Analytical Review: Focus on Fall Screening Assessments

Abstract

Falls and their associated injuries profoundly impact health outcomes, functional independence, and health care expenses, particularly for the ever-increasing elderly population. This systematic search and review assessed the current evidence for the role of fall screening assessments. To review the current evidence for fall risk screening assessments in community-dwelling (outpatient), inpatient medical and surgical wards, inpatient rehabilitation centers, and postrehabilitation outpatient settings. MEDLINE and Embase (January 1980 to December 2012). Prospective validation studies of acute medical or surgical inpatients, acute rehabilitation inpatients, outpatients who completed acute inpatient rehabilitation, or community-dwelling elderly. Sensitivity, specificity, positive predictive value, negative predictive value, receiver operating characteristics with area under the curve. We summarized key findings from 6 literature reviews. We then identified 31 articles: 12 studies in community setting, 13 in the acute medical inpatient or surgical inpatient setting, and 6 studies in the rehabilitation setting. Twenty-two studies not previously reviewed were included, and 9 studies previously reviewed were considered relevant and were included to allow comparison with data from the studies not previously reviewed. We recommend consideration of 7 assessment tools to be used in conjunction with overall clinical evaluation to assess falls risk: the Timed Up and Go Test with a cutoff of >12.34 seconds and Functional Gait Assessment among community-dwelling elderly; St Thomas Risk Assessment Tool in medical inpatients <65 years old and surgical inpatients; Hendrich fall risk model II in medical inpatients; 10-Minute Walk Test in patients in poststroke rehabilitation; and Berg Balance Scale or the Step Test in patients in poststroke rehabilitation who had fallen during their inpatient stay.