Falls Risk Assessment Falls Risk Assessment in Older People in - - PowerPoint PPT Presentation

Falls Risk Assessment Falls Risk Assessment in Older People in Older People

Professor Stephen Lord Professor Stephen Lord Prince of Wales Medical Research Prince of Wales Medical Research Institute Institute

Assessing falls risk Assessing falls risk

• unrealistic expectations?

unrealistic expectations?

• T

The causes of falls are multifactorial he causes of falls are multifactorial in nature in nature

• There is a desire for a single test or

There is a desire for a single test or quick assessment of falls risk quick assessment of falls risk

Screening or assessment? Screening or assessment?

Screening Screening – – identification of people at risk identification of people at risk

• Increased surveillance

Increased surveillance

• Referral for further assessment and

Referral for further assessment and intervention intervention Assessment Assessment -

• identification of risk factors

identification of risk factors amenable to treatments / correction amenable to treatments / correction

• Tailoring intervention strategies

Tailoring intervention strategies

Simplest screen Simplest screen

• Have you fallen in the past 12 months?

Have you fallen in the past 12 months?

• Degree of difficulty

Degree of difficulty – – easy easy

• Sensitivity and specificity

Sensitivity and specificity – – reasonable reasonable

• Information gained about prevention

Information gained about prevention strategies strategies – – nil nil

Hospitals: STRATI FY (Oliver 1997) Hospitals: STRATI FY (Oliver 1997)

• I tems

I tems

• falls as a presenting complaint

falls as a presenting complaint

• agitation

agitation

• frequent toileting

frequent toileting

• visual impairment

visual impairment

• transfer and mobility score

transfer and mobility score

• Sensitivity 93% and specificity of 88% in

Sensitivity 93% and specificity of 88% in development hospital development hospital

• Sensitivity 92% and specificity 68% in different

Sensitivity 92% and specificity 68% in different hospital hospital

Timed Up and Go Test Timed Up and Go Test

• Recommended by American and British

Recommended by American and British Geriatrics Societies Geriatrics Societies

• Surprisingly little validation as a predictor

Surprisingly little validation as a predictor

• f falls
• f falls
• Varying methods

Varying methods

• Usual vs. fast performance

Usual vs. fast performance

• Differing walk distances: 3m vs. 8ft

Differing walk distances: 3m vs. 8ft

• Differing instructions about turning: walk

Differing instructions about turning: walk to line, walk past line, walk around a cone to line, walk past line, walk around a cone

• Varying cut

Varying cut-

• points: 10s, 14s, 15s, 22s

points: 10s, 14s, 15s, 22s

Timed Up and Go Test Timed Up and Go Test -

• recommendations

recommendations

• Most widely used method

Most widely used method

• Perform at usual (own) pace

Perform at usual (own) pace

• Chair with seat height of 43cm with

Chair with seat height of 43cm with armrests armrests

• Walk distance of 3m

Walk distance of 3m

• Walk past line and turn

Walk past line and turn

• Cut

Cut-

• points

points

• 10s for community

10s for community-

• dwelling people

dwelling people

• 15s for frail groups

15s for frail groups

Assessment batteries Assessment batteries

• Berg Balance Scale

Berg Balance Scale http:/ / http:/ / www.physicaltherapy.utoronto.ca/ assetfactory.asp www.physicaltherapy.utoronto.ca/ assetfactory.asp x?did x?did= 126 = 126

• Tinetti Performance Oriented Mobility Assessment (POMA)

Tinetti Performance Oriented Mobility Assessment (POMA)

• Physical Performance battery (

Physical Performance battery ( Guralnik Guralnik et al) et al) -

• http:/ / www.coe.uga.edu/ cs

http:/ / www.coe.uga.edu/ cs-

• pfp/ pdfs/ ppt.pdf

pfp/ pdfs/ ppt.pdf

• Elderly Fall Screening Test

Elderly Fall Screening Test

• Gait Abnormality Rating Scale

Gait Abnormality Rating Scale

Guralnik Guralnik Physical performance battery Physical performance battery

• Has been used in very large studies, and

Has been used in very large studies, and normative values have been established normative values have been established

• Comprises

Comprises

• timed standing balance

timed standing balance

• repeated chair stands

repeated chair stands

• timed walk

timed walk

• Each item scored / 4 with combined

Each item scored / 4 with combined score / 12 score / 12

Guralnik Guralnik Physical performance battery Physical performance battery

Comparison of 8 function tests Comparison of 8 function tests

• Sit

Sit-

• to

to-

• stand 1x & 5x

stand 1x & 5x

• Alternate step test (19cm high step)

Alternate step test (19cm high step)

• Turn test (n steps to turn 180 degrees)

Turn test (n steps to turn 180 degrees)

• 6m walk

6m walk – – normal speed normal speed

• Pick

Pick-

• up 5kg weight test

up 5kg weight test

• Stair ascent (8 steps

Stair ascent (8 steps -

• 5cm high, 27cm deep)

5cm high, 27cm deep)

• Stair descent (8 steps

Stair descent (8 steps -

• 5cm high, 27cm deep

5cm high, 27cm deep) )

• 362 community

362 community-

• dwelling people aged 75+

dwelling people aged 75+

• Compared

Compared w.r.t w.r.t. validity, reliability and feasibility . validity, reliability and feasibility

Sit Sit-

• to

to-

• stand test an Alternate Step Tests

stand test an Alternate Step Tests

Functional tests Functional tests -

• recommendations

recommendations

5 5 4 4 1 1 Pick Pick-

• up

up 7 7 5 5 2 2 STS STS – – 1 1 9 9 5 5 4 4 Turn Turn 10 10 5 5 5 5 Stair Stair asc asc 15 15 5 5 10 10 Stair des Stair des 17 17 3 3 4 4 10 10 6m walk 6m walk 18 18 4 4 4 4 10 10 Alt step Alt step 20 20 5 5 5 5 10 10 STS STS-

• 5

5 Total Total Feasibility Feasibility Reliability Reliability Validity Validity Test Test

Need for multiple tests for falls Need for multiple tests for falls prediction prediction

• Poor performances in

Poor performances in two tests did increase two tests did increase risk risk

• Poor performances in

Poor performances in 3+ tests did not 3+ tests did not increase risk further increase risk further 4.7 4.7 2 2 4.7 4.7 4 4 5.0 5.0 3 3 1.9 1.9 1 1 1 1 Odds Ratio Odds Ratio I mpairments I mpairments

QuickScreen QuickScreen Assessment Assessment Form Form

Fall Risk Assessment Fall Risk Assessment -

• PPA

PPA

• Physiological, rather than disease

Physiological, rather than disease-

• oriented
• riented
• I nvolves quantitative functional assessment of

I nvolves quantitative functional assessment of sensorimotor abilities sensorimotor abilities

• Assumes that

Assumes that most most disease processes will be disease processes will be manifest in impaired performances in one or more manifest in impaired performances in one or more tests tests

• Cataracts

Cataracts – – poor vision poor vision

• Neuropathy

Neuropathy – – poor sensation poor sensation

• Prior

Prior-

• polio

polio – – weakness weakness

• Stroke

Stroke – – weakness, incoordination, instability weakness, incoordination, instability

Contrast sensitivity Contrast sensitivity -

• MET

MET

Melbourne Edge Test

Proprioception Proprioception

Lower Limb Strength Lower Limb Strength

Reaction Time Reaction Time-

• Hand & Foot

Hand & Foot

Sway on floor and on foam Sway on floor and on foam

PPA Short form PPA Short form

• Significant and independent predictors

Significant and independent predictors Coefficients Coefficients

• Visual contrast sensitivity

Visual contrast sensitivity

• 0.33

0.33

• Proprioception

Proprioception 0.20 0.20

• Quadriceps strength

Quadriceps strength

• 0.16

0.16

• Simple reaction time

Simple reaction time 0.47 0.47

• Postural sway on the compliant surface

Postural sway on the compliant surface 0.51 0.51

• Percentage of subjects correctly classified: 75% .

Percentage of subjects correctly classified: 75% .

Falls and Balance Research Group Prince of Wales Medical Research Institute

Barker St, Randwick NSW 2031

• Ph. (02) 9399 1062
• fax. (02) 9399 1005

www.powmri.unsw.edu.au/FBRG

Falls Screening and Assessment Trade Falls Screening and Assessment Trade-

• offs
• ffs

Low cost Low cost

SIMPLE COMPREHENSIVE

Understanding Causes Short Time Technical Simplicity Identifying Factors Amenable to Treatment Likelihood of Prevention

Conclusions Conclusions

• Epidemiological studies have identified

Epidemiological studies have identified demographic, physiological and medical risk demographic, physiological and medical risk factors for falls factors for falls

• This information can be used to compile

This information can be used to compile evidence evidence-

• based fall risk screens and

based fall risk screens and assessments assessments

• The screen or assessment used depends on

The screen or assessment used depends on the resources available and the extent to the resources available and the extent to which the understanding of the causes of which the understanding of the causes of falls is required falls is required