Balance tests
• Functional reach test
o Older veterans with less than 6” have 4x the fall rate
o Between 6-10” have a 2x fall rate
o Frail older adults <18.5cm indicates fall risk
• Berg balance
o Has a ceiling effect
o Score below 45 is commonly used as a cutoff point
o Fallers often score above a 45 though
o
• TUG
o General test of mobility and level of independence
o Score ≥13.5 seconds is a predictor of falls for community dwelling adults
o Score > 14 seconds is a predictor of falls for older stroke patients
o Score >32.6 seconds is a predictor of falls in the frail elderly
• BESTest and MiniBESTest
o BEST: MDC 8.9, 69% cutoff score
o MiniBEST: MDC 3.5, no normative or cutoff scores yet
• FGA
o 20 feet of distance 12 inches wide
o MCID 4 points
o ≤22/30 predicts fall risk
• Single leg stance time
o May be better for active adults
• Fullerton advanced balance scale (FAB)
o For higher functioning older adults
o Score of 25/40 produces highest sensitivity (74.6%) and specificity
(52.6%) in predicting fall risk
• 5xSTS
Fear of Falling Outcomes
• Fall efficacy scale (Tinetti)
o 10 activities of balance confidence, each rated as 0-10
o Score of 100 is high self efficacy
o For the frail or housebound person
• FES international (Yardley)
o 16 items with 1-4 scale, total score ranges from 16-64
o 16-19 score = low concern about falls
o 20-27 = moderate concern about falls
o 28-64 = high concerns about falls
• Activities Specific Balance Confidence Scale (ABC)
o % confidence in performing 16 activities, indoor and outdoor activities
o Each item ranked 0-100; 100 = complete confidence
o Total score is the average of the 16 activities
o Normative mean (SD) is 79.89
o For mod-high functioning
• Fear of falling avoidance behavior questionnaire (FFABQ)
o 14 items
o Score 0-56, higher score indicates greater level of activity limitations and
participation restrictions
Other assessments
• Cognition
o Mini-Mental
• Dual task ability
o TUG Cog
o Walking while talking test
o Stops walking when talking test
o Multiple tasks test
o Walking and remembering test
Screening for Ability to Participate
• Physical activity readiness questionnaire (PAR-Q)
o Identifies contraindications to exercise
o 7 questions
• Exercise assessment and screening tool for you tool (EASY)
o 6 questions
o IDs potential health problems that require health care provider clearance
before exercise
o Provides edu about each program and the value of PA
o Helps older adults choose appropriate exercises that may not first require
physician approval
Senior Fitness Tests
• Chair stand test
o # of full stands in 30s with arms across chest
• Arm curl test
o # bicep curls in 30s with 5lb for women and 8lb for men
• 6MWT
• 2min step test
• Chair sit and reach test
o Sit at edge of chair and reach towards toes, # of inches +/- from fingertips
to toes
• Back scratch test
• 8 foot up and go test
o # of sec required to get up from seated, walk 8 feet, turn and return to
sitting
• Height and weight (BMI)
Selective functional movement assessment (SFMA)
• A way of quantifying the qualitative assessment of functional movement
• Uses key specific movements common in the senior athlete
• Significant findings include:
o Unable to perform movement correctly
o Shows major limitation with 1 or more movement patterns
o Demonstrates obvious difference between L and R side of body
• 7 movement patterns
o All performed first in loaded position, then unloaded
o All graded based on FN, FP, DP, DN and all those not graded as FN are
assessed in greater detail
o Once identified, work backwards to more specific assessments
o Cervical Patterns:
▪ Flexion, extension, and rotation (R + L)
o Upper-Extremity Patterns:
▪ Medial (internal) rotation & extension pattern (R + L)
▪ Lateral (external) rotation & abduction pattern (R + L)
o Multi-Segmental Patterns:
▪ Multi-segmental flexion
▪ Multi-segmental extension
▪ Multi-segmental rotation (R + L)
▪ Single-leg stance (R + L); and overhead squat
• The 4 categories
o
• Loaded vs unloaded complications
o Can draw conclusions about stability and mobility
Recommended OMs from GeriEDGE
• Walking speed (self selected/fast)
• 6MWT/2MWT
• TUG/TUGcog/TUGmanual
• 5xSTS/30s chair stand
• Sitting balance scale
• Berg balance scale (BBS)
• Patient specific functional scale (PSFS)
• Disabilities of the arm, shoulder, and hand scale (DASH)
• Fullerton advanced balance scale
• Elderly mobility scale
• Falls efficacy scale
Gait and ADL’s
• No specific tests and measures for examination identified in CPGs for gait and
ADLs, though tests and measures may still be use and are described below
• 10 meter walk test
o Walk at comfy speed (CGS) or as fast as you can (FGS)
o
• 6MWT
o MDC for elderly is 58.21 m
o MCID for elderly is 50 m
o Community dwelling elderly norms
o
• 30 s chair stand
o Measurement to assess functional LE strength in older adults
o Community dwelling elderly norms
o
• Four square step test (FSST)
o Tests balance dynamic
o Also tests ability to step over objects fwd, bwd, and laterally
o Older adults >15 seconds is a fall risk
• Dynamic gait index (DGI)
o Assessment of ability to modify balance dynamically in the presence od
external demands
o MDC 2.9 points
o MCID 1.9 points overall
o Cutoff in community dwelling older adults < 19
• Physical performance test (PPT)
o Assesses multiple domains of physical function using observed
performance of tasks that simulate ADL’s of various levels of difficulty in
older adults
o MDIC in elderly is 2.4
o 32-36 = not frail
o 25-32 = mild frail
o 17-24 = moderate frailty
o <17 = unlikely to be able to function in the community
Choosing an outcome measure
• Based on multiple areas such as specific disease, delivery setting, current LOF,
degree of cog impairment, ease of assessment, etc.
• Common outcomes and their cutoffs
