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People aged 65 years or older accounted for 25.1% of the Japanese population in 2013, and this characterizes the country as a “super-aging society.” With increased aging, fall-related injuries are becoming important in Japan, because such injuries underlie the necessity for nursing care services. If people could evaluate their risk of falling using a simple self-check test, they would be able to take preventive measures such as exercise, muscle training, walking with a cane, or renovation of their surroundings to remove impediments. Loco-check is a checklist measure of early locomotive syndrome (circumstances in which elderly people need nursing care service or are at high risk of requiring the service within a short time), prepared by the Japanese Orthopaedic Association (JOA) in 2007, but it is unclear if there is any association between this measure and falls.
To investigate the association between falls during the previous year and the 7 “loco-check” daily activity items and the total number of items endorsed, and sleep duration.
We conducted an Internet panel survey. Subjects were 624 persons aged between 30 and 90 years. The general health condition of the participants, including their experience of falling, daily activities, and sleep duration, was investigated. A multivariate analysis was carried out using logistic regression to investigate the relationship between falls in the previous year and difficulties with specific daily activities and total number of difficulties (loco-check) endorsed, and sleep duration, adjusting for sex and age.
One-fourth of participants (157 persons) experienced at least one fall during the previous year. Fall rate of females (94/312: 30.1%) was significantly higher than that of males (63/312: 20.2%). Fall rate of persons aged more than 65 years (80/242: 33.1%) was significantly higher than that of younger persons (77/382: 20.2%). Logistic regression analysis revealed that daily activities such as “impossibility of getting across the road at a crossing before the traffic light changes” are significantly related to falling. Logistic regression analysis also demonstrated a relationship between the number of items endorsed on loco-check and incidence of falling, wherein persons who endorsed 4 or more items appear to be at higher risk for falls. However, logistic regression found no significant relationship between sleep duration and falling.
Our study demonstrated a relationship between the number of loco-check items endorsed and the incidence of falling in the previous year. Endorsement of 4 or more items appeared to signal a high risk for falls. The short self-administered checklist can be a valuable tool for assessing the risk of falling and for initiating preventive measures.
People aged 65 years or older accounted for 25.1% of the Japanese population in 2013 [
“Locomotive syndrome,” which was proposed by the Japanese Orthopaedic Association in 2007, refers to circumstances in which elderly people need nursing care service or are at high risk of requiring the service within a short time [
This study was conducted with the approval of the Ethics Committee of Nara Medical University (authorization code: 335). The general health condition of the participants, including their experience of falling and their loco-check data, was investigated with an Internet-based questionnaire in April of 2011. We conducted the survey using an Internet panel survey company. All respondents were registered as panel members with the company.
The panel survey in this study included registrants aged between 30 and 90 years. Participants were stratified into 3 age groups that spanned 20-year categories (30-49, 50-69, and 70-90 years). Each group included 208 participants (104 males and 104 females), for a total sample of 624. The survey was closed when the number of participants in each group achieved the target sample size. Registrants completed and transmitted their responses via the website.
Demographic characteristics of participants, such as age, sex, educational background, occupation, and residential area were already recorded during their registration as a member of the firm’s Internet panel. The first question specific to our study asked whether participants were familiar with locomotive syndrome, metabolic syndrome, and cognitive impairment, to determine the recognition rates for these conditions. The survey also inquired about the medical conditions of participants, their falling experiences, and loco-check items, as described in the following sections.
The loco-check checklist for locomotive syndrome was prepared by the Japanese Orthopaedic Association (JOA) in 2007 [
We asked about falling experiences and sleep duration over the previous year. Sleep duration was a multiple-choice item with 4 response options (6 hours or less, 7 hours, 8 hours, and 9 hours or more). Personal medical history items asked whether the participant had osteoarthritis of the knee or hip joints, spondylosis deformans, spinal canal stenosis, osteoporosis, low back pain, slipped disk, rheumatoid arthritis, cerebral infarction, stroke, brain tumor, or myocardial infarction.
The recognition rate for locomotive syndrome was calculated and compared with those for metabolic syndrome and cognitive impairment. Number of falls was compared between persons with and without disease of locomotive organs using a chi-square test.
A logistic regression analysis was conducted. The presence or absence of falls in the past year was the dependent variable. The independent variables included sex, age category, and presence or absence of endorsement of the 7 loco-check items. We also carried out a separate logistic regression analysis identical to the first with the exception that the total number of loco-check items endorsed was recoded into 3 categories (0, 1-3, and ≥4). The relationship between sleep duration and falling experience was analyzed by logistic regression analysis adjusted for sex and age.
The statistical analyses were conducted with SPSS version 21.0 (IBM, Chicago, IL, USA). The level of significance was set at
The mean and standard deviation (SD) for age of participants was 58.5 (SD 16.2) years and 58.5 (SD 16.5) years in male and female participants, respectively. Height and weight of the male group were significantly higher than those of the female group (mean 168.5, SD 6.4 cm vs mean 155.5, SD 5.9 cm; mean 66.8, SD 12.9 kg vs mean 52.0, SD 7.6 kg;
Recognition rates for locomotive syndrome, metabolic syndrome, and cognitive impairment were 6.3% (39/624), 84.9% (530/624), and 87.3% (545/624), respectively.
A total of 157 participants (157/624: 25.2%) had experienced at least one fall in the previous year. The percentage of females (94/312: 30.1%) who had fallen was significantly higher than that of males (63/312: 20.2%,
A. Percentage of males and females who experienced falls. B. Percentage of participants who had fallen, by age and sex. *Statistical significance (
Percentages of endorsement by item are shown in
Percentage of participants who endorsed each item of the self-assessment checklist.
The incidence of falling among persons who had disease of locomotive organs is shown in
Incidence of falling among participants with diseases of locomotive organs. *Statistical significance (
Logistic regression analysis revealed a significant relationship between all but one of the 7 loco-check items and falling. As shown in
Logistic regression analysis revealed a significant relationship between 2 of the 3 categorical measures of loco-check items endorsed (0, 1 to 3, or ≥4 items) and falling. As shown in
Logistic regression analysis for the 7 loco-check items.
Checklist items | ORa | 95% CI | |
1. You cannot put on a pair of socks while standing on one leg | 3.25 | 1.98-5.33 | <.001 |
2. You stumble or slip in your house | 8.81 | 4.53-17.18 | <.001 |
3. You need to use a handrail when going upstairs | 2.95 | 1.74-4.99 | <.001 |
4. You cannot get across the road at a crossing before the traffic light changes | 8.13 | 2.17-30.47 | <.001 |
5. You have difficulty walking continuously for 15 minutes | 2.42 | 1.07-5.50 | .03 |
6. You find it difficult to walk home carrying a shopping bag weighing about 2 kg | 2.02 | 0.93-4.37 | .08 |
7. You find it difficult to do housework requiring physical strength | 3.53 | 1.86-6.71 | <.001 |
a OR: odds ratio.
b Statistical significance (
Logistic regression analysis for accumulation of 7 loco-check items.
Independent variables | Odds ratio | 95% CI | ||
1.60 | 1.08-2.36 | .19 | ||
1.01 | 0.99-1.02 | .32 | ||
0 | Reference | |||
1-3 | 3.21 | 2.04-5.12 | <.001 | |
≥4 | 10.36 | 4.00-26.85 | <.001 |
a Statistical significance (
Logistic regression analysis for sleep duration.
Independent variables | Odds ratio | 95% CI | ||
1.78 | 1.22-2.59 | <.001 | ||
1.03 | 1.01-1.04 | <.001 | ||
≤6 | Reference | |||
7 | 1.10 | 0.71-1.71 | .68 | |
8 | 1.22 | 0.75-2.00 | .43 | |
≥9 | 0.57 | 0.18-1.81 | .34 |
a Statistical significance (
Our study demonstrated a reliable relationship between the number of loco-check items endorsed and incidence of falling, indicating that persons who endorsed 4 or more items appear to be at high risk for falls. Those who have difficulty in certain daily activities such as being able to get across the road before the traffic light changes may be at particularly high risk. A previous study reported that older people recognize falls as a serious threat and that information dissemination, along with fall risk self-assessment, may be a low-cost way to improve identification of fall risk and stimulate fall-prevention activities [
Falling is an event that often results in critical health problems such as femoral neck fracture or compression fractures of vertebrae; therefore, falls remain a major public health problem among people aged 65 years or older. Some elderly people require nursing care services as a result of these problems. There are two categories of risk factors in falls: intrinsic and extrinsic. The former includes an individual’s physical and cognitive abilities such as muscle strength, balance capacity, reactive power, dual tasking, and sleep disturbances; and the latter includes home hazards, improper use of assistive devices, and inappropriate footwear [
Insomnia and disturbed sleep are increasingly common for older people [
Fall prevention is a major public health theme because falls occur frequently and can cause subsequently devastating problems for elderly individuals, affecting their morbidity, mortality, and locomotive ability. Falls occur in 30%-60% of older persons each year, and 10%-20% of these result in injury, hospitalization, and/or death [
Previous studies have reported an association between locomotive syndrome and health-related quality of life (HRQoL). Iizuka et al [
Participants’ recognition rate of locomotive syndrome was quite low compared with metabolic syndrome and cognitive impairment at the time our survey was conducted in April 2011. The recognition rate has increased dramatically in recent years, for example, it was reported at 36.1% in 2014 [
When we recruited the participants in this study, we created 3 age categories that spanned 20-year categories because the distribution of participant numbers needed to be equivalent among ages. As the actual ages of the participants were recorded, we were able to divide the subjects into 2 groups (<65 years and ≥65 years, as shown in
This study has a few limitations. First, all measures were based on self-reporting by Internet survey. This may result in some misclassification. Second, we used an Internet panel survey company to collect data from registrants aged between 30 and 90 years. Elderly persons who use computers and the Internet may be more active and healthier than those who do not; therefore, we may have underestimated the incidence of falling. However, Internet panel surveys are becoming common for epidemiology research in the social sciences [
We conducted an Internet panel survey to investigate the relationship between falls in the previous year and difficulties with specific daily activities, total number of difficulties (loco-check) endorsed, and sleep duration. A multivariate analysis was carried out using logistic regression to investigate the relationship, with adjustments for sex and age. Our study demonstrated a relationship between the number of loco-check items endorsed and the incidence of falling in the previous year. Endorsement of 4 or more items appeared to signal a high risk for falls. To prevent falls, it would be ideal for people at home to evaluate their potential risk by means of a simple self-checklist. The short self-administered checklist of loco-check can be a valuable tool for assessing the risk of falling and for initiating preventive measures.
EuroQoL-5 dimensions
EuroQoL visual analogue scale
health-related quality of life
Japanese Orthopaedic Association
standard deviation
We thank Y Miyake and M Matsumura (Nara Medical University School of Medicine, Japan) for their assistance in data cleaning. This study was partially supported by a Grant-in-Aid for scientific research from the Ministry of Health, Labour and Welfare, Japan.
None declared.