Am I at Risk for Falls?
Should I Take Action?
How do I determine my personal degree of "risk for falls"? Should I worry about falls at all? Do I need to use a cane or a walker? How would I know? We all face these questions as we age.
No one wants to fall. We've seen that happen to others and we know how devastating falls can be. For older adults, falls are the leading cause of unintentional injury, death from injury, and hospital admissions for trauma.(3) At the same time, no one wants to use a cane or a walker. We've all seen a friend show up one day with a cane and thought, "they've certainly aged since I last saw them."
And there we have the dichotomy. We all know that if we live long enough, at some point in our lives we will need help standing and walking. On the other hand, we don't want to adopt this clear sign of aging any sooner than we must. Of course a real solution is to remain physically fit. If I could see my risk for Falls increase over time, that might be the impetus for me to start exercising more regularly. And if I knew for certain that tomorrow I would fall and hurt myself, I would start using a cane today. The hard question here is: what is my real risk for falls?
What is My Risk for Falls?
We know that as we age our bodies wear down. We don't have the balance that we used to. We don't have the core strength to stand as long as we used to. Our eye sight is less sharp than it used to be. Any of these declines can lead to a serious fall. What we would like is an objective measure of risk. I'd like a test that tells me, "your risk of a fall in the next month is 5%". Or "your risk of a fall in the next month is 80%". Imagine how you would react to that assessment. Ideally, I'd like to take a quick test every few months to chart my eventual decline.
You can search the web for information on the topic, but you will be overwhelmed with a huge number of results. As you click through these you will find that many of them are duplicative, some offer small variations on the same topic. Some are, frankly, not very good. In this article we guide you to just the best information we have found.
Having said that, we have not found any tools that are as precise as we would like. However, below we discuss a number of self assessment tests and questionnaires that can help you get a better handle on whether you need to start taking your risk of falling seriously and perhaps start using a cane or a walker or exercising more. Below you will find:
- Physician Fall Risk Assessment flow chart - what your doctor should be thinking;
- Personal Fall Risk Assessment Questionnaire - questions to ask yourself;
- Three activity based fall risk assessments - actual tests that measure your risk.
Fall Risk Assessment by Physician
Many of the self assessments suggest that you speak to your primary care physician if your score is above some threshold. What will your physician do to assess your risk? The U.S. Center for Disease Control's STEADI program provides physicians a flow chart (below) to follow in assessing your risk of falling. Knowing how your doctor will assess your risk provides you insight as well.
Assessment algorithm attribution: CDC STEADI program for fall prevention
Self Assessment Fall Risk Questionnaires
This is the first step in the physician assessment flowchart. This is a very simple set of questions that are easy to answer and provide the first assessment. The downside of this questionnaire is that it does not give you much insight. This is the first thing your physician will ask you, so you should be prepared with your answers. You can take the test (using the questions on page 2 of the brochure below) and score yourself:
Questionnaire attribution: CDC STEADI program for fall prevention
Activity Based Fall Risk Assessments
The CDC recommended physician flowchart suggests three activity based tests. These tests are intended to be used by trained professionals to assess a patient. When you see how these assesments are done (below) you will get an idea of how you might score in these tests.
We have searched the web to find the best short video to illustrate each test. The videos are designed for use by clinicians learning how to assess an older adult's for risk for falls, and so are talking to the clinician rather than to the older adult.
A. Timed Up and Go Test
This test assesses mobility, balance, and walking ability. It is a simple test where the subject stands from a chair, walks a short distance, and returns to the chair. Generally, people in their 70's should complete the test in under 10 seconds. If a person takes longer than 14 seconds they are at a high risk of falling.(1)
Video attribution: Good Shepherd Rehabilitation
B. 30 Second Chair Stand Test
This test assesses lower extremity strength. The subject rises from a chair and then returns. They repeat this as many times as possible in 30 seconds. A person in their 70's should be able to complete 13-15 repetitions during the 30 second test period. A person who cannot do this many repetitions is at risk of falling.(2)
Video attribution: The University of North Carolina at Chapel Hill
C. Four Stage Balance Test
This test assesses static balance. The subject stands with their feet in a certain position for 10 seconds. There are four different positions to be tested. A person who cannot hold one of these positions for 10 seconds is at high risk of falling.(4)
Video attribution: The University of North Carolina at Chapel Hill
Assessments as Exercise?
It is interesting to note that for some assessments, doing them more might improve your score. For instance, in the Chair Stand Test your partner counts how many times in 30 seconds you can stand from a chair and then sit down. Imagine that you test yourself one day and find that you can only do three. So you retest yourself every day. Perhaps a week later you can do five. The very act of doing the test may improve your strength; it is, in fact, a very small exercise program. Our clinician colleagues point out that any sort of testing like this should be done with a partner who is suitably qualified (strong, good balance, well trained) to make sure you are safe and don't fall while doing these assessments.
The material in this article represents the best tools we have found to assess your risk for falls. As we said at the beginning, the current tools are not as detailed as we all might like, but they do provide information that is both useful and actionable.
If you find that you have a risk of falling, then you should certainly see your physician to create a plan to reduce your risk of a devastating fall.
We will continue to monitor this area. If we find new tools, we will update this article. If you find new tools, please add them in the comments below.
Lead author: Jim Schrempp