Screening Older Adults At-Risk for Falls

Monday, 22 July 2013

Tina P. Brown Reid, EdD, MSN, BSN, RN
Department of Nursing, Salisbury University, Salisbury, MD
Dennis W. Klima, PT, MS, PhD
Physical Therapy, University of Maryland Eastern Shore, Princess Anne, MD
Roberta A. Newton, PT, PhD
Department of Physical Therapy, Temple University, Philadelphia, PA

Learning Objective 1: The learner will be able to identify key risk factors for falls and fear of falling when screening older adults in the emergency department.

Learning Objective 2: The learner will be able to identify objective balance and mobility test used to predict falls in older adults.

Background: The purpose of the study was to utilize a Fall Risk Screening tool to identify older adults at risk for falls in both the Emergency Department (ED) and community settings.

Methods: Forty-two community-dwelling older adults completed the initial pilot and follow-up phases of the Fall Risk Screen in the ED. Upon completion of the initial phase, the screening tool was revised by adding select physical performance tests, including the Timed Up and Go (TUG), Multidirectional Reach and tandem test instruments, and then administered to a second cohort of 103 older adults on-site in the community. Three month follow-up was performed. Statistical analyses included demographic analyses and logistic regression modeling for prediction of falls.

Results: Fifteen of the ED patients (35.7%) had two major fall risk factors, including: previous falls, decreased leg strength, and balance and gait problems. On follow-up, three falls occurred in two people. Of the 103 community living subjects (age: 79.3 ± 10.4 years) completing the 3-month follow-up with the revised instrument, 76.7% had one or more major fall risk factors. Select questions and objective physical performance tests predicted future falls by 70%. TUG Test performance slower than 12 seconds, a forward reach excursion > nine inches, and summed semi-tandem/tandem time >20 seconds were independent predictors of falls among the community-living group (p<0.05).

Conclusions: The revised Fall Risk Screen is beneficial for identifying older adults at risk for falls and demonstrates both psychometric stability and clinical utility to predict falls among community-living older adults. Our cut-off fall threshold score of 12 seconds is faster than previously reported findings. Interdisciplinary education and interventions, including joint nursing and rehabilitation initiatives, are warranted.