Understanding the Goals of a Falls Risk Assessment
A falls risk assessment is a comprehensive evaluation designed to identify a person's risk factors for falling. The goal is not just to assign a score, but to uncover the specific, modifiable issues contributing to the risk. Interpretation involves looking at the quantitative data (scores) and qualitative findings (underlying conditions, environmental factors, medications). A thorough assessment examines intrinsic factors, such as physical and cognitive health, alongside extrinsic factors, like potential home hazards.
Interpreting Scores from Standardized Tools
Many assessments use standardized tools that produce a score, which is then categorized into risk levels (e.g., low, moderate, high). It's important to remember that these cut-off scores serve as a guide, not an absolute determinant. A score on the borderline should still be taken seriously, as it indicates potential vulnerability.
Timed Up and Go (TUG) Test
The TUG test measures a person's gait and mobility by timing how long it takes to stand up, walk 10 feet, turn around, and sit back down.
- Interpretation: A time of 12 seconds or more may indicate a higher risk of falling. Healthy older adults typically complete it in 10 seconds or less. A time over 30 seconds suggests significant mobility impairment.
Berg Balance Scale (BBS)
This tool assesses a person's functional balance across 14 tasks. Scores range from 0 to 56.
- Interpretation: A score below 45 suggests a greater risk of falling. Scores can also help determine the level of assistance needed; for example, a score of 0-20 suggests wheelchair mobility.
Morse Fall Scale (MFS)
The MFS is commonly used in hospital settings and scores six items, including fall history, gait, and mental status.
- Interpretation: A score of 0-24 is considered low risk, 25-45 is moderate risk, and 45+ is high risk.
Tinetti Performance Oriented Mobility Assessment (POMA)
This assessment evaluates balance and gait, with a total possible score of 28.
- Interpretation: Scores of 25-28 are low risk, 19-24 are moderate, and below 19 are high risk.
Identifying Underlying Risk Factors Beyond the Score
A score alone is not enough to form a complete picture. A holistic interpretation requires analyzing the specific intrinsic and extrinsic factors that contributed to the score.
Intrinsic Factors
- Medication Review: Polypharmacy (taking four or more medications) significantly increases fall risk. Certain medications, including sedatives, antidepressants, and blood pressure drugs, can cause dizziness, sedation, or confusion. Interpreting findings involves identifying these high-risk medications and considering whether dosages can be adjusted or simplified.
- Cognitive Impairment: Poor judgment, memory issues, or a history of dementia can increase fall risk. Cognitive assessment scores help determine if this is a contributing factor.
- Physical Deficits: Weakness, balance problems, impaired gait, and foot issues are often revealed during the physical exam portion of the assessment. The interpretation should link these specific deficits to the overall risk.
- Vision Impairment: Poor vision, cataracts, or glaucoma can all increase risk by affecting depth perception and visibility.
Extrinsic Factors
- Environmental Hazards: Assessing the home environment for clutter, poor lighting, loose rugs, and lack of grab bars is a critical part of interpretation. The assessment findings should be directly tied to observations of the living space.
- Inappropriate Footwear: Wearing ill-fitting shoes or slippers that lack proper support can increase the chance of tripping or slipping.
Translating Findings into Actionable Interventions
The most important part of interpreting findings is using the information to create a personalized, targeted fall prevention plan. This involves addressing each identified risk factor with a specific intervention.
Steps to a Personalized Prevention Plan
- Summarize Findings: Document the overall risk level and the specific intrinsic and extrinsic factors identified during the assessment.
- Review Medications: Work with a pharmacist or physician to review all medications, especially those known to increase fall risk. Discuss potential dosage adjustments or alternatives.
- Create an Exercise Plan: Based on identified weaknesses in gait, balance, or strength, develop a targeted exercise regimen. This may include physical therapy referrals for personalized balance and strengthening exercises, or group activities like Tai Chi, which is proven to improve balance.
- Implement Home Modifications: Address all environmental hazards identified during the home assessment. This can involve simple changes, like securing loose rugs and improving lighting, or larger installations, such as grab bars in bathrooms and stair handrails.
- Educate and Monitor: Provide comprehensive education to the individual and caregivers on fall prevention strategies. Continually monitor progress and adjust interventions as needed. This ongoing process is crucial, as risk factors can evolve over time.
Comparison of Common Assessment Tool Score Ranges
| Assessment Tool | Low Risk Score | Moderate Risk Score | High Risk Score |
|---|---|---|---|
| Morse Fall Scale | < 25 | 25-45 | > 45 |
| Berg Balance Scale | 45-56 | 21-40 | 0-20 |
| Tinetti (POMA) | > 24 | 19-24 | < 19 |
| Timed Up and Go (TUG) | < 12 seconds | 12-14 seconds | > 14 seconds |
Conclusion
Understanding how can you interpret findings of a falls risk assessment is the key to proactive and personalized senior care. It moves beyond a simple score to create a detailed map of an individual's unique fall risks. By systematically analyzing quantitative scores from tests like the TUG and BBS alongside qualitative factors such as medication use, home environment, and physical health, caregivers and healthcare providers can develop effective, evidence-based intervention plans. Ultimately, this approach empowers older adults to maintain their safety, independence, and overall quality of life.
For more detailed guidance on clinical fall prevention strategies and resources, consult the CDC STEADI Program.
