physioscience 2017; 13(01): 25-30
DOI: 10.1055/s-0035-1567154
© Georg Thieme Verlag KG Stuttgart · New York

Bewertung des Sturzrisikos bei älteren Menschen: Divergenzen zwischen der subjektiven sturzassoziierten Selbstwirksamkeit und objektiven Sturzrisiken

Assessing the Fall Risk in Older People: Divergences of Subjective Falls-Related Self-Efficacy and Objective Fall Risks
J. Kiselev
1   Forschungsgruppe Geriatrie, Charité – Universitätsmedizin Berlin
2   Koordinierungszentrum für klinische Studien, Charité – Universitätsmedizin Berlin
S. Wegel
1   Forschungsgruppe Geriatrie, Charité – Universitätsmedizin Berlin
S. Moosburner
1   Forschungsgruppe Geriatrie, Charité – Universitätsmedizin Berlin
S. Dimitrovska
2   Koordinierungszentrum für klinische Studien, Charité – Universitätsmedizin Berlin
E. Steinhagen-Thiessen
1   Forschungsgruppe Geriatrie, Charité – Universitätsmedizin Berlin
› Author Affiliations
Further Information

Publication History

17 May 2016

14 October 2016

Publication Date:
07 March 2017 (online)


Hintergrund: Mit zunehmendem Alter stellen Stürze ein enormes Problem dar. Die Folgen von Fehleinschätzungen des eigenen Sturzrisikos sind bislang wenig untersucht.

Ziel: Die Studie verfolgte die Frage, ob Physiotherapeuten eine inadäquate Selbsteinschätzung des Sturzrisikos bei älteren Menschen mithilfe von ausschließlich funktionellen Untersuchungen identifizieren können.

Methode: Bei der Sekundäranalyse einer Validierungsstudie mit 99 älteren Teilnehmern wurden die Ergebnisse von Activities-specific Balance Confidence Scale, Berg-Balance-Skala, Timed-up-and-go-Test und selbstgewählter Gehgeschwindigkeit miteinander verglichen, um eine adäquate oder nicht adäquate Selbsteinschätzung der Sturzgefahr und mögliche Erklärungen für das Auftreten solcher Divergenzen zu ermitteln. Hierzu erfolgte eine multiple lineare Regressionsanalyse und anschließendem Mann-Whitney-U-Test.

Ergebnisse: Eine schlechte sturzassoziierte Selbstwirksamkeitserwartung erklärt sich durch höheres Alter, schlechtere Balancefähigkeit und geringere Gehgeschwindigkeit. Im Gegensatz zu den sturzgefährdeten Teilnehmern ergaben sich bei den nicht sturzgefährdeten Unterschiede zwischen den Gruppen der adäquaten und nicht adäquaten Selbsteinschätzungen.

Schlussfolgerung: Die Identifizierung einer nicht adäquaten sturzassoziierten Selbstwirksamkeitserwartung bei älteren Patienten ist mit ausschließlich funktionellen Messungen nicht möglich. Für die Wahl geeigneter Therapien sollten Physiotherapeuten deshalb neben der objektiven Sturzgefahr auch immer die sturzassoziierte Selbstwirksamkeitserwartung ermitteln.


Background: Falls are considered to be an enormous problem with increasing age. The consequences of inadequate self-assessment of fall risk are poorly investigated to date.

Objective: This study examined the question whether physiotherapists are able to identify an inadequate self-assessment of fall risk in older people using functional tests alone.

Method: A secondary analysis of a validation study with 99 older participants compared the results of the Activities-specific Balance Confidence (ABC) Scale, Berg Balance Scale, Timed-up-and-go Test and voluntary gait speed in order to identify an adequate or inadequate self-assessment of fall risk as well as a possible explanation for such divergences. For this purpose a multiple-linear regression analysis and subsequently the Mann-Whitney-U-Test were performed.

Results: A poor anticipation of falls-related self-efficacy may be explained by higher age, poorer balance and low gait speed. In comparison to participants with fall risk those with no fall risk showed differences between adequate and inadequate self-assessment of fall risk.

Conclusions: Functional tests alone cannot identify an inadequate anticipation of self-assessment of fall risk in older patients. Physiotherapists should therefore always assess the objective anticipation of falls-related self-efficacy along with the objective fall risk.

  • Literatur

  • 1 Berg KO, Maki BE, Williams JI et al. Clinical and laboratory measures of postural balance in an elderly population. Arch Phys Med Rehabil 1992; 73: 1073-1080
  • 2 Bilney B, Morris M, Webster K. Concurrent related validity of the GAITRite walkway system for quantification of the spatial and temporal parameters of gait. Gait Posture 2003; 17: 68-74
  • 3 Charité Portal. PAGE – Plattform zur Integration technologiebasierter Gesundheitsdienstleistungen in Gesundheitsnetzwerke. (06.10.2016)
  • 4 Clemson L, Kendig H, Mackenzie L et al. Predictors of injurious falls and fear of falling differ: an 11-year longitudinal study of incident events in older people. J Aging Health 2015; 27: 239-256
  • 5 Craig J, Murray A, Mitchell S et al. The high cost to health and social care of managing falls in older adults living in the community in Scotland. Scott Med J 2013; 58: 198-203
  • 6 De Vries OJ, Peeters GMEE, Lips P et al. Does frailty predict increased risk of falls and fractures? A prospective population-based study. Osteoporos Int 2013; 24: 2397-2403
  • 7 Delbaere K, Crombez G, Vanderstraeten G et al. Fear-related avoidance of activities, falls and physical frailty. A prospective community-based cohort study. Age Ageing 2004; 33: 368-373
  • 8 Delbaere K, Close JC, Brodaty H et al. Determinants of disparities between perceived and physiological risk of falling among elderly people: cohort study. BMJ 2010; 341: c4165
  • 9 Dias RC, Freire MTF, Santos ÉGS et al. Characteristics associated with activity restriction induced by fear of falling in community-dwelling elderly. Braz J Phys Ther 2011; 15: 406-413
  • 10 Filiatrault J, Gauvin L, Fournier M et al. Evidence of the Psychometric Qualities of a Simplified Version of the Activities-specific Balance Confidence Scale for Community-Dwelling Seniors. Arch Phys Med Rehabil 2007; 88: 664-672
  • 11 Fortinsky RH, Panzer V, Wakefield D et al. Alignment between balance confidence and fall risk in later life: Has over-confidence been overlooked?. Health Risk Soc 2009; 11: 341-352
  • 12 Frenken T, Vester B, Brell M et al. aTUG: Fully-automated timed up and go assessment using ambient sensor technologies. 5th International Conference on Pervasive Computing Technologies for Healthcare (PervasiveHealth); 2011
  • 13 Fried LP, Tangen CM, Walston J et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci 2001; 56: M146-M156
  • 14 Hicks GE, Shardell M, Alley DE et al. Absolute strength and loss of strength as predictors of mobility decline in older adults: the InCHIANTI study. J Gerontol A Biol Sci Med Sci 2012; 67: 66-73
  • 15 Hotchkiss A, Fisher A, Robertson R et al. Convergent and predictive validity of three scales related to falls in the elderly. Am J Occup Ther 2004; 58: 100-103
  • 16 Lajoie Y, Gallagher S. Predicting falls within the elderly community: comparison of postural sway, reaction time, the Berg balance scale and the Activities-specific Balance Confidence (ABC) scale for comparing fallers and non-fallers. Arch Gerontol Geriatr 2004; 38: 11-26
  • 17 Lord SR, Menz HB, Tiedemann A. A Physiological Profile Approach to Falls Risk Assessment and Prevention. Phys Ther 2003; 83: 237-252
  • 18 Marsh AP, Rejeski WJ, Espeland MA et al. Muscle strength and BMI as predictors of major mobility disability in the Lifestyle Interventions and Independence for Elders pilot (LIFE-P). J Gerontol A Biol Sci Med Sci 2011; 66: 1376-1383
  • 19 Moreland JD, Richardson JA, Goldsmith CH et al. Muscle weakness and falls in older adults: a systematic review and meta-analysis. J Am Geriatr Soc 2004; 52: 1121-1129
  • 20 Muir SW, Berg K, Chesworth B et al. Quantifying the magnitude of risk for balance impairment on falls in community-dwelling older adults: a systematic review and meta-analysis. J Clin Epidemiol 2010; 63: 389-406
  • 21 Podsiadlo D, Richardson S. The timed “Up & Go”: a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc 1991; 39: 142-148
  • 22 Powell LE, Myers AM. The Activities-specific Balance Confidence (ABC) Scale. J Gerontol A Biol Sci Med Sci 1995; 50A: M28-M34
  • 23 Rubenstein LZ. Falls in older people: epidemiology, risk factors and strategies for prevention. Age Ageing 2006; 35 (Suppl. 02) ii37-ii41
  • 24 Schott N. German adaptation of the “Activities-Specific Balance Confidence (ABC) Scale” for the assessment of falls-related self-efficacy. Z Für Gerontol Geriatr 2008; 41: 475-485
  • 25 Srygley JM, Herman T, Giladi N et al. Self-Report of Missteps in Older Adults: A Valid Proxy of Fall Risk?. Arch Phys Med Rehabil 2009; 90: 786-792
  • 26 Sterke CS, van Beeck EF, Looman CWN et al. An electronic walkway can predict short-term fall risk in nursing home residents with dementia. Gait Posture 2012; 36: 95-101
  • 27 Stubbs B, Patchay S, Soundy A et al. The avoidance of activities due to fear of falling contributes to sedentary behavior among community-dwelling older adults with chronic musculoskeletal pain: a multisite observational study. Pain Med Malden Mass 2014; 15: 1861-1871
  • 28 Taylor ME, Delbaere K, Lord SR et al. Neuropsychological, physical, and functional mobility measures associated with falls in cognitively impaired older adults. J Gerontol A Biol Sci Med Sci 2014; 69: 987-995
  • 29 Tinetti ME. Performance-oriented assessment of mobility problems in elderly patients. J Am Geriatr Soc 1986; 34: 119-126
  • 30 Tinetti ME, Richman D, Powell L. Falls efficacy as a measure of fear of falling. J Gerontol 1990; 45: P239-P243
  • 31 Tromp AM, Pluijm SM, Smit JH et al. Fall-risk screening test: a prospective study on predictors for falls in community-dwelling elderly. J Clin Epidemiol 2001; 54: 837-844
  • 32 Vermeulen J, Neyens JCL, van Rossum E et al. Predicting ADL disability in community-dwelling elderly people using physical frailty indicators: a systematic review. BMC Geriatr 2011; 11: 33
  • 33 Webster KE, Wittwer JE, Feller JA. Validity of the GAITRite walkway system for the measurement of averaged and individual step parameters of gait. Gait Posture 2005; 22: 317-321
  • 34 World Health Organization (WHO). WHO global report on falls prevention in older age. Geneva: WHO; 2008
  • 35 Young WR, Williams MA. How fear of falling can increase fall-risk in older adults: applying psychological theory to practical observations. Gait Posture 2015; 41: 7-12