Practical and validated tool to assess falls risk in the primary care setting: a systematic review

Abstract

ObjectiveAlthough several falls risk assessment tools are available, it is unclear which have been validated and which would be most suitable for primary care practices. This systematic review aims to identify the most suitable falls risk assessment tool for the primary care setting (ie, requires limited time, no expensive equipment and no additional space) and that has good predictive performance in the assessment of falls risk among older people living independently.DesignA systematic review based on prospective studies.MethodsAn extensive search was conducted in the following databases: PubMed, Embase, CINAHL, Cochrane and PsycINFO. Tools were excluded if they required expensive and/or advanced software that is not usually available in primary care units and if they had not been validated in at least three different studies. Of 2492 articles published between January 2000 and July 2020, 27 were included.ResultsSix falls risk assessment tools were identified: Timed Up and Go (TUG) test, Gait Speed test, Berg Balance Scale, Performance Oriented Mobility Assessment, Functional Reach test and falls history. Most articles reported area under the curve (AUC) values ranging from 0.5 to 0.7 for these tools. Sensitivity and specificity varied substantially across studies (eg, TUG, sensitivity:10%–83.3%, specificity:28.4%–96.6%).ConclusionsGiven that none of the falls risk assessment tools had sufficient predictive performance (AUC <0.7), other ways of assessing high falls risk among independently living older people in primary care should be investigated. For now, the most suitable way to assess falls risk in the primary care setting appears to involve asking patients about their falls history. Compared with the other five tools, the falls history requires the least amount of time, no expensive equipment, no training and no spatial adjustments. The clinical judgement of healthcare professionals continues to be most important, as it enables the identification of high falls risk even for patients with no falls history.Trial registraion numberThe Netherlands Trial Register, NL7917; Pre-results.

World guidelines for falls prevention and management for older adults: a global initiative

“…Clinicians cannot rely solely on older adults reporting falls, as studies indicate that many do not for a variety of reasons [ 33 ]. This is particularly true for men with less than a third mentioning them to their clinician if not directly asked ( Appendix 2 , available in Age and Ageing online) [ 34 ].…”

Association of motor index scores with fall incidence among community‐dwelling older people

“…Detecting the risk of falls for prevention trials in individuals with normal cognitive function would be more signi cant. However, risk assessment tools that have been developed for predicting future falls, including the Berg balance scale, timed up and go test, performance oriented mobility assessment, functional reach test, gait speed test, and history of falls, have shown low predictive ability (area under the curve < 0.7) [25]. Therefore, more sensitive and speci c prediction tools should be further investigated.…”

Patients' experience with a community pharmacy fall prevention service

“…Of these four questions, the first two were based on evidence-based fall risk screening tools, and the latter two questions were asked to ensure that patients were included who are more or less motivated to participate in a pharmacy-led fall prevention service. 5 , 25 , 30 …”