Falls Risk Assessment Tools

Falls Risk Assessment
Tools: A Systemic Review
Source: Information
provided from the
Canadian Falls Prevention
Curriculum and Dr. Vicky
Scott Presentations

Risk Assessment Tools
Risk Assessment Tools are designed:
– To help identify get those at greatest
risk of falling
– To tailor prevention to individual risk
factors
Risk Assessment Tools are either:
– Multifactor in assessment
– Functional mobility assessment tools
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Three Types of Tools
Multifactorial
Functional mobility
Environmental hazard checklists

Choosing a Risk Assessment Tool
Falls occur due to a loss of balance or an
inability to recover balance
A broad set of factors interconnect and
contribute to risk
Risk profiles differ for those in residential
and acute settings and for those at risk of
injury
Tools exist for the assessment of risk in all
settings

When selecting a tool
consider…
Your purpose
Cost
Ease of use
Training requirement
Potential for acceptance
Evidence of reliability and validity
Staffing needs
Content consistent with evidence of
known risk factors

Review of Studies
Review of studies was done from
1980 – July 2004
– Reviewed predictive value of one or
more fall assessment tools on a
population of 65+
– The primary outcomes: falls, falls
related injury or gait balance
– Only studies that used prospective
validation were considered.
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Review Literature Findings
199 studies
34 studies met criteria for validity
and reliability of 38 tools
27 of the 38 were functional
mobility
8 were screening tools
3 were a combination
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27 Functional Mobility Assessments
Activity based balance
and gait
Area of ellipse of
Postural sway
Berg balance scale
Dynamic gait index
Elderly Mobility Scale
Floor transfer
Five minute walk
Functional reach test
Lateral reach test
Maximal Step Length
Mean Velocity Postural
Sway
Mobility Interaction Fall
Chart
8
100% Limit of stability
POAM-B
Postural Balances
Postural Stability Tests
Quantitative gait
assessment
Rapid step test
Step up test
Tandem stance
Times chair stands
Timed up and go
Timed Walk
Tinetti balance scale
Tinetti balance sub-
scale
8

8 Screening Tools
Balance and self
efficacy test
Conley scale
Fall risk assessment
Fall risk screening test
Home assessment
profile
Morse fall scale
Geriatric postural
screen
Stratify
3 Combined functional
Screening
Downton index
Elderly fall screening
Physiological & clinical
predictors
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Settings and Tools
Community: 14 studies/23 tools
Acute: 12 studies/8 tools
Long-Term care: 6 studies/tools
Home support: 4 studies /4 tools
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Findings for Review
There are a number of risk
assessment tools available with a
reasonable amount of evidence to
support their use
No single tool can be recommended
for implementation in all settings for
all subpopulations within each setting
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Tools With Predictive Values
Community: 5 minute walk; 5 step test,
CTSIB, Floor transfer, Maximum Step
length, TUG ( timed up and go)
Supportive Housing: Berg, Physiological &
Clinical Predictors
LTC Mobility Fall Chart, Area Ellipse of
Postural Sway , Tinetti Balance Subscale
Acute : Fall Risk Assessment: Stratify
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Timed-Up
Up-And-Go (TUG)
Sit to Stand
Turn
Around
46 cm
64 cm
Walk 1
Slow, Stop,
Turn and Sit
Walk 2
0
1 2
DISTANCE (m)
3

Tools with Good Validity &
Reliability
Community: 5-minute Walk, 5-step 5
Test,
Functional Reach, Clinical Test Sensory
Interaction for Balance, Floor Transfer,
Maximum Step Length, Timed-Up
Up-and-Go
Test
Supportive housing: BERG Balance,
Physiological and Clinical Predictors
Residential: Mobility Fall Chart, Area
Ellipse of Postural, Tinetti Balance
Subscale
Acute: Schmid Fall Risk Assessment,
STRATIFY, Morse Fall Scale

Selection Considerations
What is your work setting and target population
What fall risk assessment tool do you use now
and how was it selected
What is the purpose of the tools and what is done
with the info gathered
How do you know if these tools are reliable and
valid for intended purposes
What would you change in your practice to
improve your ability to predict and prevent falls
What information or support do you need to
improve current risk assessment and prevention
practices.
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References
Dr. Scott “ A Systemic Review of Assessment
Tools for Fall Risk” BC Injury Research and
Prevention Unit
University of British Columbia
References: For slide on Tools with Good predictive
Values;
Berg 1992, Boulgarides 2003; Cho 2004; Duncan
1992; Lord 1998; Lundin Olsson 2000; Murphy
2003; Oliver 1997; Oliver 2004; Perell 2001;
Schmid 1990; Thapa 1996.
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