fall risk assessment 081004

8/2/2019 Fall Risk Assessment 081004

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Fall Risk AssessmentFall Risk Assessment

Jamie LauJamie Lau

Senior Physiotherapist, PWHSenior Physiotherapist, PWH20082008


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Mobility at the expense of Stability

Stable quadriped Unstable biped


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Increase inIncrease in

Postural SwayPostural Swaywith Agewith Age

BrocklehurstBrocklehurstJC et al. ClinicalJC et al. Clinical

correlates of sway in old age:correlates of sway in old age:sensory modalities. Age Ageingsensory modalities. Age Ageing

1982;11:11982;11:1--10.10.

Meansway

Age in years

40 60 >80


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Fall Risk AssessmentFall Risk Assessment

ContentContent

Patient interviewPatient interview Physical examinationPhysical examination

Functional mobility testingFunctional mobility testing Demonstration & practicalDemonstration & practical

Pilot screening in PWPilot screening in PW


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Patient interviewPatient interview

History of fallHistory of fall

Last 3 fallsLast 3 fallswhen? What time? Where? Whichwhen? What time? Where? Which

room? What were they doingroom? What were they doingturning? Getting up?turning? Getting up?Hanging clothes?Hanging clothes?

What do they think triggered the falls?What do they think triggered the falls?

Effects off the fallEffects off the fall

LOC?LOC? InjuriesInjuriesfractures / lesions / bruises?fractures / lesions / bruises?

How did they get up from the floor? If not, what didHow did they get up from the floor? If not, what didthey do?they do?


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Patient interviewPatient interview

Call for helpCall for helpAlarm available? Where was it?Alarm available? Where was it?

OR shout? Bang on floor?OR shout? Bang on floor? Confidence ofConfidence ofmobilisationmobilisation after the falls?after the falls?


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Physical examinationPhysical examination

Joint mobility and muscle strengthJoint mobility and muscle strength

KneeKneequadricepsquadricepsAnkleAnkledorsiflexesdorsiflexes,, plantarflexesplantarflexes

Integrated testingIntegrated testing

Get up from seat height of seat without handsheight of seat without hands

supportsupport

Get up and down on their toesGet up and down on their toes

on both legs or one legon both legs or one leg


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Physical examinationPhysical examination

Abnormalities of balance and gait suggestingAbnormalities of balance and gait suggesting

patients at high risk of fallingpatients at high risk of falling

Take 5 stepsto turn round

Prolong doubleleg stance (>10%)

Shuffling

gait


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Functional mobility testingFunctional mobility testing

Modified Functional Ambulation CategoriesModified Functional Ambulation CategoriesCategoriesCategories StageStage DefinitionDefinition

II LyerLyer WalkWalk

/assist to sit/ sit without/assist to sit/ sit withoutsupport>1minsupport>1min

IIII SitterSitter sit without support >1min/ walksit without support >1min/ walk

with 1 personwith 1 person

IIIIII DependentDependent

walkerwalker

Walk with 1 personWalk with 1 personlevel groundlevel ground

(continuous manual contact to(continuous manual contact tosupport body weight)support body weight)

IVIV AssistedAssisted

walkerwalker

Walk with 1 personWalk with 1 personlevel groundlevel ground

(continuous or intermittent manual(continuous or intermittent manualcontact)contact)


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Modified Functional Ambulation CategoriesModified Functional Ambulation Categories

CategoriesCategories StageStage DefinitionDefinition

VV SupervisedSupervised

walkerwalkerWalk with standby guarding from 1Walk with standby guarding from 1

personpersonlevel groundlevel ground

VIVI IndoorIndoorwalkerwalker

Transfer, turn & walk on levelTransfer, turn & walk on levelground independently, needsground independently, needs

assistance on stairs/inclinesassistance on stairs/inclines

VIIVII OutdoorOutdoorwalkerwalker

Walk independently on level or nonWalk independently on level or non--level surfaceslevel surfaces

This classification does not take account of any aid used.This classification does not take account of any aid used.


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TimedTimed--upup--andand--go testgo test

2 Walk for 3 meters

Return for 3 meters

Turn around

1Sta

ndup

3

Sit

down

Walking aid and regular footwearis allowed, but no other physical

assistance is given


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TimedTimed--upup--andand--go testgo test A reliableA reliable time scoretime score

Good correlation withGood correlation with BarthelBarthel Index and BergIndex and BergBalance Scale & gait speedBalance Scale & gait speed

PredictsPredicts patientpatients ability to go outside alones ability to go outside alone

safelysafely Reflects patientReflects patientss basic mobility skillsbasic mobility skills (chair(chair

transfer, toilet transfer)transfer, toilet transfer)

Reflects patientReflects patientss extended mobility skillsextended mobility skills(tub/shower transfers, walking 50 yards, climb(tub/shower transfers, walking 50 yards, climb

stairs, going out alone)stairs, going out alone)Podsiadlo D. Journal of American Geriatric Society 39:142-148, 1991


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TimedTimed--upup--andand--go testgo test


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TimedTimed--upup--andand--go test (TUG)go test (TUG)

Kristensen M T. Physical Therapy Jan 2007; 87, 1, 24-30

Patients with hip fracture,

operated and rehabilitated,performed TUG upon discharge

Repeat TUG upon 6 months

follow-up

19 subjects (32%) had 1 or more falls

TUG at discharge with cutoff point 24 significantlypredicted falls during 6-month FU


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Elderly Mobility ScaleElderly Mobility Scale (EMS)(EMS)

Developed as core clinical assessment packageDeveloped as core clinical assessment packagein elderly medicine recommended by the Royalin elderly medicine recommended by the Royal

College of Physicians and British GeriatricCollege of Physicians and British Geriatric

Society (1992)Society (1992) Performance based testPerformance based test

Applicable in busy medical professional clinicsApplicable in busy medical professional clinics


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TasksTasks Maximum scoreMaximum score

LyingLying sittingsitting 22SittingSitting lyinglying 22

SittingSitting

standingstanding 33StandingStanding 33

GaitGait 33

Timed walkTimed walk 33

Functional reachFunctional reach 44

TotalTotal 2020


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Functional reach testFunctional reach test

Hold theposition for

3 sec.

Measure thedistance


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Functional reach testFunctional reach test

NormsNorms Men (in.)Men (in.) Women (in.)Women (in.)

2020--40 yr40 yr 16.716.7 1.91.9 14.614.6 2.22.2

4141--69 yr69 yr 14.914.9 2.22.2 13.813.8 2.22.2

7070--87 yr87 yr 13.213.2 1.61.6 10.510.5 3.53.5

Shumway-Cook. Motor Control: Theory and Practical Applications 2001Behrman. Archives of Physical Medicine & Rehabilitation 2002, 83,538-42


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Functional reach testFunctional reach test25.4 cm

Not a sensitive

instrument for

identifying

individuals

at risk

For those identified

as at risk is highly

likely at riskto be referred for

falls risk intervention

Criterion for falls riskCriterion for falls risk


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Pilot screening of patients with hip fracture inPilot screening of patients with hip fracture inPWH forPWH for

fall riskafter discharge from rehabilitation hospitalafter discharge from rehabilitation hospital

July to September, 2007July to September, 2007

In Department of PhysiotherapyIn Department of Physiotherapy

n= 14n= 14


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Modified FunctionalModified Functional

Ambulation CategoriesAmbulation Categories

7%14%

29%21%

29%

SitterAssisted

walker

SupervisedwalkerIndoorwalker

Outdoor

walker7%

51%1%

7%

14%Wheelchair

FrameQuadripod

Stick

Nil

Use of Walking AidUse of Walking Aid

n=144 weeks after discharge from Rehabilitation hospital


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012

345

6

/=14 =200

0.51

1.52

2.53

3.54

20

n=14Maximum score =20

n=12in cm.

< 25.4 cm = 1125.4 = 1

Elderly Mobility ScoreElderly Mobility Score Functional ReachFunctional Reach

il i f f ll i k 4 kPil i f f ll i k 4 k


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Pilot screening for fall risk 4 weekPilot screening for fall risk 4 week

after dischargeafter discharge MobilityMobility status for all patients were wellstatus for all patients were well

maintained during the discharged period prior tomaintained during the discharged period prior toscreeningscreening

Patients and their relatives do have a number ofPatients and their relatives do have a number of

questions to clarify upon their home stay periodquestions to clarify upon their home stay periodconcerning mobility issueconcerning mobility issue Stairs? Outdoor activities? Change of walking aid?Stairs? Outdoor activities? Change of walking aid?

ReassuranceReassurancevery fruitful in maintaining andvery fruitful in maintaining andimproving their physical mobility levelimproving their physical mobility level


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fall risk assessment 081004

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