Capstone Project - Fall Risk Assessment Tools

1. Denise Winters
Pima Medical Institute
PTA-490 Professional Capstone
Mary Jo Rodriquez
May 9, 2015

2. Who?
According to CDC and Prevention:
 One third of people 65 and older fall each year.
 Less than half of those who fell talked to their
healthcare provider about it.
 1 out of 5 falls causes a serious injury such as a
head trauma or fracture.
(see handout #1)

3. Unintentional Falls
 Males: Unintentional Falls
 Females: Unintentional Falls
Age: 65-74 Age: 75-84 Age: >85
168,369 196,573 119,797
Age: 65-74 Age: 75-84 Age: >85
326,598 445,894 384,738

4. Evaluations are Needed
Nonfatal, >65 years
Falls
Overexertion
Struck by or against
Cut/pierced
Natrual/environmental
Motorvehicle traffic
occupant
Other unspecified

5. Falls Related to Animals
Falls are the leading cause of nonfatal injuries in the
United States. In 2006, nearly 8 million persons were
treated in emergency departments (EDs) for fall injuries.
An estimated average of 86,629 fall injuries each year
were associated with cats and dogs, for an average annual
injury rate of 29.7 per 100,000 population.
CDC-MMWR. Nonfatal Fall-Related Injuries Associated with Dogs and Cats – United States,
2001-2006. Information retrieved from:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5811a1.htm

6. Why?
Falls among older adults, unlike other ages tend to occur from
multifactorial etiology such as acute and chronic illness, and
medications. Because the rate of falling increases proportionally
with increased number of pre-existing conditions and risk factors,
fall risk assessment is a useful guideline for practitioners.
• Discover the underlying etiology of why a fall occurred
• Follow up with a comprehensive post-fall assessment.
Fall risk assessment and post-fall assessment are two interrelated,
but distinct approaches to fall evaluation, both recommended by
national professional organizations.
(see handout #2

7. Communication
The goal in therapy is the suggestion to the aging adult to
stay active and maintain as much of their previous lifestyle
as possible; however, modification will be required to
prevent a fall injury secondary to the patients inability to
recognize their own declining cognitive state.
Communication is important too. Therefore, the next
handout available provides information to help that
communication process happen between the healthcare
provider and the patient.
(see handout #3)

8. Barbara Fischer – Declining Cognition and
Falls: Role of Risky Performance of Everyday
Mobility Activities
- Fischer’s team examined 245 individuals with a mean
age of 79 years of age that still lived independently in their
own homes.
- There were a total of 500 individuals selected for the
study; they were divided in half (controlled group and an
intervention group).
- They used tools such as interviewing and in-home
assessment data to determine if the individuals were a fall
risk while performing mobility-related activities of daily
living.
-This research data was collected over a one year span.

9. Screening and Assessment
The examining tests that were performed during the
examination included a Depression Scale, Rhomberg
Test, relative balance, Modified clinical test of
sensory interaction, and a balance portion of the Berg
Balance Scale, Tinetti Performance-Oriented
Mobility Assessment-gait test, Dynamic Gait Index,
and a Timed "Up & Go" test with and without a
cognitive task.

10. Martina Mancini Studied Relevance
An in-depth look into the basic balance system was
performed by Mancini (2010, June). The research of
Mancini et. al. discusses the basic balance system of
maintenance of postural alignment in all positions,
activation of voluntary movement when transitioning
between postures, and reactive time when an external
force is applied.

11. Relevance
The primary reasons for a clinical evaluation of balance
are:
1) does a balance problem exists;
2) determining the underlying cause of the
balance issue.
Mancini (2010, June) provided a research document that is
a quick reference table providing a brief look at common
balance tests that are used in the clinical setting already.
(see handout #4)

12. Which is the Bestest tool?
This research article identifies a common complaint that
Physical Therapists have when testing a patients' balance.
The patient clearly needs continued balance therapy to be
safe, however, they "ceiling" out on the basic balance
tests.
This makes it difficult for a therapist to validate to the
doctor or insurance company that continued care is
needed. Without incurring the expensive cost of
purchasing a Posturography for advanced testing, Mancini
et. al. developed the BESTest balance test. There is a short
and long version to the test.
(see handouts 5 & 6)

13. Functional, Affordable, Valid,
Reliable, and Sensitive
The ceiling affect was depicted in a study performed
by Leddy (2011, January) where she evaluated the
reliability, validity, sensitivity, and specificity for
identifying individuals with Parkinsons Disease who
fall.

14. Continued….
Leddy et. al. tested the Berg (BBS), Functional Gait
(FGA), and the BESTest on 80 individuals with
Parkinsons Disease (PD).
- The study concluded that the FGA and FGA were
the most reliable and indicated the most validity for
assessing patients with PD.
- The study indicated that PD comes in all stages and
degrees of progression and is no different than most
with any kind of balance/proprioception issues.
- The study determine that these two specific tests can
validate the need for early intervention with a patient
that is a risk for falls, however, is in early stages of
PD

15. Integrating Fall Prevention into the
Practice
As a team of healthcare professionals, we all work
together and assess our patients for improvement,
gains, and losses. However, we can also help reduce
falls by screening the older population for previous
falls or balance problems.
The handout provided next will provide helpful ways
to integrate this system into the clinic setting.
(see handout #7)

16. Fall Risk Assessment &
Interventions
The next handout is a simple graph that helps identify when it
would be an appropriate time to intergrade additional risk
assessment tools, such as the “BESTest Test” and the “Cognitive
Questionnaire Screening Tool.”
(see handout #8)

17. Conclusion
 Ask about falls
 Ask how often
 Ask if walking is difficult
 Patients that have
suffered multiple falls
within a year should have
a fall risk assessment
performed
 Patients suffering from
a single fall in the last
year should be assessed
for gait and balance.
 If the patient performs
poorly on the gait test,
they should have a fall
risk assessment.
For a full list see handout #9

18. References
 Abigail L. Leddy, B. E. (2011, January). Functional Gait Assessment and Balance Evaluation System Test:
Reliability, Validity, Sensitivity, and Specificity, for Identifying Individuals With Parkinson Disease Who Fall.
Journal of the American Physical Therapy Association, pp. Vol 91, No. 1, pgs. 102-113.
 Anne Shumway-Cook, M. B. (1997, August). Predicting the Probability for Falls in Community-Dwelling
Older Adults. Physical Therapy, Journal of the American Physical Therapy Association, pp. Vol. 77 No. 8 pgs.
812-819.
 Barbara L. Fischer, C. E. (2014, March). Declining Cognition and Falls: Role of Risky Performance of
Everyday Mobility Activities. Journal of the American Physical Therapy Association, pp. Vol. 94, No. 3, pgs
355-362.
 Centers for Disease Control and Prevention. National Center for Injury Prevention and Control (2014).
www.cdc.gov/injury/STEADI
 Diane M. Wrisley, M. L. (2003, October). Reliability of the Dynamic Gait index in People with Vestibular
Disorders. Physical Medicine and Rehabilitation, pp. Vol. 84, Issue 10, pgs. 1528-1533.
 Horak, M. M. (2010, June). The relevance of clinical balance assessment tools to differentiate balance deficits.
NIH Public Access. Eur J Phys Rehabil Med., pp. vol 46 No. 2: pgs 239-248.
 Sara B. Vyrostek, J. L. (2004, September). Surveillance for Fatal and Nonfatal Injuries - United States, ,2001.
Morbidity and Mortality Weekly Report - Surveillance Summaries -MMWR, pp. Vol. 53/ SS-7 1-57.
 Steffen T, Seney M. Test-retest Reliability and minimal detectable change on balance and ambulation tests, the
36-item short-form health survey, and the unified Parkinsons disease rating scale in people with parkinsonism
[erratum in Phys Ther. 2010;90:462]. Phys Ther. 2008;88:733-746