Eye-head coordination during postural perturbation as a predictor of falls in community-dwelling elderly women

Objectives: To assess the functional significance of eye-head coordination during postural perturbations and to determine the contribution of angular vestibulo-ocular reflex (AVOR) suppression to the prediction of 1-year fall history in community-dwelling elderly women. Design: Descriptive analysis of factors correlated with falls. Setting: Community-based independent and senior assisted living facilities. Participants: Volunteer sample of 38 older women (mean age ± standard deviation, 81.6±3.9y; range, 74-92y). Interventions: Not applicable. Main Outcome Measures: Multiple and logistic regression variables (slope coefficients, partial R², percent-correct fall history classifications) and fall prediction equations generated by using minimal sets of predictor variables. Results: Instantaneous AVOR gain and sedative use were predictors of 1-year history of falls in all minimal sets of predictor variables. R² for the prediction models varied from.47 to.62 and indicated substantial shared variance with the 1-year history of falling. Elderly women who failed to suppress the AVOR gain were 18 times more likely to have experienced a fall in the past year compared with elderly women who showed AVOR suppression (odds ratio = 18; 95% confidence interval, 1.63-198.42). Conclusions: When controlling for all other variables in the model, instantaneous AVOR gain accounted for nearly 30% of the variance of fall history. The strong association between 1-year fall history, the use of sedatives, and changes in the AVOR gain supports a functional link between AVOR suppression and effective balance in elderly women.