Assessing Fall Risk: Too Many Choices!

By and

on January 9, 2018

Categories: Geriatrics, Geriatrics, Occupational Therapy, Physical Therapy

assessing fall risk

Disability due to falls has increased by 54% from 1990 to 2010, making falls a major concern for older adults and healthcare providers.1 The higher incidence also means clinicians need to be able to identify individuals at risk for falls as well as the components of fall prevention that put this group at an elevated risk. By selecting an appropriate outcome measure a clinician should be able to write accurate assessments and decrease fall risk.

Selecting Fall Risk Outcome Measures

Using the following questions and recent evidence, a clinician should be able to select an appropriate outcome measure for their patient population/practice setting:

  • How feasible is the measure? (time/cost)
  • How portable is the measure? What equipment is needed?
  • Is performance better than self-report?
  • Has measure been evaluated in my patient population or setting?
  • What dimensions of risk/balance are captured?
  • Can I get better info using a set of measures?
  • Who needs to do the test? What is the training?
  • How easily can results be interpreted?
  • How should I use test findings in documentation?

Psychometrics & Feasibility of Fall Assessment

Due to significant number of fall risk assessment tools and ethical value of providing the best patient care, it is important that a clinician selects an appropriate tool with strong psychometric properties and is feasible for a clinical setting.  

Using psychometric data a clinician can answer the following questions:

  • What tools should a clinician use for screening versus fall risk assessment?
  • How accurately does a particular test/measure evaluate balance and fall risk?
  • How reliable is the test/measure?
  • How should a clinician interpret test results? What is the best “cut score” as indicator of fall risk for the specific patient population?
  • What combination of tests/measures provide best information about future fall risk?
  • Did intervention make a difference?

Using the information you gain from our course, Improving Balance and Reducing Fall Risk, and answering the questions above you will be able to select appropriate assessment tools for your patient as well as write a thorough assessment with the goal of justifying your skilled therapy services.

Fall Risk Assessment Resources

Medbridge is here to get you started with fall risk assessment. Below are a few of our free cheat sheets for a handful of fall risk tests:

Michelle M. Lusardi, PT, DPT, PhD, FAPTA

Dr. Lusardi’s interest in balance and falls in later life has its roots in her early years as a physical therapist on the neurological service at Hartford Hospital, where she noticed that many of her patients with stroke and amputation limited their physical activity because of concern about falling. Seeing the functional consequence of inactivity in the older adults who completed rehabilitation, Dr. Lusardi returned to graduate school to prepare for an academic and research career that has focused on geriatrics and functional mobility.

Dr. Lusardi served on the physical therapy faculty at the University of Connecticut from 1981 through 1996, where she was responsible for the neurological curriculum thread as well as content on prosthetics and orthotics. She moved to the problem-based learning master’s program at Sacred Heart as a founding faculty member in 1997 and coordinated the second semester with its emphasis on neurological rehabilitation across the lifespan. During her time at Sacred Heart, her research produced gender- and age-based "norms" for many functional tests and measures used in rehabilitation. Although now a retired Professor Emeritus, Dr. Lusardi has continued to write and teach about physical therapy care for older adults.

Mariana Wingood, PT, DPT, GCS, CEEA

Mariana Wingood, PT, DPT, GCS, CEEAA, is a physical therapist at the University of Vermont-Acute Inpatient Department. She is a highly enthusiastic member of the Academy of Geriatrics who is involved in numerous projects, including the CPG research group, GeriEDGE Fall Risk Assessment workgroup, Chair of the Balance and Falls SIG, Vermont State Advocate, and Program Committee.

Dr. Wingood’s focus is on fall prevention and exercise prescription for older adults. Her professional goal is improving the profession by increasing the knowledge base of evidence-based practice. This is why she has taught at the University of Vermont and presented at numerous state and national conferences.

References
  1. Stubbs B, Binnekade T, Eggermont L, Sepehry A, Patchay S, Schofield P. Pain and the risk for falls in community-dwelling older adults: Systematic review and meta-analysis. Archives of physical medicine and rehabilitation. 2013;95(1):175–187
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