Using the Timed Up and Go Test to stratify elderly inpatients at risk of falls

Large, Julienne; Gan, Neesha; Basic, David; Jennings, Natalie

doi:10.1191/0269215506cr959oa

Cited by 56 publications

(46 citation statements)

References 17 publications

(11 reference statements)

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“…The TUG was also dichotomised, primarily to simplify its use in the emergency department, into patients able to undertake the test (perform all components independently) compared with those who were unable. 22 In the logistic regression model in which all significant variables were dichotomised, the Wald χ 2 values were used to assign relative weights to each variable. The relative weights were then used to assign scores of 0-20 to all patients, with higher scores indicating an increased likelihood of a short LOS.…”

Section: Discussionmentioning

confidence: 99%

Admission variables predicting short lengths of stay of acutely unwell older patients: relevance to emergency and medical short-stay units

Basic¹,

Khoo²

2009

Aust. Health Review

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Objective: To help develop criteria to identify older patients suitable for admission to medical short-stay units, by determining predictors of length of stay (LOS) of 3 days or less. Methods: The data were prospectively collected from consecutive older patients admitted from the emergency department of a university hospital to an acute geriatric medicine service. Data included active medical diagnoses, the Modified Barthel Index (MBI), the Timed Up and Go (TUG) test, and demographic information. Logistic regression was used to model the probability of LOS of 3 days or less (short LOS). Results: Among 2036 patients discharged alive from hospital (mean age, 82 years; median LOS, 7 days), 398 had a short LOS (median, 2 days), while 1638 had a long LOS (median, 9 days). In logistic regression analysis, the main independent predictors of short LOS were an MBI score > 15/20 (OR, 2.98; 95% CI, 1.97-4.49), ability to perform the TUG test (OR, 2.08; 95% CI, 1.34-3.24) and absence of delirium (OR, 2.66; 95% CI, 1.56-4.54). Patients without infection, anaemia, gastrointestinal disorder and stroke were also more likely to have a short LOS in multivariate analysis (all P < 0.05). Conclusion: Preserved function, measured using the MBI and TUG, and the absence of delirium are strong predictors of short LOS. In conjunction with early, skilled clinical evaluation, these criteria could be used to select older patients presenting to the emergency depart- ments for admission to short-stay units.THE INCREASING NUMBER and proportion of older persons is having profound consequences and far-reaching implications, especially for health care systems. Older persons visit the emergency department and are admitted to hospital in greater numbers than their proportion in the total population.1 Due to escalating demands on a limited health workforce and budget, pressures on emergency departments and hospitals are growing, 2 leading to increasing scrutiny and evaluation of systems of care.

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Section: Discussionmentioning

confidence: 99%

Admission variables predicting short lengths of stay of acutely unwell older patients: relevance to emergency and medical short-stay units

Basic¹,

Khoo²

2009

Aust. Health Review

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“…Over 15 scales attempt to identify patients at risk of falling. [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] The majority of these tools have not been validated, include only 1 population, or lack adequate sensitivity or specificity for clinical use. Three of these fall risk tools have been validated in multiple studies across the populations.…”

Section: Risk Stratificationmentioning

confidence: 99%

“…8,[26][27][28][31][32][33][34][35]42,[49][50][51][52][53][54][55][56] Two additional risk factors that are often mentioned are male sex and poor functioning or inability to independently perform activities of daily living. 13,15,19,24,27,35,56,57 …”

Section: Risk Stratificationmentioning

confidence: 99%

Inpatient Falls

Cumbler

Simpson

Rosenthal

et al. 2013

The Neurohospitalist

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In this 2 part series, analysis of the risk stratification tools that are available, definition for the scope of the problem, and potential solutions through a review of the literature are presented. A systematic review was used to identify articles for risk stratification and interventions. Three risk stratification systems are discussed, St Thomas's Risk Assessment Tool in Falling Elderly Inpatients, Morse Fall Scale, and the Hendrich Fall Risk Model. Of these scoring systems, the Hendrich Fall Risk Model is the easiest to use and score. Predominantly, multifactorial interventions are used to prevent patient falls. Education and rehabilitation are common themes in studies with statistically significant results. The second article presents a guide to implementing a quality improvement project around hospital falls. A 10-step approach to Plan-Do-Study-Act (PDSA) cycles is described. Specific examples of problems and analysis are easily applicable to any institution. Furthermore, the sustainability of interventions and targeting new areas for improvement is discussed. Although specific to falls in the hospitalized patient, the goal is to present a stepwise approach which is broadly applicable to other areas requiring quality improvement.

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“…It is a test of functional mobility in older adults and has good correlation with gait speed (r = 0.745) [63] and the Berg Balance test (r = 0.47) [64]. Inability to complete the TUG has been reported to predict hospital length of stay in one recent study [65]. Although the TUG has been validated in older persons the responsiveness of this test has not previously been reported in an ICU population.…”

Section: Physical Functionmentioning

confidence: 99%

Evaluation of Exercise Rehabilitation for Survivors of Intensive Care: Protocol for a Single Blind Randomised Controlled Trial

Denehy¹,

Berney²,

Skinner³

et al. 2008

TOCCMJ

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Abstract:Introduction: Intensive care (ICU) survivors have poor quality of life (QoL) and physical outcomes compared to people of the same age and sex [1]. Although rehabilitation of patients in ICU is now advocated as routine clinical practice [2] there are few randomised controlled trials (RCTs) examining patient outcomes. The primary aim of this single blind randomised controlled trial is to investigate the efficacy of a comprehensive rehabilitation intervention begun in ICU compared to standard care on health related quality of life (HRQoL) and physical function.Method: Participants who have been in one tertiary ICU for 5 days, aged 18 years, who can understand written and spoken English, will be randomly allocated to receive either standard care or a comprehensive physiotherapy rehabilitation program beginning in ICU and continuing upon discharge to the ward and as an out patient (OP). Blinded assessment of the primary outcome measures physical function, health status and HRQoL will be performed at baseline, 3, 6 and 12 months after discharge. Physical function measures will be obtained at ICU and hospital discharge and for the intervention group, pre and post OP classes. The intervention will include individualised exercises prescribed by physiotherapists in ICU and on the ward and given by an exercise physiologist and physiotherapist in OP.Results: We aim to enrol 200 participants over two years. The study will determine whether comprehensive physiotherapy rehabilitation from ICU to discharge and OP attendance will improve physical functioning, health status and quality of life in critical care survivors. The cost utility (CUA) and cost effectiveness of such a program will also be evaluated using utility scores and a purpose designed economics questionnaire. Secondary outcomes related to proxy and subject HRQoL comparisons, mechanical ventilation, critical illness neuromyopathy, ICU readmission and discharge destination will also be examined. Conclusion:The outcomes measured are of significance to critical care patients. The CUA of the intervention will be of interest to health service providers. The results will enable development of clinical practice guidelines for the appropriate exercises in survivors of ICU.

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Using the Timed Up and Go Test to stratify elderly inpatients at risk of falls

Abstract: In the acute care setting, the value of the Timed Up and Go lies in the inability to complete the test, and the reasons for this inability, rather than the time recorded.

Cited by 56 publications

References 17 publications

Admission variables predicting short lengths of stay of acutely unwell older patients: relevance to emergency and medical short-stay units

Admission variables predicting short lengths of stay of acutely unwell older patients: relevance to emergency and medical short-stay units

Inpatient Falls

Evaluation of Exercise Rehabilitation for Survivors of Intensive Care: Protocol for a Single Blind Randomised Controlled Trial

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