The INITIATE (Initial Test for Fall Risk Assessment in The Elderly) Prospective Cohort Study: Baseline Results

Background Clinical practice guidelines (CPGs) for fall prevention recommend mobility or balance testing to identify older adults with high fall risk, who require further intervention. However, there is no consensus on the best tests or optimal cut-off values. The INITIATE study was designed to determine the optimal screening test(s) for predicting falls among community-dwelling older adults. Here we describe the study design, data collection, and baseline results. Methods We undertook a 1-year prospective cohort study of community-dwelling older adults (≥65 years) able to walk 10m without assistance at baseline and living in Ontario, Canada. Participants underwent a 2-hour baseline visit where 7 validated balance and mobility tests (Timed up and go (TUG) usual pace, TUG fast pace, TUG with a cognitive dual task, Brief-BESTest, chair stand, single leg stance, gait speed) were administered. Falls were tracked for 12 months using monthly diaries and follow-up calls for context. Participants received quarterly calls to monitor general wellbeing, healthcare utilization, and changes to mobility. Descriptive statistics were calculated and differences by 12-month fall history were tested using t-tests, chi square tests, and Wilcox Rank Sum tests as appropriate. Results From 3211 contacted older adults, 514 (19%) consented. The mean age was 76.4 years (SD 6.7), 64% were female, 68% had a postsecondary degree/diploma, and 231(45%) reported a fall in the last 12 months. Means(SD) for the performance-based tests were as follows: TUG = 11.8s(4.0), TUG fast pace = 9.2s(3.4), TUG cog = 14.2s(5.9), Brief BESTest = 15.9 score(5.3), chair rise = 12.5s(4.3), single leg stance = 14.1s(16.3), gait speed = 1.14 m/s(0.28). Comparisons between baseline fallers and non-fallers showed no differences in age, sex, income, or education (p>0.05) but did show differences in all 7 tests (p<0.05). Conclusions Participants in INITIATE had baseline characteristics and test performance scores that were comparable to those reported in Canadian population-based studies. Differences in the balance and mobility tests between fallers and non-fallers at baseline support the need for rigorous prospective comparisons of the predictive validity of tests. Follow-up results, expected in late 2025, will help inform future updates to fall risk assessment and prevention guidelines.