Age and Ageing Advance Access originally published online on May 30, 2008
Age and Ageing 2008 37(4):442-448; doi:10.1093/ageing/afn101
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Prognostic validity of the Timed Up-and-Go test, a modified Get-Up-and-Go test, staff's global judgement and fall history in evaluating fall risk in residential care facilities
1 Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, SE-901 87 Umeå, Sweden
2 Department of Health Sciences, Physiotherapy Unit, Luleå University of Technology, SE-971 87 Luleå, Sweden
3 Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, SE-901 87 Umeå, Sweden
Address correspondence to: E. Nordin. Tel: +46 90 786 9429; Fax: +46 90 786 9267. Email: ellinor.nordin{at}physiother.umu.se
Objectives: to evaluate and compare the prognostic validity relative to falls of the Timed Up-and-Go test (TUG), a modified Get-Up-and-Go test (GUG-m), staff's judgement of global rating of fall risk (GLORF) and fall history among frail older people.
Design: cohort study, 6-month prospective follow-up for falls.
Participants: 183 frail persons living in residential care facilities in Sweden, mean age 84 years, 73% women.
Methods: the occurrence of falls during the follow-up period were compared to the following assessments at baseline: the TUG at normal speed; the GUG-m, a rating of fall risk scored from 1 (no risk) to 5 (very high risk); the GLORF, staff's rating of fall risk as ’high’ or ’low’; a history of falls in the previous 6 months. These assessment tools were evaluated using sensitivity, specificity and positive and negative likelihood ratios (LR+ to rule in and LR– to rule out a high fall risk).
Results: 53% of the participants fell at least once. Various cut-off values of the TUG (12, 15, 20, 25, 30, 35, 40 s) and the GUG-m showed LR+ between 0.9 and 2.6 and LR– between 0.1 and 1.0. The GLORF showed an LR+ of 2.8 and an LR– of 0.6 and fall history showed an LR+ of 2.4 and an LR– of 0.6.
Conclusions: in this population of frail older people, staff judgement of their residents' fall risk as well as previous falls both appear superior to the performance-based measures TUG and GUG-m in ruling in a high fall risk. A TUG score of less than 15 s gives guidance in ruling out a high fall risk but insufficient information in ruling in such a risk. The grading of fall risk by GUG-m appears of very limited value.
Keywords: fall risk, prognostic validity, likelihood, sensitivity, specificity, elderly
Received 27 April 2007; accepted in revised form 5 February 2008.