Notes

Elderly Fall Screening Tests
All older persons who present to health care practitioners should be asked about falls, including the frequency and circumstances. They should also be assessed for balance and gait.

A simple screening question may lead to nothing, but a comprehensive multifactorial assessment of fall risk factors could make a difference in preventing injury. Tools for assessing fall risk have been developed for use in hospital settings and with community-dwelling adults.
30-Second Chair Stand Test

The 30-Second Chair Stand Test is a single-item physical performance test that assesses lower body strength and related functional outcomes. It is easy to administer and scores based on the number of repetitions the patient can complete. The test is particularly useful in assessing fall risk in community-dwelling elderly patients, as it has shown to be an accurate indicator of lower body strength.

To administer the test, have your geriatric patient sit in a chair with their feet shoulder width apart and flat on the floor. The chair must be placed beside a wall, but facing away from it so that the geriatric patient is not at risk of falling backward should they lose their balance and fall. They should then start counting the number of times they can assume a full stand from sitting.

The geriatric patient may use the chair armrests for support, but they must let go of them as soon as they assume a full standing position. This test is more precise than the regular version of it, as it takes into account one of the most common accidents involving seated patients, which is falling backward.
4-Stage Balance Test

The 4-Stage Balance Test is a static balance assessment and measures an individual's ability to hold a series of four positions, each more challenging than the previous. A score of less than 10 seconds at the third position (Tandem stand) or fourth position (Single leg stand) indicates increased fall risk.

This testing battery requires more physical effort and is more challenging than the 30-second chair stand test. Physiotherapists can use this test to identify individuals who may require more intensive rehabilitation for improving their balance and mobility to reduce falls risk.

PTs can also assess balance and postural control by using dynamic tests such as the Functional Reach test. Pamela Duncan developed this dynamic test in 1990 and it has good test-retest reliability. Medical Alarms AU The Functional Reach test measures the maximum distance the individual can reach forward over their head from a standing position and it has been shown to be a useful predictive tool of future falls in elderly clients.
Timed Up-and-Go (TUG) Test

The TUG is a common assessment tool in physical therapy and occupational therapy to identify fall risk. A patient stands up from a chair while a timer is used to record how long it takes them to walk at a normal walking pace to a marker placed 3 meters away, turn around it, then return back to the chair and sit down.

In a recent systematic review, Shumway-Cook and colleagues evaluated the ability of the TUG to predict fall in community-dwelling elderly individuals. The TUG was compared with a more extensive test battery that includes gait, balance and vision as well as neuropsychological measures.

They found that the TUG was not reliable enough to distinguish fallers from non-fallers. The TUG also lacked specificity in the elderly population and was less effective than other assessments when it came to identifying people who were at high risk of falling. Heterogeneity was high and sensitivity and specificity were close to chance. In addition, the TUG does not assess other accepted risk factors for falls including medication use and morbidity.
One-Foot Stand Test

This is a field sobriety test that asks people to stand on one leg while counting out loud. Police officers look for certain clues when observing a person doing this test, including putting the foot down before the 30-second mark, swaying and hopping in an attempt to balance, and using arms more than 6 inches from the sides of the body to help maintain balance.

It is important to note that health and medical conditions, including age, can significantly impact performance on this type of test. Therefore, it is recommended that this test not be given to people who have physical or mental impairments that interfere with balance.

For the test, the officer will instruct you to stand with your feet together and your arms at your side. He will then instruct you to raise your right foot, approximately six inches off the ground and point it outward, and to count out loud by thousands (one thousand-one, two, three, etc.). Then he will tell you to continue this pattern until he signals you to stop.
Two-Foot Stand Test

This test requires the individual to stand on one leg and raise that foot about six inches off the ground, with the toe pointed. They must then keep their arms by their side, look at the elevated foot and count out loud to themselves (typically by 1000’s) until told to stop. The test takes approximately 30 seconds and is timed by the law enforcement officer.

If the suspect shows two or more of these clues during the One-Leg Stand, there is a strong chance their BAC is above 0.10. However, even when administered correctly by police, this test is only about 65% accurate.

If you are testing an elderly person, you should consider whether their health conditions could affect their performance on this test. For example, they may have a knee or back problem that would make standing on one leg difficult. Also, older adults tend to lose balance and mobility skills as they age.
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