Determining Risk of Falls in Community Dwelling Older Adults: A Systematic Review and Meta-analysis Using Posttest Probability.
Michelle M Lusardi, Stacy Fritz, Addie Middleton and 7 others
PMID 27537070WHAT IT FOUND
No single test identified fallers reliably.
Combining Berg Balance ≤50, Timed Up and Go ≥12 s, single-limb stance <6.5 s, walking speed <1.0 m/s, and five times sit-to-stand ≥12 s raised estimated fall chance above 30% baseline.
Key findings
01Performance-based measures predicted future falls better than medical history questions or self-report measures.
02A Berg Balance Scale score of 50 points or less raised estimated fall probability to 59%, while a score of 51 or more lowered it to 23% in a combined sample of 1130 older adults.
03Adding single-limb stance under 6.5 seconds and walking speed under 1.0 m/s to history questions raised cumulative estimated fall chance to 80% in the worked example.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
Retrospective studies were included because prospective studies were limited, and recall of falls may be inaccurate. The second search strings were not recorded, so the search cannot be fully replicated. Only English articles from January 1990 to September 2013 were included, so newer evidence is missing. People with cognitive dysfunction, orthopedic or neurological diagnoses, and acute, postacute, or extended care settings were excluded, so results may not apply to those groups. Many promising measures came from single studies with small samples and wide uncertainty ranges. No single test was diagnostic on its own, and cumulative probability estimates may overestimate risk because the questions and measures are related. The analysis assumed a 30% pretest probability, which may not match every patient's setting or age group. Study quality, fall definitions, and scoring methods varied across included studies.
The easy way to misread this
Do not treat any one cut point as proof that a patient will fall. The review found no single medical history question, self-report measure, or performance test was diagnostic on its own; the cumulative estimates were built from several results and assumed a starting community fall risk.