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

Nordin, Ellinor
Lindelöf, Nina
Rosendahl, Erik
Jensen, Jane
Lundin-olsson, Lillemor

¹Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, SE-901 87 Umeå, Sweden
²Department of Health Sciences, Physiotherapy Unit, Luleå University of Technology, SE-971 87 Luleå, Sweden
³Department 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: [email protected]

Received 27 April 2007; accepted in revised form 5 February 2008

Age and Ageing 37(4):p 442-448, July 2008.

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.