{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T13:58:49Z","timestamp":1780322329626,"version":"3.54.1"},"reference-count":41,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2020,12,4]],"date-time":"2020-12-04T00:00:00Z","timestamp":1607040000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:p><jats:bold>Introduction:<\/jats:bold> Falls are the leading cause of accidental death in older adults. Each year, 28.7% of US adults over 65 years experience a fall resulting in over 300,000 hip fractures and $50 billion in medical costs. Annual fall risk assessments have become part of the standard care plan for older adults. However, the effectiveness of these assessments in identifying at-risk individuals remains limited. This study characterizes the performance of a commercially available, automated method, for assessing fall risk using machine learning.<\/jats:p><jats:p><jats:bold>Methods:<\/jats:bold> Participants (<jats:italic>N<\/jats:italic> = 209) were recruited from eight senior living facilities and from adults living in the community (five local community centers in Houston, TX) to participate in a 12-month retrospective and a 12-month prospective cohort study. Upon enrollment, each participant stood for 60 s, with eyes open, on a commercial balance measurement platform which uses force-plate technology to capture center-of-pressure (60 Hz frequency). Linear and non-linear components of the center-of-pressure were analyzed using a machine-learning algorithm resulting in a postural stability (PS) score (range 1\u201310). A higher PS score indicated greater stability. Participants were contacted monthly for a year to track fall events and determine fall circumstances. Reliability among repeated trials, past and future fall prediction, as well as survival analyses, were assessed.<\/jats:p><jats:p><jats:bold>Results:<\/jats:bold> Measurement reliability was found to be high (ICC(2,1) [95% CI]=0.78 [0.76\u20130.81]). Individuals in the high-risk range (1-3) were three times more likely to fall within a year than those in low-risk (7\u201310). They were also an order of magnitude more likely (12\/104 vs. 1\/105) to suffer a spontaneous fall i.e., a fall where no cause was self-reported. Survival analyses suggests a fall event within 9 months (median) for high risk individuals.<\/jats:p><jats:p><jats:bold>Conclusions:<\/jats:bold> We demonstrate that an easy-to-use, automated method for assessing fall risk can reliably predict falls a year in advance. Objective identification of at-risk patients will aid clinicians in providing individualized fall prevention care.<\/jats:p>","DOI":"10.3389\/fmed.2020.591517","type":"journal-article","created":{"date-parts":[[2020,12,4]],"date-time":"2020-12-04T17:50:20Z","timestamp":1607104220000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":11,"title":["A Postural Assessment Utilizing Machine Learning Prospectively Identifies Older Adults at a High Risk of Falling"],"prefix":"10.3389","volume":"7","author":[{"given":"Katharine E.","family":"Forth","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kelly L.","family":"Wirfel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sasha D.","family":"Adams","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nahid J.","family":"Rianon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erez","family":"Lieberman Aiden","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan I.","family":"Madansingh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2020,12,4]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"5","DOI":"10.1016\/j.injury.2016.10.037","article-title":"Trends in 1029 trauma deaths at a level 1 trauma center: impact of a bleeding control bundle of care","volume":"48","author":"Oyeniyi","year":"2017","journal-title":"Injury."},{"key":"B2","doi-asserted-by":"publisher","first-page":"CD007146","DOI":"10.1002\/14651858.CD007146.pub3","article-title":"Interventions for preventing falls in older people living in the community","volume":"15","author":"Gillespie","year":"2012","journal-title":"Cochrane Database Syst Rev."},{"key":"B3","doi-asserted-by":"publisher","first-page":"993","DOI":"10.15585\/mmwr.mm6537a2","article-title":"Falls and fall injuries among adults aged \u226565 years \u2014 United States, 2014","volume":"65","author":"Bergen","year":"2016","journal-title":"MMWR Morb Mortal Wkly Rep."},{"key":"B4","doi-asserted-by":"publisher","first-page":"693","DOI":"10.1111\/jgs.15304","article-title":"Medical costs of fatal and nonfatal falls in older adults","volume":"66","author":"Florence","year":"2018","journal-title":"J Am Geriatr Soc."},{"key":"B5","doi-asserted-by":"publisher","first-page":"281","DOI":"10.1016\/j.mcna.2014.11.004","article-title":"Assessment and management of fall risk in primary care settings","volume":"99","author":"Phelan","year":"2015","journal-title":"Med Clin North Am."},{"key":"B6","first-page":"16","volume-title":"Annual Wellness Visit. Med Learn Netw","year":"2018"},{"key":"B7","doi-asserted-by":"publisher","first-page":"799","DOI":"10.1016\/j.apmr.2010.12.032","article-title":"Dynamic gait stability, clinical correlates, and prognosis of falls among community-dwelling older adults","volume":"92","author":"Bhatt","year":"2011","journal-title":"Arch Phys Med Rehabil."},{"key":"B8","doi-asserted-by":"publisher","first-page":"1701","DOI":"10.1056\/NEJM198812293192604","article-title":"Risk factors for falls among elderly persons living in the community","volume":"319","author":"Tinetti","year":"1988","journal-title":"N Engl J Med."},{"key":"B9","doi-asserted-by":"publisher","first-page":"508","DOI":"10.1046\/j.1532-5415.2001.49107.x","article-title":"Visual risk factors for falls in older people","volume":"49","author":"Lord","year":"2001","journal-title":"J Am Geriatr Soc."},{"key":"B10","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1001\/jama.297.1.77","article-title":"Will my patient fall?","volume":"297","author":"Ganz","year":"2007","journal-title":"JAMA."},{"key":"B11","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1016\/j.gaitpost.2014.09.006","article-title":"How fear of falling can increase fall-risk in older adults: applying psychological theory to practical observations","volume":"41","author":"Young","year":"2015","journal-title":"Gait Posture."},{"key":"B12","doi-asserted-by":"publisher","first-page":"148","DOI":"10.1111\/j.1532-5415.2010.03234.x","article-title":"Summary of the updated American geriatrics society\/British geriatrics society clinical practice guideline for prevention of falls in older persons","volume":"59","year":"2011","journal-title":"J Am Geriatr Soc"},{"key":"B13","doi-asserted-by":"publisher","first-page":"59","DOI":"10.1016\/j.amepre.2012.03.008","article-title":"Gender differences in seeking care for falls in the aged medicare population","volume":"43","author":"Stevens","year":"2012","journal-title":"Am J Prev Med."},{"key":"B14","doi-asserted-by":"publisher","first-page":"171","DOI":"10.1093\/gerona\/63.2.171","article-title":"Force platform balance measures as predictors of indoor and outdoor falls in community-dwelling women aged 63\u201376 years","volume":"63","author":"Pajala","year":"2008","journal-title":"J Gerontol A Biol Sci Med Sci."},{"key":"B15","doi-asserted-by":"publisher","first-page":"345","DOI":"10.1159\/000094983","article-title":"Posturography and risk of recurrent falls in healthy non-institutionalized persons aged over 65","volume":"52","author":"Buatois","year":"2006","journal-title":"Gerontology."},{"key":"B16","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1159\/000089820","article-title":"Force platform measurements as predictors of falls among older people \u2013 a review","volume":"52","author":"Piirtola","year":"2006","journal-title":"Gerontology."},{"key":"B17","doi-asserted-by":"publisher","first-page":"291","DOI":"10.1186\/s12877-017-0682-2","article-title":"Falls efficacy, postural balance, and risk for falls in older adults with falls-related emergency department visits: prospective cohort study","volume":"17","author":"Pua","year":"2017","journal-title":"BMC Geriatr."},{"key":"B18","doi-asserted-by":"publisher","first-page":"e0172398","DOI":"10.1371\/journal.pone.0172398","article-title":"Elderly fall risk prediction using static posturography","volume":"12","author":"Howcroft","year":"2017","journal-title":"PLoS ONE."},{"key":"B19","doi-asserted-by":"publisher","first-page":"273","DOI":"10.1080\/03091900600968908","article-title":"Modelling stabilograms with hidden markov models","volume":"32","author":"Rasku","year":"2008","journal-title":"J Med Eng Technol."},{"key":"B20","doi-asserted-by":"publisher","first-page":"215","DOI":"10.3233\/IDA-173704","article-title":"Classification of patients and controls based on stabilogram signal data","volume":"23","author":"Joutsijoki","year":"2019","journal-title":"Intell Data Anal."},{"key":"B21","doi-asserted-by":"publisher","first-page":"138","DOI":"10.1016\/j.jbiomech.2019.04.039","article-title":"Validating a low-cost, consumer force-measuring platform as an accessible alternative for measuring postural sway","volume":"90","author":"Bartlett","year":"2019","journal-title":"J Biomech."},{"key":"B22","volume-title":"Identifying Fall Risk Using Machine Learning Algorithms. US20170000387A1","author":"Forth","year":"2019"},{"key":"B23","doi-asserted-by":"publisher","first-page":"1275","DOI":"10.1016\/j.jhealeco.2008.05.012","article-title":"Optimal recall length in survey design","volume":"27","author":"Clarke","year":"2008","journal-title":"J Health Econ."},{"key":"B24","doi-asserted-by":"publisher","first-page":"2190","DOI":"10.1111\/j.1532-5415.2005.00509.x","article-title":"Monitoring falls in cohort studies of community-dwelling older people: effect of the recall interval","volume":"53","author":"Ganz","year":"2005","journal-title":"J Am Geriatr Soc."},{"key":"B25","doi-asserted-by":"publisher","first-page":"331","DOI":"10.1016\/j.otohns.2010.05.007","article-title":"A practical guide to understanding kaplan-meier curves","volume":"143","author":"Rich","year":"2010","journal-title":"Otolaryngol Head Neck Surg"},{"key":"B26","doi-asserted-by":"publisher","first-page":"155","DOI":"10.1016\/j.jcm.2016.02.012","article-title":"A guideline of selecting and reporting intraclass correlation coefficients for reliability research","volume":"15","author":"Koo","year":"2016","journal-title":"J Chiropr Med."},{"key":"B27","unstructured":"30421236ViennaR Foundation for Statistical ComputingR: A Language and Environment for Statistical Computing [Internet]. 3.4.1.2017"},{"key":"B28","doi-asserted-by":"publisher","first-page":"1127","DOI":"10.1093\/oxfordjournals.aje.a009592","article-title":"Slopes of a receiver operating characteristic curve and likelihood ratios for a diagnostic test","volume":"148","author":"Choi","year":"1998","journal-title":"Am J Epidemiol."},{"key":"B29","doi-asserted-by":"publisher","first-page":"14","DOI":"10.1186\/1471-2318-14-14","article-title":"Is the timed up and go test a useful predictor of risk of falls in community dwelling older adults: a systematic review and meta-analysis","volume":"14","author":"Barry","year":"2014","journal-title":"BMC Geriatr."},{"key":"B30","doi-asserted-by":"publisher","first-page":"1191","DOI":"10.1136\/jech-2017-209769","article-title":"Operationalization and validation of the stopping elderly accidents, deaths, and injuries (STEADI) fall risk algorithm in a nationally representative sample","volume":"71","author":"Lohman","year":"2017","journal-title":"J Epidemiol Community Health."},{"key":"B31","doi-asserted-by":"publisher","first-page":"938","DOI":"10.1001\/archinternmed.2009.66","article-title":"Disorders of balance and vestibular function in US adults: data from the national health and nutrition examination survey, 2001-2004","volume":"169","author":"Agrawal","year":"2009","journal-title":"Arch Intern Med."},{"key":"B32","doi-asserted-by":"publisher","first-page":"1309","DOI":"10.1097\/MAO.0b013e31822e5bee","article-title":"The modified romberg balance test: normative data in US adults","volume":"32","author":"Agrawal","year":"2011","journal-title":"Otol Neurotol."},{"key":"B33","doi-asserted-by":"publisher","first-page":"328","DOI":"10.1093\/ptj\/83.4.328","article-title":"Use of clinical and impairment-based tests to predict falls by community-dwelling older adults","volume":"83","author":"Boulgarides","year":"2003","journal-title":"Phys Ther."},{"key":"B34","doi-asserted-by":"publisher","first-page":"650","DOI":"10.1093\/geront\/46.5.650","article-title":"Older people's views of falls-prevention interventions in six European countries","volume":"46","author":"Yardley","year":"2006","journal-title":"The Gerontologist."},{"key":"B35","doi-asserted-by":"publisher","first-page":"449","DOI":"10.1017\/S0144686X07006861","article-title":"A systematic review of older people's perceptions of facilitators and barriers to participation in falls-prevention interventions","volume":"28","author":"Bunn","year":"2008","journal-title":"Ageing Soc."},{"key":"B36","doi-asserted-by":"publisher","first-page":"2528","DOI":"10.1111\/jgs.14375","article-title":"Person-centered fall risk awareness perspectives: clinical correlates and fall risk","volume":"64","author":"Verghese","year":"2016","journal-title":"J Am Geriatr Soc."},{"key":"B37","first-page":"p. 47","volume-title":"WHO Global Report on Falls Prevention in Older Age","year":"2008"},{"key":"B38","doi-asserted-by":"publisher","first-page":"315","DOI":"10.1016\/j.gaitpost.2005.04.009","article-title":"Destabilization of human balance control by static and dynamic head tilts","volume":"23","author":"Paloski","year":"2006","journal-title":"Gait Posture."},{"key":"B39","doi-asserted-by":"publisher","first-page":"65","DOI":"10.1186\/s12877-017-0447-y","article-title":"Racial-ethnic differences in fall prevalence among older women: a cross-sectional survey study","volume":"17","author":"Geng","year":"2017","journal-title":"BMC Geriatr."},{"key":"B40","doi-asserted-by":"publisher","first-page":"535","DOI":"10.1016\/j.jamda.2016.02.009","article-title":"Greater fall risk in elderly women than in men is associated with increased gait variability during multitasking","volume":"17","author":"Johansson","year":"2016","journal-title":"J Am Med Dir Assoc."},{"key":"B41","doi-asserted-by":"publisher","first-page":"1060","DOI":"10.1177\/0898264314541698","article-title":"Racial\/Ethnic predictors of falls among older adults: the health and retirement study","volume":"26","author":"Nicklett","year":"2014","journal-title":"J Aging Health."}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2020.591517\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,1,10]],"date-time":"2021-01-10T16:31:21Z","timestamp":1610296281000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2020.591517\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,12,4]]},"references-count":41,"alternative-id":["10.3389\/fmed.2020.591517"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2020.591517","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,12,4]]},"article-number":"591517"}}