. (2023). Comparison of the Ability of Static and Dynamic Balance Tests to Determine the Risk of Falls among Older Community-Dwelling Individuals. Journal of Functional Morphology and Kinesiology, 8, 43. https://doi.org/10.3390/jfmk8020043
Sadaqa, M., Németh, Z., Makai, A., Prémusz, V., & Hock, M. (2023). Effectiveness of exercise interventions on fall prevention in ambulatory community-dwelling older adults: a systematic review with narrative synthesis [Systematic Review]. Frontiers in Public Health, 11. https://doi.org/10.3389/fpubh.2023.1209319
Sato, M., Yamashita, T., Okazaki, D., Asada, H., & Yamashita, K. (2024). Valid Indicators for Predicting Falls in Community-Dwelling Older Adults Under Ongoing Exercise Intervention to Prevent Care Requirement. Gerontology and Geriatric Medicine, 10, 23337214241229328. https://doi.org/10.1177/23337214241229328
Skelton, D. A., Kennedy, J., & Rutherford, O. M. (2002). Explosive power and asymmetry in leg muscle function in frequent fallers and non‐fallers aged over 65. Age and Ageing, 31(2), 119-125. https://doi.org/10.1093/ageing/31.2.119
Takai, Y., Ohta, M., Akagi, R., Kanehisa, H., Kawakami, Y., & Fukunaga, T. (2009). Sit-to-stand test to evaluate knee extensor muscle size and strength in the elderly: a novel approach. J Physiol Anthropol, 28(3), 123-128. https://doi.org/10.2114/jpa2.28.123
Tan, T. C., Guo, Y. Y., Ho, D. J., Sanwari, N. A. B., Quek, P. H., Tan, R. S., Yap, F. S., Yang, M., & Yeung, M. T. (2023). Reference Values, Determinants and Regression Equation for the Timed-Up and Go Test (TUG) in Healthy Asian Population Aged 21 to 85 Years. International Journal of Environmental Research and Public Health, 20(9), 5712. https://www.mdpi.com/1660-4601/20/9/5712
Tanaka, S., Imaizumi, T., Morohashi, A., Sato, K., Shibata, A., Fukuta, A., Nakagawa, R., Nagaya, M., Nishida, Y., Hara, K., Katsuno, M., Suzuki, Y., & Nagao, Y. (2023). In-Hospital Fall Risk Prediction by Objective Measurement of Lower Extremity Function in a High-Risk Population. J Am Med Dir Assoc, 24(12), 1861-1867.e1862. https://doi.org/10.1016/j.jamda.2023.07.020
Trevisan, C., Welmer, A.-K., Curreri, C., Noale, M., Maggi, S., & Sergi, G. (2023). The impact of falls on the need for hospital care in older people: results from the Pro.V.A. study. Journal of Gerontology and Geriatrics, 71, 1-9. https://doi.org/10.36150/2499-6564-N406
Wages, N. P., Simon, J. E., Clark, L. A., Amano, S., Russ, D. W., Manini, T. M., & Clark, B. C. (2020). Relative contribution of muscle strength, lean mass, and lower extremity motor function in explaining between-person variance in mobility in older adults. BMC Geriatrics, 20(1), 255. https://doi.org/10.1186/s12877-020-01656-y
Winger, M. E., Caserotti, P., Cauley, J. A., Boudreau, R. M., Piva, S. R., Cawthon, P. M., Orwoll, E. S., Ensrud, K. E., Kado, D. M., Strotmeyer, E. S., & Group, O. F. i. M. R. (2022). Lower Leg Power and Grip Strength Are Associated With Increased Fall Injury Risk in Older Men: The Osteoporotic Fractures in Men Study. The Journals of Gerontology: Series A, 78(3), 479-485. https://doi.org/10.1093/gerona/glac122
Wu, W., Zhou, Q., Gao, Q., Li, H., Zhang, J., Wu, J., Shen, J., Li, J., & Shi, H. (2024). Construction of an instrument to enable the assessment of the risk of falls in older outpatients: A quantitative methodological study. Journal of Advanced Nursing, 80(9), 3825-3834. https://doi.org/https://doi.org/10.1111/jan.16059
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Noppharath Sangkarit, Weerasak Tapanya, Puttipong Poncumhak, Patchareeya Amput, Saisunee Konsanit
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and ensure the magazine the right to be the first publication of the work as licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgment of authorship of the work and the initial publication in this magazine.
- Authors can establish separate additional agreements for non-exclusive distribution of the version of the work published in the journal (eg, to an institutional repository or publish it in a book), with an acknowledgment of its initial publication in this journal.
- Is allowed and authors are encouraged to disseminate their work electronically (eg, in institutional repositories or on their own website) prior to and during the submission process, as it can lead to productive exchanges, as well as to a subpoena more Early and more of published work (See The Effect of Open Access) (in English).
This journal provides immediate open access to its content (BOAI, http://legacy.earlham.edu/~peters/fos/boaifaq.htm#openaccess) on the principle that making research freely available to the public supports a greater global exchange of knowledge. The authors may download the papers from the journal website, or will be provided with the PDF version of the article via e-mail.
