Tests for Falls

 

     There are several scales for assessing a patient’s potential for future falls.  These identify if a patient has any “falls risk factors”.  For example, in order to assess falls risk of hospital patients, the Morse Fall Scale uses only a nurse’s observations and chart information.  A very popular current assessment scale for hospital patients is the Hendrich II, which uses not only chart information, but also a practical examination of the patient, including performance on a gait test (Get-up-and-go test), as well as presence of specific medical conditions such as a vertigo disorder.  The Hendrich II is a standardized scale.  Medicare requires a balance assessment of all new inpatient’s under the “Welcome to Medicare” provision. 

     A problem with most falls assessment scales is that they only measure a few falls risk factors.  There are such a large number of risk factors that there is little overlap of these factors on the various scales, in other words, each scale measures a different set of risk factors not found on other scales.  Using just one scale will miss a significant number of individuals, but assessing all possible individual risk factors would require a huge amount of time.  Another approach the author (me) recommends is a “systems” based assessment, that is, a screening or assessment of disorders in the various body systems that can cause falls (musculoskeletal, vestibular, visual, etc).  The Alvord Falls Screening Examination protocol assesses function in 6 body systems as well as any history of prior falls, and a balance physical examination.  By assessing the body systems that can cause falls, a more complete falls risk analysis is made, thereby missing fewer individuals with less common causes of falls.  The Alvord Falls Screening Examination is such a scale.  See Additional information section below for details of this examination.