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a Physical Medicine and Rehabilitation Service, VA Greater Los Angeles Healthcare System – West Los Angeles Healthcare Center, California
b Department of Medicine, University of California, Los Angeles
c Department of Physical Therapy, Mount St. Mary's College, Los Angeles, California
d Veterans Integrated Service Network 8, Patient Safety Center of Inquiry, James A. Haley Veterans Administration Medical Center, Tampa, Florida
e Office of Quality and Performance, VA Headquarters, Washington, DC
f Physical Medicine and Rehabilitation Service, Gait and Balance Clinic of North Florida/South Georgia Veterans Health System, Gainesville, Florida
g Geriatrics Research, Education, and Clinical Center, VA Greater Los Angeles Healthcare System – Sepulveda Ambulatory Care Center, California
Karen L. Perell, Physical Medicine and Rehabilitation (117), VA Greater Los Angeles Healthcare System–West Los Angeles Healthcare Center, 11301 Wilshire Blvd., Los Angeles, CA 90073 E-mail: Karen.Perell{at}med.va.gov.
Decision Editor: John E. Morley, MB, BCh
Background. Clinicians are often unaware of the many existing scales for identifying fall risk and are uncertain about how to select an appropriate one. Our purpose was to summarize existing fall risk assessment scales to enable more informed choices regarding their use.
Methods. After a systematic literature search, 21 articles published from 1984 through 2000 describing 20 fall risk assessments were reviewed independently for content and validation by a panel of five reviewers using a standardized review form. Fourteen were institution-focused nursing assessment scales, and six were functional assessment scales.
Results. The majority of the scales were developed for elderly populations, mainly in hospital or nursing home settings. The patient characteristics assessed were quite similar across the nursing assessment forms. The time to complete the form varied from less than 1 minute to 80 minutes. For those scales with reported diagnostic accuracy, sensitivity varied from 43% to 100% (median = 80%), and specificity varied from 38% to 96% (median = 75%). Several scales with superior diagnostic characteristics were identified.
Conclusions. A substantial number of fall risk assessment tools are readily available and assess similar patient characteristics. Although their diagnostic accuracy and overall usefulness showed wide variability, there are several scales that can be used with confidence as part of an effective falls prevention program. Consequently, there should be little need for facilities to develop their own scales. To continue to develop fall risk assessments unique to individual facilities may be counterproductive because scores will not be comparable across facilities.
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