What is a good fall score? Understanding your risk assessment

According to the National Council on Aging, one in four Americans age 65+ falls each year. Understanding what is a good fall score is crucial for proactive prevention, but the ideal number depends entirely on the specific assessment tool used by healthcare professionals.

Quick Summary

A low fall risk score, like 0-24 on the Morse Fall Scale or under 5 on the Hendrich II Fall Risk Model, is considered a 'good' outcome. It indicates a lower likelihood of falls, but it is not a guarantee of safety. The score helps identify specific risk factors to address with tailored prevention strategies.

Key Points

• Good Score Varies: A 'good' fall score depends on the specific assessment tool used, such as the Morse Fall Scale or the Hendrich II Fall Risk Model.

• Morse Fall Scale (MFS) Interpretation: A low-risk score, considered a 'good' score, is typically 0-24 on the MFS.

• Hendrich II Interpretation: On the Hendrich II model, a low-risk score is anything less than 5.

• Scores Are Indicators, Not Guarantees: Fall scores identify risk factors but don't predict with 100% accuracy. A low score doesn't eliminate all risk.

• Actionable Prevention is Key: The most important step is to use the assessment results to implement targeted prevention strategies, like exercise, medication review, and home safety upgrades.

• Proactive Strategy Over Passive Confidence: Even with a low score, ongoing vigilance and proactive measures are essential for maintaining safety and preventing future falls.

Demystifying Fall Risk Assessment Scores

Fall risk scores are a tool used by healthcare providers to systematically evaluate an individual's likelihood of falling. They are not a pass/fail test but rather a guide to identify specific areas of risk that can be addressed. The concept of a “good” score is relative to the tool being used, with a lower score always indicating a lower risk. Two of the most commonly used tools in healthcare settings are the Morse Fall Scale and the Hendrich II Fall Risk Model.

The Morse Fall Scale (MFS)

The Morse Fall Scale is one of the most prevalent assessment tools used in hospitals, nursing homes, and rehabilitation facilities. It evaluates six specific risk factors, assigning points for each. A total score is calculated, and the risk level is determined based on the following ranges:

• Low Risk: A score of 0-24. This is the ideal outcome, suggesting a minimal risk of falling. This range is considered a good fall score.
• Moderate Risk: A score of 25-45. In this range, heightened vigilance and standard fall prevention interventions are recommended.
• High Risk: A score of 46 or higher. This indicates a significantly higher risk, requiring more intensive and frequent fall prevention measures.

The MFS assessment considers:

• History of falling
• Secondary diagnoses
• Ambulatory aid needed
• IV therapy presence
• Gait
• Mental status

The Hendrich II Fall Risk Model

The Hendrich II model is another validated tool that screens for eight different risk factors. Its scoring and interpretation are different from the MFS, so it’s important not to confuse them. In the Hendrich II model, a total score of 5 or greater indicates a high risk for falls. Therefore, a score of 4 or less would be considered a good fall score.

Key factors assessed by the Hendrich II include:

• Confusion, disorientation, or impulsivity
• Symptomatic depression
• Altered elimination (incontinence, urgency, or frequency)
• Dizziness or vertigo
• Gender (male gender is a risk factor)
• Certain medications (benzodiazepines and antiepileptics)
• Performance on the Get-Up-and-Go test

Interpreting and Acting on Your Score

Simply receiving a “good” or low risk score should not lead to complacency. Fall risk assessments are not predictive guarantees; they are proactive tools. A low score doesn't mean you are immune to falling, just that fewer of the identified risk factors are present at the time of the assessment. The real value of any score, whether low or high, lies in understanding the why behind the number. For instance, even with a low MFS score, a patient who forgets their limitations may still require specific interventions, such as frequent reminders.

Strategies to Improve Your Score (and Overall Safety)

Regardless of your current score, there are many proactive strategies you can implement to reduce your risk of falling. Focus on addressing modifiable risk factors identified during the assessment. These steps can help improve your next fall score and enhance your overall safety and independence.

1. Review your medications annually. Discuss all prescriptions, over-the-counter drugs, and supplements with your doctor or pharmacist. Certain medications, like sedatives or antidepressants, can cause dizziness or drowsiness that affects balance.
2. Stay active with targeted exercises. Physical activity, including walking, water aerobics, and particularly Tai Chi, can significantly improve strength, balance, coordination, and flexibility. A physical therapist can create a custom program for you.
3. Get annual vision and hearing checks. Poor vision and hearing impairment are major risk factors for falls. Regular check-ups and updated glasses or hearing aids are crucial.
4. Make your home safer. Look for and eliminate common household hazards. Simple modifications can have a significant impact.
   • Remove or secure loose throw rugs with non-slip backing or double-sided tape.
   • Ensure pathways are clear of clutter, cords, and furniture.
   • Install brighter lighting, especially in hallways, stairways, and bathrooms, and use night lights.
   • Add grab bars in the bathroom and handrails on both sides of staircases.
5. Wear supportive footwear. Avoid walking in just socks, floppy slippers, or high heels. Opt for sturdy, well-fitting shoes with non-skid soles.

Comparison of Common Fall Risk Assessment Tools

Assessment Tool	Items Assessed	Good/Low-Risk Score	High-Risk Score	Typical Setting	Standard Interventions
Morse Fall Scale (MFS)	History of falls, secondary diagnosis, ambulatory aid, IV, gait, mental status	0-24	>45	Inpatient hospital, skilled nursing	Tailored to individual risk factors
Hendrich II Fall Risk Model	Confusion, depression, elimination, dizziness, gender, medication, Get-Up-and-Go	<5	≥5	Inpatient hospital	Based on specific identified risks
St. Thomas Risk Assessment (STRATIFY)	History of falls, agitation, vision, incontinence, mobility	<2	≥2	Hospital, rehabilitation	Patient-specific, focus on identified risks

Working with Your Healthcare Provider

Regular fall risk assessments are an integral part of healthy aging. The Centers for Disease Control and Prevention (CDC) recommends fall prevention programs and discussions with healthcare providers. Whether you are a senior, a caregiver, or a healthcare professional, using these scores as a starting point for discussion is key. Consult your doctor or a physical therapist for a personalized assessment and to develop a comprehensive fall prevention plan. Taking these proactive steps can make a difference in maintaining your independence and quality of life.

For more information on fall prevention strategies and resources, you can visit the official CDC Falls Prevention page.

Conclusion

In summary, a good fall score isn't a single universal number but rather a low-risk classification based on a specific assessment tool. On the widely used Morse Fall Scale, a score below 25 is considered good, while on the Hendrich II model, a score less than 5 is desirable. Ultimately, these scores serve as an indicator, and the most crucial step is to act on the information provided. By addressing modifiable risk factors through lifestyle changes and home safety improvements, individuals can significantly reduce their risk of falls and live more confidently and safely.

Frequently Asked Questions

What is the lowest possible score on the Morse Fall Scale?

The lowest possible score on the Morse Fall Scale is 0, indicating a minimal risk for falling based on the scale's criteria. This is considered the best possible outcome.

Does a good fall score mean I won’t fall?

No, a good or low-risk fall score does not guarantee you won't fall. It means that, based on the factors assessed, your likelihood of falling is lower. The score is a tool to guide prevention, not a shield against all potential accidents.

How can I improve my fall score?

You can improve your fall score by addressing the modifiable risk factors assessed by the scale. This can include doing balance and strength exercises, having your medications reviewed, improving home safety by removing hazards, and correcting vision or hearing problems.

Are there different fall assessment tools for different age groups?

Yes, different assessment tools may be used depending on the patient's age and clinical setting. For instance, while the Hendrich II model is often used for geriatric patients, some tools may be better suited for younger individuals or specific conditions. Your healthcare provider will choose the most appropriate tool.

How often should a fall risk assessment be performed?

In healthcare settings, a fall risk assessment is typically performed upon admission, with any change in the patient's condition, or after a fall incident. For older adults in general, an assessment should be part of a yearly checkup or anytime concerns about falls arise.

Is a high score on the Hendrich II model worse than a high score on the Morse Fall Scale?

The scores from different scales are not directly comparable. A high score on either scale indicates an increased risk of falling, but the specific score values mean different things. It's more important to understand which risk factors led to the high score on the specific test you took.

What happens after I receive a fall risk score?

After receiving a fall risk score, a healthcare professional will typically discuss the results with you and create a personalized fall prevention plan. This may involve recommendations for exercise, medication adjustments, home modifications, or referral to other specialists like a physical therapist.