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Falls assessment kits (the physiological assessments)
 

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Book - Falls in Older People

 
Falls assessment kits

There are two versions of our falls assessment kits: a comprehensive or long version and a screening or short version. The comprehensive version is suitable for rehabilitation, physical therapy and occupational therapy settings and for dedicated falls clinics, and takes 45 minutes to administer. The screening version takes 10-15 minutes to administer and is suitable for acute hospitals and long-term care institutions. The table below describes the test items for the comprehensive version. The screening version contains five of these items: a test of vision (edge contrast sensitivity), peripheral sensation (proprioception), lower limb strength (knee extension strength), reaction time using a finger press as the response and body sway (sway when standing on medium density foam rubber). These five items were identified from discriminant analyses as being the most important for discriminating between fallers and non-fallers. 

The Physiological Profile Assessment Tests

Test Description
High and Low Contrast Visual acuity

Visual acuity is measured using a chart with high contrast visual acuity letters (similar to a Snellen scale) and low (10%) contrast letters, (where contrast = the difference between the maximum and minimum luminances divided by their sum). Acuity is assessed binocularly with subjects wearing their glasses (if needed) at a test distance of three metres and measured in terms of the minimum angle resolvable (MAR) in minutes of arc.

Contrast sensitivity

Edge contrast sensitivity is assessed using the Melbourne Edge Test. This test presents 20 circular patches containing edges with reducing contrast. Correct identification of the orientation of the edges on the patches provides a measure of contrast sensitivity in decibel units, where dB=-10log10 contrast.
Depth Perception

The depth perception test presents two vertical rods, the objective being to align these rods side-by-side. The subject is seated 3 metres away and pulls on the string to move the right rod while the left rod remains fixed. Any discrepancies in the position of the rods are measured in millimetres.
Tactile sensitivity

Tactile sensitivity is measured with a pressure aesthesiometer. This instrument contains eight nylon filaments of equal length, but varying in diameter. The filaments are applied to the centre of the lateral malleolus and measurements are expressed in logarithms of milligrams pressure.
Vibration sense

Vibration is measured using an electronic device which generates a 200 Hz vibration of varying intensity. The vibration is applied to the tibial tuberosity and is measured in microns of motion perpendicular to the body surface.
Proprioception

Proprioception is assessed by asking seated subjects with eyes closed to align the lower limbs on either side a 60cm by 60cm by 1cm thick clear acrylic sheet inscribed with a protractor. Any difference in matching the great toes is measured in degrees.
Lower limb strength

The strength of three leg muscle groups (knee flexors and extensors and ankle dorsiflexors) is measured while subjects are seated. In each test, there are three trials and the greatest force is recorded.
Reaction time

Reaction time is assessed using a light as the stimulus and depression of a switch (by either the finger or the foot) as the response. Reaction time is measured in milliseconds.
Postural sway

Sway is measured using a swaymeter that measures displacements of the body at waist level. The device consists of a 40cm long rod with a vertically mounted pen at its end. The rod is attached to subjects by a firm belt and extends posteriorly. As subjects attempt to stand as still as possible, the pen records the sway of subjects on a sheet of millimetre graph paper fastened to the top of an adjustable height table. Testing is performed with the eyes open and closed on a firm surface and on a piece of medium density foam rubber (15 cm thick). Total sway (number of square millimetre squares traversed by the pen) in the 30 second periods is recorded for the four tests.

For both the short and long forms, a computer software program has been developed to assess an individual’s performance in relation to a normative database complied from large population studies . This program produces a falls risk assessment report for each individual which includes the following four components:

  1. A graph indicating an individual’s overall falls risk score.

  2. A profile of the individual’s test performances. This allows a quick identification of physiological strengths and weaknesses.

  3. A table indicating the individual’s test performances in relation to age-matched norms.

  4. A written report which explains the results and makes recommendations for improving functional performances and compensating for any impairments identified.

To view a demonstration of the computer software, click here.

Details of each of the tests used in the PPA can be found in the following paper: Lord SR, Menz HB, Tiedemann A. A physiological profile approach to falls risk assessment and prevention. Physical Therapy 2003;83:237-252.PDF

Pricing of access to the falls risk web page depends on frequency of use. Please view our terms of sale prior to order (PDF file).

To order a falls assessment kit, or for further information please email us.

Other resources

Guidelines for the prevention of falls in older persons (American Geriatrics Society, British Geriatrics Society, American Academy of Orthopaedic Surgeons)

Guidelines for the prevention of falls in people over 65 (BMJ)

Coordinated stability track (Word) Coordinated stability track (PDF)

 NB: when printing the Coordinated stability track, select NO page scaling within your printer properties.

 

Book - Falls in older people: risk factors and strategies for prevention

Falls in Older People

Falls in older people: risk factors and strategies for prevention 2nd Edition (Lord, Sherrington, Menz, Close)

 

Falls in older people: risk factors and strategies for prevention 1st edition (Lord, Sherrington, Menz)

Since the first edition of this very successful book was written to synthesise and review the enormous body of work covering falls in older people, there has been an even greater wealth of informative and promising studies designed to increase our understanding of risk factors and prevention strategies. This new edition is written in three parts: epidemiology, strategies for prevention, and future research directions. New material includes the most recent studies covering: balance studies using tripping, slipping and stepping paradigms; sensitivity and depth perception visual risk factors; neurophysiological research on automatic or reflex balance activities; and the roles of syncope, vitamin D, cataract surgery, health and safety education, and exercise programs. This new edition will be an invaluable update for clinicians, physiotherapists, occupational therapists, nurses, researchers, and all those working in community, hospital and residential or rehabilitation aged care settings.  

For more information and to place an order, follow the relevant link to Cambridge University Press:

Australia, NZ / Europe, Middle East, Africa / Asia / Americas

 

Contents:

Part I. Epidemiology and Risk Factors for Falls: 1. Epidemiology of falls and fall-related injuries; 2. Postural stability and falls; 3. Gait patterns and falls; 4. Sensory and neuromuscular risk factors for falls; 5. Psychological factors and falls; 6. Medical risk factors for falls; 7. Medications as risk factors for falls; 8. Environmental risk factors for falls; 9. The relative importance of falls risk factors - an evidence-based summary.

Part II. Strategies for Prevention: Overview: Falls prevention; 10. Exercise interventions to prevent falls; 11. Exercise interventions to improve physical functioning; 12. Medical management of older people at risk of falls; 13. Assistive devices and falls prevention; 14. Modifying the environment to prevent falls; 15. Prevention of falls in hospitals and residential aged care facilities; 16. A physiological profile approach to falls risk assessment and prevention; 17. Falls prevention strategies - from research into practice; Part III. Research Issues in Falls Prevention: 18. Falls in older people: future directions for research.

 

Reviews:

DAVID OLIVER, for Age and Ageing

Whether we are specialist clinicians or researchers in falls and syncope, or whether we are generalists working in the care of older people, we all encounter, on a daily basis, patients who have fallen, or have one or more risk factors for falls. Prevention of falls and fractures has also featured prominently in government policy and guidelines in the UK, but where do we find the evidence to inform our research, teaching or clinical practice? Yes, there are many systematic reviews and guidelines in the journals, but no single resource which pulls together all the relevant knowledge in an accessible way. This first-rate book provides an excellent resource, which is easily readable, well laid out and comprehensively referenced. Written by authors with long experience in falls research and clinical services for fallers, Falls in older people is divided into three sections which follow-on naturally, one from the other. First, a review of the epidemiology and risk factors for falls, with specific chapters on gait, postural stability, medication, medical causes and psychological sequelae. Second, a comprehensive review of the research evidence for single and multifaceted interventions to prevent falls. Finally, a section on future challenges for research and for translating research findings into clinical practice. To criticise such a fine book seems petty. One problem inherent with all monographs is that no sooner is a book published than new research appears. I would have also welcomed a separate chapter on the ‘public health’ approach to falls prevention, i.e. moving from clinical trial evidence and beyond dedicated clinics, to implementing fall and injury prevention across whole populations. The final ‘research into practice’ chapter did not adequately address these issues, perhaps because research evidence, rather than service delivery, is the book’s main focus. The book perhaps also reflects the research interests of the authors, in that there is strong emphasis on physiological screening assessments, which are of unproven utility in ‘real-life’ services. Despite these minor reservations, the best compliment I can pay this book is that as someone who has been active in this field for years, I learnt a tremendous amount from reading it, and every chapter provided me with new and useful insights. I hope there will be a third edition.

 

First Edition Reviews:

"I have nothing but praise for this monograph...the authors write elegantly and apply academic rigour to the data" - Graham Mulley,  Journal of the Royal Society of Medicine 2001; 94: 202. PDF

"This is a stimulating and valuable book" - Janet M Simpson, Ageing and Society 2001; 21: 673-675. PDF

"This is an excellent book...evidence-based medicine at its most relevant" - John Grimley Evans, Family Practice 2001; 18: 470. PDF

"This new book on falls in older people synthesises a vast literature very concisely...I am sure it will become a classic" - Karim Khan, Gerontology Division Newsletter of the Canadian Physiotherapy Association Summer 2001: 16.

"The authors...have certainly done an outstanding job of collating and formally reviewing the available literature" - J Keen, Palliative Medicine 2001: 15.

"This Australian book is a 'must have' for all geriatricians...it deserves to be on the shelves of all day hospitals and in all orthopaedic departments" - W Reid, www.doctors-net 2001: June.

"Chapters whilst heavy with facts and figures, are very readable … clearly written yet containing enough depth to satisfy the scientific mind. I think the book would appeal to any healthcare professional with an interest in falls prevention, either from a theoretical or practical standpoint."  - Jo-Anne Wilson, Dementia.

"… this is undoubtedly a useful book to have as a resource for the interdisciplinary team." -  Palliative Medicine.

"The quality of the book is good and it is a good buy for psychiatrists, primary care physicians, geriatricians, orthopedic surgeons, physical and occupational therapists and domiciliary nurses." -  Maher S. Jadid, Saudi Medical Journal.

"This is a book written by experts who have first-hand experience of the academic and practical issues involved in identifying patients at risk...I strongly recommend it, not just to clinicians, but to nurses, physiotherapists, occupational therapists, podiatrists, and indeed anyone with a professional interest in this problem" - PW Overstall, Gerontology 2002; 48: 119-120. PDF

"This work bridges the gap between highly specialized journal articles and the often sketchy and superficial chapters on this topic that appear in many textbooks. It is clearly written and can be highly recommended to students, medical practitioners (including geriatricians and rheumatologists), nurses, physiotherapists and research workers in the field of gerontology and geriatrics." - Steven Boonen, Clinical Rheumatology.

"This book constitutes an easy-to-read introduction to the risk factors and prevention of falls that provides much assistance with this integral part of the responsibilities of the podiatric physician" - Leonard Levy, Journal of the American Podiatric Medical Association 2002;92:371. PDF 

"The greatest strengths of this most welcome book are its analytic and comprehensive nature...it  brings together the most salient issues for falls prevention for the first time in a specialised text. This authoritative book should become a well worn and dog-eared part of every falls prevention practitioners resource library" - Lesley Day, Injury Prevention.

"This book is a clear and concise an account as you could hope to find on the subject" - Dr Michael Dorevitch, Australian Journal on Ageing.

 

Sample chapter

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