Stepping-forward affordance perception test cut-offs: Red-flags to identify community-dwelling older adults at high risk of falling and of recurrent falling

PLoS One. 2020 Oct 8;15(10):e0239837. doi: 10.1371/journal.pone.0239837. eCollection 2020.

Abstract

The stepping-forward affordance perception test (SF-APT) fills an important gap within the screening of falls risk factors by considering the perception of affordances. The test showed to be a valid instrument for community-dwelling older adults falls risk assessment. The present study aimed to distinguish and test the key outcomes of the SF-APT usable for falls risk assessment in community-dwelling older adults to determine the respective cut-offs. This cross-sectional study enrolled 347 participants (73.1 ± 6.2 years; non-fallers: 57.9%; fallers: 42.1%; recurrent-fallers: 17.9%). Falls occurrence and SF-APT outcomes were assessed. Analyses were performed using multivariate binary logistic regression analysis and receiver operating characteristic (ROC). The area under the ROC curve was computed (AUC) for each built model explaining falling or recurrent falling. Results distinguished the Estimated stepping-forward, and Absolute-error in interaction with Error-tendency as the SF-APT key outcomes for falls risk assessment [AUCfalling: 0.665 (CI 95%: 0.608-0.723); AUCfalling recurrently: 0.728 (CI 95%: 0.655-0.797)]. Computed cut-offs' analysis showed that (i) a boundary stepping-forward estimation >58 cm plus an underestimation bias >5 cm (>42nd percentile) avoid older adults to be recurrent-fallers, and (ii) a boundary stepping-forward estimation >62 cm plus an underestimation bias >6 cm (>54th percentile) avoid older adults to be fallers. In conclusion, results suggest that SF-APT is a valuable tool for falls risk assessment in community-dwelling older adults. Interventions targeting the prevention of falls should consider the above key outcomes and the respective cut-offs as alert red-flags.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Accidental Falls / prevention & control
  • Accidental Falls / statistics & numerical data*
  • Aged
  • Aged, 80 and over
  • Female
  • Humans
  • Independent Living
  • Male
  • Neurologic Examination / methods*
  • Neuropsychological Tests
  • Perception*
  • Postural Balance
  • Walking*

Grants and funding

This work was supported by European Fund for regional development through Horizon 2020 –Portugal 2020 - Programa Operacional Regional do Alentejo (ALT20-03- 0145- FEDER-000007) with respect to the ESACA Portuguese study - Ageing Safety in Alentejo. Understanding for action. The sponsors had no role in the design, analysis, or preparation of this manuscript. There is no conflict of interest.