Multifactorial and functional mobility assessment tools for fall risk among older adults in community, home-support, long-term and acute care settings.

OBJECTIVE to conduct a systematic review of published studies that test the validity and reliability of fall-risk assessment tools for use among older adults in community, home-support, long-term and acute care settings. METHODS searches were conducted in EbscoHost and MEDLINE for published studies in the English language between January 1980 and July 2004, where the primary or secondary purpose was to test the predictive value of one or more fall assessment tools on a population primarily 65 years and older. The tool must have had as its primary outcome falls, fall-related injury or gait/balance. Only studies that used prospective validation were considered. FINDINGS thirty-four articles testing 38 different tools met the inclusion criteria. The community setting represents the largest number of studies (14) and tools (23) tested, followed by acute (12 studies and 8 tools), long-term care (LTC) (6 studies and 10 tools) and home-support (4 studies and 4 tools). Eleven of the 38 tools are multifactorial assessment tools (MAT) that cover a wide range of fall-risk factors, and 27 are functional mobility assessment tools (FMA) that involve measures of physical activity related to gait, strength or balance. CONCLUSION fall-risk assessment tools exist that show moderate to good validity and reliability in most health service delivery areas. However, few tools were tested more than once or in more than one setting. Therefore, no single tool can be recommended for implementation in all settings or for all subpopulations within each setting.

[1]  Measures of Balance and Fear of Falling in the Elderly , 1999 .

[2]  J. Wyatt,et al.  Commentary: Prognostic models: clinically useful or quickly forgotten? , 1995 .

[3]  Neil B Alexander,et al.  Tests of Stepping as Indicators of Mobility, Balance, and Fall Risk in Balance‐Impaired Older Adults , 2004, Journal of the American Geriatrics Society.

[4]  Special feature: The home assessment profile - A reliable and valid assessment tool , 2001 .

[5]  J. Morse,et al.  A prospective study to identify the fall-prone patient. , 1989, Social science & medicine.

[6]  S L Luther,et al.  Fall risk assessment measures: an analytic review. , 2001, The journals of gerontology. Series A, Biological sciences and medical sciences.

[7]  S R Lord,et al.  Simple physiological and clinical tests for the accurate prediction of falling in older people. , 1996, Gerontology.

[8]  D. Streiner,et al.  Health Measurement Scales: A practical guide to thier development and use , 1989 .

[9]  J. McNitt-Gray,et al.  Quantitative gait assessment as a predictor of prospective and retrospective falls in community-dwelling older women. , 1994, Archives of physical medicine and rehabilitation.

[10]  D. Oliver,et al.  Evaluation of the STRATIFY falls prediction tool on a geriatric unit. , 2003, Outcomes management.

[11]  L. K. Boulgarides,et al.  Use of clinical and impairment-based tests to predict falls by community-dwelling older adults. , 2003, Physical therapy.

[12]  Nicole Ferko,et al.  Prediction of falls using a risk assessment tool in the acute care setting , 2004, BMC medicine.

[13]  D. Kiel,et al.  Identifying Nursing Home Residents at Risk for Falling , 1998, Journal of the American Geriatrics Society.

[14]  K. Berg.  Balance and its measure in the elderly: a review , 1989 .

[15]  E. Protas,et al.  Screening for Falls in Community-Dwelling Elderly , 2003 .

[16]  B. E. Maki,et al.  A prospective study of postural balance and risk of falling in an ambulatory and independent elderly population. , 1994, Journal of gerontology.

[17]  L. Nyberg,et al.  The Mobility Interaction Fall chart. , 2000, Physiotherapy research international : the journal for researchers and clinicians in physical therapy.

[18]  Hélène Corriveau,et al.  Screening older adults at risk of falling with the Tinetti balance scale , 2000, The Lancet.

[19]  Helen Myers,et al.  Hospital fall risk assessment tools: a critique of the literature. , 2003, International journal of nursing practice.

[20]  S. Nikoletti,et al.  Fall risk assessment : A prospective investigation of nurses' clinical judgement and risk assessment tools in predicting patient falls in an acute care setting , 2003 .

[21]  L. Bouter,et al.  Fall-risk screening test: a prospective study on predictors for falls in community-dwelling elderly. , 2001, Journal of clinical epidemiology.

[22]  1989 Federal Nursing Service Award Winner. Reducing patient falls: a research-based comprehensive fall prevention program. , 1990, Military medicine.

[23]  J. Poole,et al.  A review of balance instruments for older adults. , 1998, The American journal of occupational therapy : official publication of the American Occupational Therapy Association.

[24]  R. Cumming,et al.  WITHDRAWN: Interventions for preventing falls in elderly people. , 2009, The Cochrane database of systematic reviews.

[25]  A. Schultz,et al.  The challenge of predicting patients at risk for falling: development of the Conley Scale. , 1999, Medsurg nursing : official journal of the Academy of Medical-Surgical Nurses.

[26]  L. Nyberg,et al.  Using the Downton index to predict those prone to falls in stroke rehabilitation. , 1996, Stroke.

[27]  A. Biderman,et al.  Validation of a fall-risk screening test, the Elderly Fall Screening Test (EFST), for community-dwelling elderly. , 1998, Disability and rehabilitation.

[28]  L. Rubenstein,et al.  The epidemiology of falls and syncope. , 2002, Clinics in geriatric medicine.

[29]  M. E. McCollam.  Evaluation and implementation of a research-based falls assessment innovation. , 1995, The Nursing clinics of North America.

[30]  Tze-Wey Loong,et al.  Understanding sensitivity and specificity with the right side of the brain , 2003, BMJ : British Medical Journal.

[31]  D. Oliver,et al.  Development and evaluation of evidence based risk assessment tool (STRATIFY) to predict which elderly inpatients will fall: case-control and cohort studies , 1997, BMJ.

[32]  D. Pendergast,et al.  Physical condition, activity pattern, and environment as factors in falls by adult care facility residents. , 1993, Archives of physical medicine and rehabilitation.

[33]  M. Mcmurdo,et al.  Risk factors and risk assessment tools for falls in hospital in-patients: a systematic review. , 2004, Age and ageing.

[34]  R. Newton,et al.  Use of the Berg Balance Test to predict falls in elderly persons. , 1996, Physical therapy.

[35]  L. Nyberg,et al.  Predicting falls in residential care by a risk assessment tool, staff judgement, and history of falls , 2003, Aging clinical and experimental research.

[36]  Simon A Naji,et al.  Health measurement scales: a practical guide to their development and use (5th edition). , 1990, Australian and New Zealand journal of public health.

[37]  D J Eagle,et al.  Comparison of three instruments in predicting accidental falls in selected inpatients in a general teaching hospital. , 1999, Journal of gerontological nursing.

[38]  A. Eagger.  Rehabilitation , 1960 .

[39]  W A Ray,et al.  Clinical and biomechanical measures of balance as fall predictors in ambulatory nursing home residents. , 1996, The journals of gerontology. Series A, Biological sciences and medical sciences.

[40]  S. Brauer,et al.  A prospective study of laboratory and clinical measures of postural stability to predict community-dwelling fallers. , 2000, The journals of gerontology. Series A, Biological sciences and medical sciences.

[41]  S. Studenski,et al.  Functional reach: predictive validity in a sample of elderly male veterans. , 1992, Journal of gerontology.

[42]  B. Maki,et al.  Are Activity‐Based Assessments of Balance and Gait in the Elderly Predictive of Risk of Falling and/or Type of Fall? , 1993, Journal of the American Geriatrics Society.

[43]  M. Tinetti,et al.  Risk factors for falls among elderly persons living in the community. , 1988, The New England journal of medicine.

[44]  L. Rubenstein,et al.  The Yield, Reliability, and Validity of a Postal Survey for Screening Community‐Dwelling Older People , 2003, Journal of the American Geriatrics Society.

[45]  Lillemor Lundin-Olsson,et al.  Prediction of falls among older people in residential care facilities by the Downton index , 2003, Aging clinical and experimental research.

[46]  Karen White,et al.  Balance Self-Efficacy Predicts Risk Factors for Side Falls and Frequent Falls in Community-Dwelling Elderly , 2003 .

[47]  W. Kruse,et al.  FALLS IN COMMUNITY‐DWELLING OLDER PERSONS , 1996, Journal of the American Geriatrics Society.

[48]  B. E. Maki,et al.  Measuring balance in the elderly: validation of an instrument. , 1992, Canadian journal of public health = Revue canadienne de sante publique.

[49]  McCollam Me.  Evaluation and implementation of a research-based falls assessment innovation. , 1995 .

[50]  K. Rockwood,et al.  Feasibility and measurement properties of the functional reach and the timed up and go tests in the Canadian study of health and aging. , 2000, The journals of gerontology. Series A, Biological sciences and medical sciences.

[51]  L Prosser,et al.  Further validation of the Elderly Mobility Scale for measurement of mobility of hospitalized elderly people , 1997, Clinical rehabilitation.