Instrumental Activities of Daily Living Staging as a Possible Clinical Tool for Falls Risk Assessment in Physical Medicine and Rehabilitation

Objective: To determine whether instrumental activity of daily living (IADL) limitation stages can distinguish among elderly, community-dwelling persons with high likelihoods to have fallen once and more than once. Design: A cross-sectional survey. Setting: A nationally representative sample from the Second Longitudinal Study of Aging (LSOA II). Participants: Included were 7401 community-dwelling persons 70 years of age and older. Methods: The association of falling once and more than once within the past 12 months and 5 stages of increasing IADL limitation were explored by using a multinomial logistic regression model that controlled for demographics, education, perceived lack of home accessibility features, and health conditions. Sample proportions were weighted to reflect the prevalence in the U.S. population of 1994. Main Outcome Measurements: Subject recall of fall history. There were 3 categories for this variable: no fall, falling once, and falling more than once in the past 12 months. Results: Compared with IADL stage 0, the adjusted relative risk ratio of falling once peaked in individuals at IADL stage II at 2.0 (95% confidence interval [CI], 1.5-2.6), and those at IADL stage III had a relative risk ratio of 1.8 (95% CI, 1.3-2.6). The relative risk ratio of falling more than once was 2.1 (95% CI, 1.7-2.6), 4.0 (95% CI, 3.0-5.3), 3.7 (95% CI, 2.8-5.0), and 2.7 (95% CI, 1.5-4.9) for IADL stages I, II, III, and IV, respectively, when treating IADL stage 0 as reference. Conclusions: IADL limitation stages could represent a powerful and practical tool for screening patients in the U.S. elderly population according to fall risk. Clinical implementation and prospective testing for validation as a screening tool would be necessary.