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.
OBJECTIVE
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.


METHODS
cohort study, 6-month prospective follow-up for falls.


METHODS
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.
Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, SE-901 87 Umeå, Sweden. ellinor.nordin@physiother.umu.se
Ellinor
E
Nordin
Nina
N
Lindelöf
Erik
E
Rosendahl
Jane
J
Jensen
Lillemor
L
Lundin-Olsson
D000058:Accidental Falls / Q000517:prevention & control* / Q000706:statistics & numerical data*; D000368:Aged; D000369:Aged, 80 and over; D004185:Disability Evaluation; D005260:Female; D015577:Geriatric Assessment / Q000379:methods*; D006801:Humans; D008297:Male; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D015203:Reproducibility of Results; D012112:Residential Facilities / Q000706:statistics & numerical data*; D012307:Risk Factors; D012680:Sensitivity and Specificity