Screening & Referral Tools
for Community-Dwelling Older Adults
Falls Prevention Screening (PDF)
The Saskatoon Falls Prevention Consortium recommends two options for screening and referral for community-dwelling older adults. The recommended options are part of this process.
Option 1 - Screening questions recommended by the Clinical Practice Guidelines for prevention of falls in older persons. Published by the Panel on Prevention of Falls in Older Persons the American Geriatrics Society/British Geriatrics Society (AGS/BGS) in 2011. J Am Geriatric Soc 59:148-157, 2011
The advantage to this approach is the simplicity of the initial screen, which requires no objective assessment and could be easily done by anyone who is in contact with the older adult in a clinic, home, or institutional setting.
Option 2 - The FROP-Com (Falls Risk for Older People in the Community) screen. Developed by the National Aging Research Institute (NARI) at the University of Melbourne, Australia (info@nari.unimelb.edu.au).
The advantage of this tool is the ability to score and classify older adults into low and higher risk in order to direct treatment and monitor change. There is ongoing development and research being conducted on this tool.
Both approaches are evidence based, comprehensive methods to determine fall risk and should be chosen based on the health practitioners’ environment, circumstances and preferences.
No matter which option is used, both methods emphasize the following important aspects of screening:
- All older persons who are under the care of a health professional should be assessed at least once each year.
- Fall history: individuals should be asked about falls, frequency of falling.
- Balance and gait: Difficulties in gait, balance, mobility, and ability to perform daily tasks should be identified.
- Individuals who are identified as at potential risk for falls should receive further assessment and management if required.
Tests for Evaluation of Gait and Balance
TUG – Timed Up and Go Test
The “Timed Up and Go” test is a timed walking test designed to measure gait performance and balance. The Timed Up and Go procedure (PDF) is simple: Participants must stand up from a seated position, walk 3 metres, and return to their seated position.
Results correlate with gait speed, balance, functional level, the ability to go out, and can follow change over time. Healthy community-dwelling elderly usually complete this task in 10 seconds or less.
A score of ≥ 14 seconds has been shown to indicate a higher risk of falls.
STS – Senior’s Chair Stand Test
The “Senior’s Chair Stand” test measures lower body strength, endurance and functional fitness of the elderly. This test is quite simple: seniors sit on a chair placed against a wall for safety, then stand completely up and sit down again. The number of repetitions is recorded.
Scoring of this test varies with age and gender, and by age, however one may review available charts or online calculators to assess performance.
Decisions following the screen
Older persons who present to a health care practitioner because of a fall, report recurrent falls (two or more) in the past year, or report difficulties in walking or balance (with or without activity curtailment) should have further fall risk assessment (FROP-Com or multifactorial fall risk assessment).
Falls Prevention Screening (PDF)
FROP-Com Assessment Form (PDF)
Individuals who score greater than 10 seconds on the TUG and also report difficulties in walking or balance, demonstrate any unsteadiness or modifications to reduce unsteadiness during the observation of sit to stand and walking, OR score 14 seconds or greater on the TUG, should be followed by a physical therapist for further evaluation of walking and balance, and should have a further fall risk assessment.
Older persons who present with one fall in the past year, with no acute injury or need for health practitioner follow up, should be observed for walking and balance (i.e. TUG) and if abnormalities are noted, then a FROP-Com or multifactorial fall risk assessment should be conducted (see below).
Multifactorial Assessment Tools
Depending on the setting and practitioner, fall risk assessment tools may differ. What is important is that this tool identifies the individual’s risk factors so that interventions can be planned.
Multifactorial risk assessments are comprehensive and should include the following categories:
- Focused History: Assess history of falls (frequency, injuries, circumstances), medical history (acute or chronic medical problems, other symptoms), and medication review (all prescribed and over-the-counter medication and dosages should be assessed)
- Physical Examination: Assessment of gait, balance, mobility and muscle strength in lower extremities, neurological functioning (cognitive evaluation, reflexes, sensory loss), cardiovascular status (heart rate and rhythm, blood pressure, impairments), vision (blurriness, depth perception, frequency of eye exams), feet and footwear
- Functional Assessment: Assess activities of daily living (ADL) skills, perceived functional ability and fear of falling
- Environmental Assessment: Hazards in the environment
Interventions
If an individual scores less than 19 points on the FROP-Com assessment, or positive on three or less factors on the Staying On Your Feet (SOYF) multifactorial questionnaire, actions should be taken to mitigate those identified risk factors.
Many options exist as interventions to prevent falls and mitigate risks, including education, support/specialist referrals, exercise programming, etc. See guidelines/recommendations below.
If multiple problems were found, or the cause of falls was not able to be ascertained, individuals should be referred to a falls clinic, and their GP should be informed of their risk level and individual risk factors.
Sample Physician Letter: PDF | MS Word
Multifactor Fall Risk Assessments and Intervention Guideline Resources:
- The “Staying On Your Feet” (SOYF) risk assessment is a condensed checklist that assesses fall risk, and is suitable for more general assessment.
Multi-Factor Questionnaire (PDF)
- The FROP-Com multifactor risk assessment definition and scoring options offer a more detailed assessment that takes more time to complete, and is often best suited for an individual home visit.
FROP-Com Questionnaire (PDF)
Staying on Your Feet:
A Guide to Fall Prevention (PDF)
A 40 page guide prepared by The Saskatoon Falls Consortium - to be used by the older adult and their care-givers to examine their personal risk factors and identify local resources to assist them to prevent falls and injury.
Also included is a page for setting goals to improve the areas where fall risk has been identified.
