Why Are Fall Risk Assessments So Important?
As we age, a number of physical changes can increase the likelihood of a fall, such as decreased muscle strength, poorer balance, and visual impairment. Additionally, certain medications and health conditions can play a significant role. A formal fall risk assessment is not just about identifying risk; it's about empowering individuals with the knowledge and tools to mitigate that risk. By assessing a person's mobility, strength, cognition, and overall health profile, healthcare providers can tailor prevention strategies to their specific needs. This might include physical therapy, medication adjustments, or home modifications.
Initial Screening: The 3 Key Questions
For many older adults, the assessment process begins with a simple, three-question screening during a routine medical check-up. The answers to these questions can help a clinician determine if a more in-depth assessment is needed. A positive answer to any of the following indicates an increased fall risk:
- Have you fallen in the past year?
- Do you feel unsteady when standing or walking?
- Do you worry about falling?
If the individual has had two or more falls in the past year, or if they report trouble walking or balancing, a full, comprehensive assessment is typically recommended. Even a fear of falling alone, without a recent fall, warrants a deeper look, as this fear can lead to reduced activity, which paradoxically increases weakness and the risk of a fall.
Detailed Physical and Functional Tests
When a comprehensive assessment is necessary, it often involves a series of physical and functional tests to evaluate specific aspects of a person's mobility and balance. These are often conducted by a physical therapist or other trained healthcare professional.
The Timed Up and Go (TUG) Test
This is one of the most common and practical tests for mobility and balance. It measures the time it takes for a person to rise from a chair, walk 10 feet (3 meters), turn around, walk back to the chair, and sit down again. Taking longer than 12 seconds to complete the TUG test suggests a high risk of falling.
The 30-Second Chair Stand Test
This test assesses lower-body strength and endurance. The test involves repeatedly standing up and sitting down from a chair for 30 seconds. A below-average score compared to age and gender norms indicates increased risk.
The 4-Stage Balance Test
This assessment measures static balance in progressively challenging positions, starting with feet side-by-side and moving to standing on one foot. An inability to hold the tandem stance for at least 10 seconds is a strong indicator of fall risk.
Beyond Movement: Other Assessment Factors
A comprehensive fall risk assessment is not limited to physical tests. A thorough evaluation also considers a range of other factors.
Medication Review
Many medications can have side effects that increase fall risk, such as dizziness or drowsiness. A healthcare provider will review all medications to minimize these side effects.
Environmental Assessment
A large number of falls occur in the home due to hazards like throw rugs or poor lighting. An environmental assessment identifies and helps address these risks.
Cognitive Screening
Cognitive impairment can significantly increase fall risk. A simple cognitive screen or dual-tasking assessments may be used.
Comparing Common Fall Risk Assessment Tools
| Feature | Morse Fall Scale (MFS) | STRATIFY Risk Assessment | Berg Balance Scale | Tinetti Assessment Tool |
|---|---|---|---|---|
| Best Used In | Hospitals, Ambulatory Settings | Hospitals | Clinics, Senior Care | Clinics, Senior Care |
| Focus | History of falls, gait, mental status, IV access | History of falls, cognition, vision, toileting, mobility | Static and dynamic balance | Gait and balance |
| Key Tasks | Scoring based on 6 criteria | Scoring based on 5 criteria | 14 functional balance tasks | 16 balance and gait tasks |
| Administered By | Nurses, Healthcare Staff | Nurses, Healthcare Staff | Physical Therapists | Trained Clinicians |
| Time Required | Very quick, ~3 minutes | Very quick, ~3 minutes | Moderate, ~15-20 minutes | Moderate, ~10-15 minutes |
| Outcome | Fall Risk Score | Fall Risk Score | Balance Ability Score | Fall Risk Score |
For more detailed information on specific fall risk screening and prevention protocols, you can consult resources from the National Institutes of Health: https://pmc.ncbi.nlm.nih.gov/articles/PMC4707663/.
What Happens After an Assessment?
Following an assessment, a personalized care plan is developed based on the identified risks. This may include physical therapy, medication management, assistive devices, home modifications, and vision/hearing checks.
Conclusion
Testing for a fall risk assessment involves medical history, functional tests, and a review of environmental and medication factors. A proactive approach with healthcare professionals can significantly reduce the risk of falling.
