Streamlining assessment and intervention in a falls clinic using the Timed Up and Go Test and Physiological Profile Assessments
1 King’s College Hospital (Dulwich Site), East Dulwich Grove, London SE22 8PT, UK
2 Prince of Wales Medical Research Institute, University of New South Wales, Sydney, Australia
Address correspondence to: J. C. T. Close. Email: j.close{at}unsw.edu.au
Background: the Timed Up and Go Test (TUGT) has been recommended as a simple screening tool to identify those at risk of falling. However, subsequent detailed assessment is required to identify underlying falls risk factors to provide direction for optimal targeted intervention strategies.
Methods: 110 consecutive falls clinic patients underwent the TUGT, the Abbreviated Mental Test and the Physiological Profile Assessment (PPA), a validated tool for quantifying risk of falling based on a combination of physiological measures—contrast sensitivity, knee extension strength, proprioception, reaction time and postural sway. Regression analysis was used to determine how well the TUGT and presence of cognitive impairment could identify patients at high risk of falls as defined by the PPA.
Results: TUGT and cognitive status were found to be independent and significant predictors of PPA scores. These variables accounted for 21% of the variance in PPA scores (multiple R = 0.47, P<0.001). The standardised beta weights were 0.403 for TUGT and 0.236 for cognitive status. A receiver–operator curve (ROC) indicated that 15 seconds in the TUGT was the optimal cut-point for identifying those with a high risk of falling: 70% of the total sample.
Conclusions: the TUGT and a simple test of cognition can be used to streamline referrals in a high-risk population, allowing for more efficient use of available resources in clinical practice. A subsequent PPA provides quantification of risk and direction for tailored intervention.
Keywords: aged, accidental falls, mobility, falls risk, cognitive impairment, elderly
Received September 28, 2004; accepted in revised form July 14, 2005.
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