Decoding Your Fall Risk: What is a fall risk score of 20?

According to the CDC, millions of older adults experience falls each year, many of which can lead to serious injuries. When a healthcare provider performs a fall risk assessment, they may assign a numerical value. But what is a fall risk score of 20 and what does it indicate about your personal safety?

Quick Summary

A fall risk score of 20 has different meanings depending on the assessment tool used, such as the Morse Fall Scale, FRAT, or Berg Balance Scale. Interpreting the score requires knowing the specific scale to determine the level of concern and implement appropriate interventions to enhance safety and prevent falls.

Key Points

• Assessment Tool Matters: A score of 20 means different things depending on which fall risk assessment tool (e.g., MFS, FRAT, BBS) was used to generate it.

• Morse Fall Scale Interpretation: A total score of 20 on the MFS is in the low-risk category, although 20 points may be specifically assigned for an impaired gait, highlighting a mobility issue.

• High Risk on FRAT and BBS: On the FRAT, a score of 20 is considered high risk. On the BBS, a score of 20 or less indicates high fall risk and potential need for wheelchair assistance.

• Action is Key: Regardless of the risk category, a score of 20 signals that specific risk factors, such as impaired gait or medication side effects, need to be addressed.

• Multifaceted Prevention: Effective fall prevention involves home modifications, balance and strength exercises, medication review, and vision checks, all tailored to the individual's specific needs.

• Consult a Professional: Always discuss your fall risk score and the assessment findings with a healthcare provider to receive a personalized safety plan.

Not All Fall Risk Scores Are the Same

Understanding what a fall risk score of 20 means is impossible without first identifying the specific assessment tool used. While 20 is a number, its implication for a patient's safety can vary dramatically from low risk to high risk, depending on the scale. It is crucial to ask your healthcare provider which tool they used for a proper interpretation.

A Score of 20 on the Morse Fall Scale (MFS)

The Morse Fall Scale is a common tool used in healthcare settings to assess a patient's fall risk by evaluating six different risk factors. In this scale, 20 points are specifically assigned for an 'impaired gait'. An impaired gait is characterized by difficulty rising from a chair, shuffling steps, watching the ground while walking, and relying heavily on supports like furniture or a person for stability.

However, a total MFS score of 20 is generally considered a low-risk category. The MFS assigns different point values for other factors, such as a history of falls (25 points) or having an IV lock (20 points). Since the threshold for moderate risk on the MFS starts at 25, a cumulative score of 20 would put the individual in the low-risk bracket. While technically 'low risk', the 20 points for an impaired gait highlight a specific, significant area of concern that requires attention and intervention.

A Score of 20 on the Falls Risk Assessment Tool (FRAT)

The Falls Risk Assessment Tool (FRAT) is another widely used assessment. On the FRAT, the scoring is interpreted differently. For this tool:

• 5-11: Low Risk
• 12-15: Medium Risk
• 16-20: High Risk

Therefore, if a healthcare provider used the FRAT, a score of 20 indicates a high fall risk, not a low one. In this scenario, it is standard practice to commence an immediate 'Fall Alert Protocol' with targeted, comprehensive interventions to prevent falls. This is a critical distinction and underscores why knowing the specific assessment is so important.

A Score of 20 on the Berg Balance Scale (BBS)

Unlike the Morse Fall Scale, which is often used in hospitals, the Berg Balance Scale is a performance-based assessment that measures balance and is frequently used by physical therapists. The scale has a maximum score of 56. The score ranges on the BBS are as follows:

• 41-56: Low risk (independent walking)
• 21-40: Medium risk (walking with assistance)
• 0-20: High risk (likely requiring wheelchair assistance)

For the BBS, a score of 20 or lower indicates a high risk of falling. In this case, the interventions are focused on improving balance and mobility, and potentially providing assistive devices or training for safer transfers.

The Components of Fall Risk: More Than Just the Score

Regardless of the total score, fall risk assessments evaluate several key areas. Even if a score of 20 is in the 'low risk' category on one scale, the underlying factors contributing to that score still need to be addressed. Common risk factors include:

• History of falls: Falling once doubles the risk of falling again.
• Lower body weakness: Muscle weakness and sarcopenia can impair balance and gait.
• Medications: Certain drugs, like sedatives or antidepressants, can cause dizziness or drowsiness.
• Vision problems: Impaired vision increases the risk of tripping over obstacles.
• Foot pain and footwear: Unsafe footwear and foot problems are significant risk factors.
• Environmental hazards: Clutter, throw rugs, and poor lighting are common culprits.
• Balance and gait problems: Issues with walking style and stability are core components of risk.

Comparing Fall Risk Assessment Tools

Feature	Morse Fall Scale (MFS)	Falls Risk Assessment Tool (FRAT)	Berg Balance Scale (BBS)
Scoring	0-125 points	0-20+ points	0-56 points
Score Interpretation	0-24 (Low), 25-44 (Medium), ≥45 (High)	5-11 (Low), 12-15 (Medium), 16-20 (High)	41-56 (Low), 21-40 (Medium), 0-20 (High)
Primary Setting	Hospital Inpatient	General Adult Population (varied)	Physical Therapy/Rehab
Type of Assessment	Self-report & clinical observation	Self-report & clinical observation	Performance-based
Key Factors	Gait, history, diagnosis, mobility aids, IV, mental status	Clinical judgment, mobility, mental state, medications, etc.	Functional balance tasks

Actionable Strategies for Fall Prevention

Mitigating fall risk involves a proactive, multi-faceted approach. Based on your specific assessment results, your healthcare team will recommend interventions, but some general strategies include:

1. Consult Your Healthcare Provider: Schedule an appointment to discuss your score and the specific contributing factors. Review all medications (prescription and over-the-counter) for side effects that could impact balance or cause dizziness.
2. Engage in Regular Exercise: Physical activity improves strength, balance, coordination, and flexibility. Tai Chi, water workouts, and walking are excellent choices.
3. Perform a Home Safety Evaluation: Remove tripping hazards like throw rugs, clutter, and loose cords. Ensure adequate lighting, especially in hallways and on stairs. Install grab bars in the bathroom and handrails on all staircases.
4. Wear Proper Footwear: Choose sturdy, flat shoes with non-skid soles. Avoid walking in socks or loose-fitting slippers.
5. Get Vision and Hearing Checks: Annual checks are important, as even minor changes can affect balance. Make sure new glasses or hearing aids are comfortable and worn consistently.
6. Use Assistive Devices if Needed: If your doctor recommends a cane or walker, use it correctly. A physical therapist can provide training for safe use.

Conclusion

A fall risk score of 20 is not a universal indicator but a data point that gains meaning from the context of the specific assessment tool. Whether it signals low risk with a specific concern or immediate high-risk intervention, the score is a crucial prompt for action. Understanding the scoring system and proactively addressing the underlying risk factors is the most effective way to protect your health and independence. For more information, visit the CDC's STEADI program: Preventing Falls: How to reduce your chances.

Frequently Asked Questions

Does a fall risk score of 20 on the Morse Fall Scale mean I am high risk?

No, on the Morse Fall Scale (MFS), a total score of 20 places you in the low-risk category. However, 20 points are specifically assigned if a patient has an impaired gait, which is a significant factor to address even if the overall risk is low.

What is considered a high fall risk score on the Morse Fall Scale?

On the Morse Fall Scale, a score of 45 or higher is considered a high fall risk. Scores between 25 and 44 indicate a moderate risk, and scores below 25 indicate a low risk.

How is a fall risk score of 20 interpreted on the Berg Balance Scale?

A score of 20 on the Berg Balance Scale (BBS) indicates a high fall risk. The BBS range of 0 to 20 is typically associated with individuals who may need a wheelchair for mobility.

Why is it important to know which fall risk assessment tool was used?

Knowing the specific tool, such as the MFS or FRAT, is crucial because the same score of 20 can represent completely different levels of risk. Without this context, you cannot accurately interpret the result or determine the appropriate course of action.

What are common risk factors for falls in older adults?

Common risk factors include lower body weakness, balance issues, vision problems, certain medications, and environmental hazards like throw rugs or poor lighting.

What kind of exercise can help improve balance and reduce fall risk?

Exercises like Tai Chi, walking, and water workouts are excellent for improving balance, strength, and flexibility, which are all key to fall prevention.

Should I be concerned about a score of 20 even if it's considered low risk?

Yes, you should always be concerned about the contributing factors. For example, if the score is from an MFS and 20 points were for impaired gait, that is a serious issue that needs medical attention, regardless of the overall risk category.