Mitchell SL, Devine BL, McDaid D, Dhayalan B; Glasgow Royal Infirmary, Physiotherapy Department, Glasgow, Scotland. Sarah.Mitchell@northglasgow.scot.nhs.uk.

PURPOSE: Falls are common in the elderly population especially in long-term care facilities. Falls risk assessment tools have largely been validated in the community and acute hospital settings. Nursing home environments differ from acute hospitals in many ways. The residents on average are older, frailer, more chronically ill and more physically dependent, have a much higher prevalence of dementia, gait disorders than those in acute settings. It is necessary therefore to investigate whether risk assessment tools validated in community settings are appropriate tools in long term care settings. The aim of this evaluation was to investigate whether the falls risk assessment tools used in our rehabilitation hospital are also predictors of future falls in patients in our long term care setting. SUBJECTS: 200 consecutive patients admitted to the long-term care facility were measured. The mean age of the group was 83.2 (±7.4 SD). The mean abbreviated mini mental test score (AMT) was 4.8 (±3.6 SD). METHODS AND MATERIALS: All patients had a Cannard and Tinetti risk assessment performed by the physiotherapist. Abbreviated mental test scores, Barthel and Elderly Mobility scores were also noted. ANALYSES: Analysis was performed using the Statistical Package for the Social Sciences (SPSS-PC) version 8. Comparisons were made using the Chi-squared test, unpaired Student’s t-test (2-tailed) and Analysis of variance (ANOVA). Differences were accepted as being statistically significant at p £ 0.05. RESULTS: The median Barthel score was 6 (3-11), median EMS 6 (0-13). Eighty two percent of all the patients were stratified into the high risk falls category. A total of 56% of the patients had falls within the 6 month follow up period. Univariate analysis of all the patients showed that neither tools could predict falls (P > 0.05). When identifying patients who were mobile (EMS>4-20) n = 119 univariate analysis showed that the Tinetti assessment tool was useful in predicting whether a patient would fall/not fall (P = 0.006), and also in predicting multiple falls (P = 0.004). When identifying patients who were more functionally dependent (EMS<12) n = 148 the Cannard could predict whether a patient would fall/not fall (P = 0.04) but not multiple fallers (P = 0.06). CONCLUSION: The results suggest that if patients are mobile then the preferred tool might be the Tinetti. If however the patients are highly dependent in mobility then the Cannard might be the preferred tool. This is logical as the Tinetti assessment tool identifies gait and balance. The Cannard assessment tool is a generic tool and incorporates criteria other than gait and balance such as cognition, sex and medication. FUNDING SOURCE: None.

Copyright 2004 by the American Physical Therapy Association

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