Functional Balance Tests to Assess Physiological Fall Risk in Older Adults

Functional balance tests are employed as clinical tools to assess physiological fall risk in older adults by healthcare professionals.

The timed up and go (TUG) is an assessment of mobility, measuring the time taken for an individual to stand up from a chair, walk 3 meters, turn around and sit down. It is a well-established, recommended routine screening test. A time which exceeds 13.5 seconds is suggested to indicate increased risk of falls. Meta-analysis suggests that the TUG has poor to moderate ability to predict fall risk in older adults, and should not be used in isolation.

Barry et al., (2014) suggest that because falls are multifactorial in nature, a single test of mobility does not consider other fall risk factors, such as the addition of a cognitive task.

The 30 second sit to stand (STS) test is another clinical tool utilized to assess physiological fall risk in older adults. It is a measure of lower limb strength and endurance (de Jong et al., 2016); counting the number of times a participant can arise from a chair and sit down repeatedly over 30 seconds.

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The participant must keep their hands on their shoulders, in order to restrict the use of upper body strength. STS scores have been found to have moderate to strong correlations (r = .43 to .77) with measures of leg strength in older adults. A score of less than eight repetitions is suggested to be indicative of increased fall risk. Variations of the STS have been utilized, such as the modified STS where participants can use their arms, and the five time STS, which measures the time taken to complete 5 sit to stand repetitions.

Applebaum et al., (2017) state that due to the multitude of variations of the STS test, the validity of the test is questionable. On the other hand, Cho, Bok, Kim, and Hwang, (2012) state that decreased lower limb strength has been identified as a risk factor for falls, and the 30 second STS test is a quick, non-invasive method of assessing lower limb strength.

The 4 point balance test (4PBT) is a clinical tool which assesses an individual’s static balance in up to 4 stages. The participant starts on stage 1, and must perform the balance for 10 seconds, in order to progress to stage 2. This process is repeated until the participant either fails any stage or completes stage 4. The balance stages get progressively harder. Stage 1 involves standing with the feet together, side by side. Stage 2 is standing in a semi-tandem stance, feet together with one foot slightly in front of the other. Stage 3 is the tandem stance, with the feet in a straight line, with the toes of one foot touching the heel of the other foot. Stage 4 is standing on one foot (of the participant’s choice). Failure is deemed to be excessive movement of the feet or holding onto a surface. Balance assessment and increased fall risk has been heavily investigated. The Berg balance scale is a 14 item scale, which entails the participant attempting static and dynamic balance tasks whilst both seated and stood. Whitney, Wrisley, & Furman (2003) demonstrated concurrent validity in regards to the dynamic gait index (r = .71; p < .01). The 4PBT is adapted from the static segments of the Berg balance scale, and due to having less items, can be administered in a shorter period of time, making it useful for clinical settings.