Fall Risk Screening Training and Instructions ENCOURAGING COMMUNITY - - PDF document

8/23/2018 1

Fall Risk Screening Training and Instructions

ENCOURAGING COMMUNITY OUTREACH APTA OF MA GERIATRIC SPECIAL INTEREST GROUP (GSIG)

Presenter and Contributors

• Carolyn Cwalinski PT, DPT, MS, GCS
• Carolyn Cwalinski PT, DPT, MS, GCS – Chair

Laurel Mangelynkx PT, DPT, GCS – Vice Chair Catherine McLaughlin PT, DPT, GCS – Treasurer Emily Righter PT, DPT, GCS – Secretary

Objectives

!

1.

Educate community members about the benefit of physical therapy for reducing falls

▶ True Cost of a Fall Poster ▶ Balance Poster 2.

Identify community members who are at risk for falling

▶ Fall Risk Screening 3.

Refer community members at risk for falling to appropriate professionals

▶ Fall Risk Screening Results Handout

8/23/2018 2

Objectives Continued

4.

Educate community members about how to decrease their risk of falling

▶ How to Get Up from the Floor Handout (includes facts to decrease risk of

falling

5.

Educate community members about how to modify their home to decrease their risk of falling

▶ Home Modification Handout 6.

Educate community members about how to safely get up from the floor

▶ How to Get Up from the Floor Handout

National Fall Prevention Day

• National Council on Aging – First day of

fall – Sept 22, 2018

• This year is their 10th annual national fall

prevention day

• APTA of MA campaign will run from

Sept 20;23 (Thurs;Sun)

Planning for the day

• FAQ about holding a fall

screening

8/23/2018 3

Planning

▶ You can hold the

screening in a variety

• f places:

▶

Physical therapy clinic

▶

Church function room

▶

Senior center

▶

Doctors office

▶

Library

▶

Town hall

▶

Pharmacy/drug store

▶ Where should I hold the fall risk screening?

GSIG Board Member Performing Balance Tests while Advocating at the State House

Planning

▶ How much time do I need to conduct a fall risk

screening?

▶

This will depend on how many people attend and how many people are helping to run the screening.

▶

We generally allot around 20;25 mins per participant to complete the screening.

▶

TUG < 5 mins

▶

30 second sit to stand < 3 mins

▶

10 Meter walk test < 5 mins

▶

4 stage balance test (including SLS) < 5mins

▶

Review of results ~ 5 mins

▶

We generally allot 3;4 hours for the entire event.

• Planning

▶ How much space will I need?

▶ Again, this depends on if you are doing one

person at a time or multiple stations approach.

▶ Generally, we allot a minimum of 6’ x 35’ –

enough to perform the 10 meter walk test

8/23/2018 4

Planning

▶ What kind of supplies

do I need to do a fall risk screening?

▶ Stop watch ▶ Standard chair (18” high

with arm rests)

▶ Tape for floor ▶ Handouts ▶ Posters

Planning

▶ What additional (optional) resources

might be included in a fall risk screening?

▶ Food/snacks ▶ Drinks

Planning – TO DO List

In general…..

▶

Months/Weeks Prior

▶

Secure location

▶

Market event: senior centers, doctor’s offices, churches – we have flyers you can use to send out.

▶

Gather/purchase supplies for tests

▶

Print handouts – we will provide these to you!

▶

Print posters – we will provide these to you!

▶

Week before

▶

Order food

▶

Day of

▶

Set up area/stations

8/23/2018 5

The day has come!

• Overview
• Stations

Overview of Day

• May do all of these at one station or have separate

stations depending on how many people are helping day of and the amount of space you have.

• Registration
• Testing
• Review of results

Registration Station

Registration

▶ Have person fill out

the first page of your participant screening sheet which contains:

▶ Fall risk checklist ▶ Medication check list

▶ Explain process

8/23/2018 6

Testing Area

• Tests

▶ 30 second sit to stand ▶ TUG ▶ Walking speed ; 10 Meter

Walk test

▶ 4 Stage Balance Test

▶ Optional Additions

(info at end of presentation)

▶ Vital signs ▶

Orthostatic hypotension test

▶

Exercise;induced hypertension

▶ Cognitive screen

GSIG Board Member Performing a Test at the State House

A Bit of Background

Why did we choose the tests we chose?

• CDC RECOMMENDATIONS
• STEADI Program ; Stopping Elderly Accidents, Deaths, &

Injuries Initiative

• TUG
• 4 Stage Balance Test
• 30 second sit to stand
• Vital signs – orthostatic hypotension
• SYSTEMATIC REVIEW WITH META ; ANALYSIS BY LUSARDI ET AL.

(2017)

• Determining Risk of Falls in Community Dwelling Older

Adults: A Systematic Review and Meta;analysis Using Posttest Probability

• Single leg stance – eyes open
• Walking speed – 10 meter walk test

What do they promote?

According to systematic review with meta;analysis from 2017 – CDC STEADI materials

• Algorithm and check list for Fall Assessment and Interventions
• Functional Assessments
• Medication Review
• Other Tools

▶

Fall Prevention Referral Form

▶

Falls Risk checklist

According to systematic review with meta;analysis from 20003 – updated 2015 – Lusardi et al.

To identify persons in need of more in;depth examination of balance:

▶

5 simple medical history questions (yes/no)

▶

Any previous falls

▶

Psychoactive medication

▶

List of meds: http://whatmeds.stanford.edu/medications/categories.html ▶

Requiring any ADL assistance

▶

Self;report fear of falling

▶

Ambulatory assistive device use

Centers for Disease Control and Prevention, 2015; Centers for Disease Control and Prevention, 2017; Lusardi et al, 2017

8/23/2018 7

Performing the Tests

• Four stage balance test
• Timed up and go ; TUG
• 30 second sit to stand
• Walking speed – 10 meter walk test

Test ; TUG

Purpose: Screen mobility, balance, walking ability and fall risk in older adults. Equipment & Set;up:

▶

Measure and mark a 3 meter walkway (9.8 feet).

▶

Place a standard height chair (seat height 18''/47 cm and arm height 67 cm) at the beginning of the walkway.

▶

Stopwatch to time test.

Podsiadio & Richardson, 1991; Shumway;Cook et al. 2000

Image: Benavent- Caballer V. (2016). The effectiveness of exercise interventions and the factors associated with the physical performance in older adults. Retrieved from https://www.researchgate. net/profile/Vicent_Benave nt- Caballer/publication/3156 98817/figure/fig1/AS:477 564104908800@149087 1563212/Schematic- illustration-of-the-Timed- Up-and-Go-Test.jpg

Test ; TUG

General Instructions:

▶

Subject sits in a standard armchair, placing their back against the chair and resting their arms on the chair’s arms.

▶

Subject can use any assistive device for this test.

▶

The subject walks to a line that is 3 meters away, turns around at the line, and walks back to the chair and sits back down.

▶

The test ends when the subject’s buttocks touches the seat.

▶

Subject is instructed to use a comfortable and safe walking speed. Patient Instructions:

▶

Instruct the subject to sit in the chair and place his/her back against the chair and rest arms on arm rests.

▶

Demonstrate the test to the

• subject. When the subject is

ready, say “Go”. The stop watch should start when you say “Go” and should be stopped when the patient’s buttocks touches the seat. Time to complete:

▶

< 3 mins

Podsiadlo and Richardson, 1991; University of Missouri, n.d.

8/23/2018 8

Test ; TUG

Video Instructions

▶ https://youtu.be/BA7Y_oLElGY

Outcomes

▶ "#$%&'()* +adults

(Shumway;Cook et al, 2000)

▶ > 32.6 seconds = frail elderly (Thomas et al, 2005) ▶ < 20 seconds = independent for basic transfers in community

dwelling adults (Podsiadlo and Richardson, 1991)

▶ > 30 seconds = dependent on transfers, needed help to

enter/exit shower or tub, did not go out alone (Podsiadlo and Richardson, 1991)

Test – 4 Stage Balance Test

Purpose:

• To assess static

balance Equipment:

• Stopwatch

Time to complete:

• < 5 mins (including

SLS)

Centers for Disease Control and Prevention, 2017; Rossiter-Fornoff, Walf & Wolfson 1995

Test – 4 Stage Balance Test

General Instructions:

• There are four progressively more challenging
• positions. Patients should not use an assistive device

(cane or walker) and keep their eyes open.

• Describe and demonstrate each position. Stand next

to the patient, hold his/her arm and help them assume the correct foot position. When the patient is steady, let go, but remain ready to catch the patient if he/she should lose their balance. For each stage, say “Ready, begin” and begin timing. After 10 seconds, say “Stop.”

Centers for Disease Control and Prevention, 2017; Rossiter-Fornoff, Walf & Wolfson 1995

8/23/2018 9

Test – 4 Stage Balance Test

Patient Instructions:

• Instructions to the patient: I’m going to show you four positions.

Try to stand in each position for 10 seconds. You can hold your arms out or move your body to help keep your balance but don’t move your feet. Hold this position until I tell you to stop.

Criteria to stop test:

• If the patient can hold a position for 10 seconds without

moving his/her feet or needing support, go on to the next

• position. If not, stop the test.

Test – 4 Stage Balance Test

Video Instructions

• https://youtu.be/3HvMLLIGY6c

Outcomes:

• FALL RISK: Tandem < 10 seconds
• ▶ Purpose:

▶ To assess static balance skills with decreased

base of support

▶ Equipment:

▶ None

Test – Single Leg Stance – Open Eyes

Springer, Marin, Cyhan, & Roberts & Gill, 2007

8/23/2018 10

Directions/Patient Instructions:

▶

Performed with eyes open and . The subject must stand unassisted on one leg and is timed in seconds from the time one foot is flexed off the floor.

▶

The participant must stand unassisted on one leg and is timed in seconds from the time one foot is flexed off the floor to the time when it touches the ground or the standing leg

• r an arm leaves the hips.

Criteria to stop test:

▶

Subject’s foot touches the ground or standing leg or ,%

Test – Single Leg Stance – Open Eyes

Springer, Marin, Cyhan, & Roberts & Gill, 2007

Outcomes

▶

• .//0!12%&

▶

Norms: .+ Time (in seconds) 40;49 41.9 50;59 41.2 60;69 32.1 70;79 21.5 80;99 9.4

Test – Single Leg Stance – Open Eyes

Springer, Marin, Cyhan, & Roberts & Gill, 2007

Test – 30 second sit to stand

Purpose! Screen functional lower extremity strength in older adults. Equipment:

▶

Straight back chair without arm rests (Seat 18” high)

▶

Stopwatch

Jones & Rikki 1999 Image: Dzhagaryan, A., Milenkovic A, Jovanov E & Milosevic M. (2015). Smart Button: A Wearable System for Assessing Mobility in Elderly ; Scientific Figure on

• ResearchGate. Retrieved

from: https://www.researchgate.n et/282888196_fig1_Fig;1; Timed;Up;and;Go;test; phases

8/23/2018 11

Test – 30 second sit to stand

Directions/Patient Instructions:

▶

Have subject sit in the middle of the chair and place their hands

• n opposite sides of their shoulders.

▶

Keeping their feet flat on the floor and back straight. On “Go”, rise to a full standing position and then sit back down again. Repeat this for 30 seconds.

▶

Beginning timing when you say “Go”. Count the number of times the subject comes to full standing in the 30 seconds. If subject is

• ver halfway to standing when 30 seconds have elapsed, count

it as a stand. Criteria to stop test:

▶

If subject must use his/her arms to stand, stop test and score is 0.

Jones & Rikli 1999; Centers for Disease Control and Prevention, 2017

Test ; 30 second sit to stand

Video Instructions:

• https://youtu.be/Ng;UOHjTejY

Outcomes:

• 30 second sit to stand test norms

Age Male (25-75%) Female (25-75%) 60-64 14 - 19 12 - 17 65-69 12 - 18 11 - 16 70-74 12 - 17 10 - 15 75-79 11 - 17 10 - 15 80-84 10 - 15 9 - 14 85-89 8 - 14 8 - 13 90-94 7 - 12 4 - 11

Jones & Rikki, 1999

Test – Walking Speed ; 10 Meter Walk

Purpose! Assess walking speed in meters per second over a short distance. Equipment & Set;up:

▶

Measure and mark a 10 meter walkway.

▶

Add a mark at 2 meters and then at 8 meters.

▶

Stop watch to time test. Time to complete:

▶

< 5 mins

Bohannon, 1997; Dite & Temple, 2002

• !"#

$!!!$!# !%""#%% &'# #$$!"

• (()

(* %++"&"+ ,-+()(*((++$.(/

8/23/2018 12

General Instructions:

▶

Subject walks without assistance for 10 meters and the time is measured for the intermediate 6 meters.

▶

Start timing when the toes of leading foot cross the 2 meter mark and stop timing when toes of leading foot cross the 8 meter mark.

▶

Subject can use any assistive device for the test.

▶

Divide subjects speed in seconds by 6 to determine average self; selected velocity (m/s). Patient Instructions:

▶

“I will say ready, set, go. When I say go, walk at your normal comfortable speed until I say stop.”

Test – Walking Speed ; 10 Meter Walk

Wolf, 1999; Bohannon, 1997; Dite & Temple, 2002

Outcomes

3)+

45

4-67/*89::;5 1.2 ;1.4 m/s Crosses street normally (Lerner;Frankiel, Varcas, Brown & Schoneberger, 1986) 0.8 ;1.2 m/s Community ambulatory (Perry & Mulroy, 1995) > 1.0 m/s Independent in ADLs (Studenski et al, 2003) < 0.6 m/s Dependent in ADLs (Studenski et al, 2003) 0.4 ; 0.8 m/s Limited community ambulatory

(Perry & Mulroy, 1995)

< 0.4 m/s Household walker (Perry & Mulroy, 1995)

Test – Walking Speed ; 10 Meter Walk

Bohannon, 1997; Dite & Temple, 2002; Steffen & Hacker et al., 2002

Test – Walking Speed – 10 Meter Walk

Figure from Fritz & Lusardi, 2009

8/23/2018 13

Recording the Results

• Participant

screening sheet pg 2

• Areas for:
• Their actual score
• Normal or not
• Comments

Clinician Reference Sheet

• Test
• Purpose
• Fall Risk Cut

Offs

• Norms
• References

Review of Results

8/23/2018 14

Review of Results

• Results

▶

Review results of tests

▶

Refer to appropriate health care professionals as needed

▶

Provide appropriate handouts and educate participant

Laybourne et al., 2008

Review of the Results – Discussion Points

What is a fall?

There are 4 types of falls:

Grade 1 ; a near fall Grade 2 ; a fall without resulting injury Grade 3 ; a fall resulting in injury but without hospital admission Grade 4 ; a fall resulting in injury and with a hospital admission

(Davalos-Bichara et al. 2001; Moyer, 2018)

Older adults benefit from increasing their activity level

▶

“Many older adults chose to limit their activities in the belief that this will result in a decreased fall risk.” (Childers, 2017)

▶

Many older adults did not believe walking would be considered physical activity (Lee et al, 2008)

▶

Activities to recommend:

▶

Gardening

▶

Dancing

▶

Swimming

▶

Walking

(Childers, 2017; Lee, Arthur, Avis, 2008 )

Review of the Results – Discussion Points

8/23/2018 15

Additional Information on Tests

▶

Rehab Measures Database

▶

https://www.sralab.org/rehabili tation;measures

▶

Some have better luck finding tests on their site searching through google rather than using the search engine on the website home page

▶ Google: “TUG rehab

measures” ▶

Lists information on tests:

▶ Links to test online ▶ MCID ▶ Cut offs ▶ Instructions

Ability Lab, 2018

Handouts and Help

The following handouts are available from the GSIG/APTA of MA for you to use during your falls screening.

▶

Clinician Reference Sheet

▶

Participant Score Sheet

▶

How to Get Up From a Fall

▶

Fall Proofing Your Home

▶

Posters

▶

Liability release

▶

Photo release

Help

• Clinician volunteers and students

Thank you to Elizabeth Robbins, Erin Kaye and Jennifer Koot (Bay State College PTA students) for putting together the “How to get up from a fall” and “Fall proofing your home” handouts.

Optional Additions

• Blood pressure
• Orthostatic hypotension
• Exercise Induced hypertension
• Cognitive Screening
• Montreal Cognitive Assessment

(MoCA)

8/23/2018 16

Vital Signs – Orthostatic Hypotension

Definition According to the American Autonomic Society and the American Academy of Neurology*, OH is defined as a decline

• f

▶

> 20 mm Hg in systolic BP

• ▶

> 10 mm Hg diastolic BP

▶ The decrease must be present within 3 minutes of standing.

Equipment

▶

Noninvasive blood pressure measurement device.

▶

Blood pressure cuff of correct size for the patient.

*Consensus statement on the definition of orthostatic hypotension, pure autonomic failure, and multiple system atrophy. The Consensus Committee of the American Autonomic Society and the American Academy of Neurology. Neurology 1996;46:1470. Agency for Healthcare Research and Quality (2013)

Procedure

▶

Instruct the patient on the process of orthostatic blood pressure measurement and its rationale.

▶

Assess by verbal report and observation the patient's ability to stand.

▶

Have patient lie in bed with the head flat for a minimum of 3 minutes, and preferably 5 minutes.

▶

Measure the blood pressure and the pulse while the patient is supine.

▶

Instruct patient to sit for 1 minute.

▶

Ask patient about dizziness, weakness, or visual changes associated with position change. Note diaphoresis or pallor.

▶

Check sitting blood pressure and pulse.

▶

If the patient has symptoms associated with position change or sitting blood pressure ≤90/60, put patient back to bed.

Vital Signs – Orthostatic Hypotension

Agency for Healthcare Research and Quality (2013)

Procedure continued

▶

Instruct patient to stand.

▶

Ask patient about dizziness, weakness, or visual changes associated with position change. Note diaphoresis or pallor.

▶

If patient is unable to stand, sit patient upright with legs dangling over the edge of the bed.

▶

The patient should be permitted to resume a supine position immediately if syncope or near syncope develops. ▶

Measure the blood pressure and pulse immediately after patient has stood up, and then repeat the measurements 3 minutes after patient stands. Support the forearm at heart level when taking the blood pressures to prevent inaccurate measurement.

▶

Assist patient back to bed in a position of comfort.

▶

Document vital signs and other pertinent observations on the nursing flowsheet or in the medical record. Note all measurements taken and the position of the patient during each reading.

Vital Signs – Orthostatic Hypotension

Agency for Healthcare Research and Quality (2013)

8/23/2018 17

Outcomes

Subtract values 3 minutes after standing (or if patient cannot stand, then sitting) from lying values.

▶

A decline of ≥20mm Hg in systolic or ≥10 mm Hg in diastolic blood pressure after 3 minutes of standing = orthostatic hypotension.

▶

A heart rate increase of at least 30 beats per minute after 3 minutes of standing may suggest hypovolemia, independent of whether the patient meets criteria for orthostatic hypotension.

▶

A blood pressure drop immediately after standing that resolves at 3 minutes does not indicate orthostatic hypotension. However, this finding may be useful to confirm a patient's complaint of feeling dizzy upon standing and may lead to patient education about using caution when arising from a lying or sitting position. Report all findings to the treating medical provider, including all sets of blood pressure and pulse results, and whether the patient experienced pallor, diaphoresis, or faintness when upright.

Vital Signs – Orthostatic Hypotension

Agency for Healthcare Research and Quality (2013)

Orthostatic Hypotension

Orthostatic Hypotension

• Access score sheet here:

https://www.cdc.gov/steadi/pdf/Measuring_Ort hostatic_Blood_Pressure;print.pdf

• )+*(<=*

> By Hannah Williams and Evan Prost

▶

What they did:

▶

Participants had baseline vital as entered screening area.

▶

PT students took participant’s heart rate and blood pressure immediately after finishing the test.

▶

Participant was asked to rate their exertion on the RPE scale.

▶

If participant had a rise in systolic blood pressure > 50 mm Hg, the nurse trauma team member followed up with questions regarding shortness of breath, chest pain, nausea, diaphoresis and any visual/mental changes.

▶

Team members inquired if participant had an upcoming PCP visit and when.

▶

A written record of the adverse affects was recorded on the fall screening form and given to patient to bring to PCP on next visit.

▶

Participants were educated on: hypertension is typically asymptomatic and they would be wise to monitor their BP on a regular basis and when they exercised, to do so in a setting where vitals could be monitored.

Exercise;Induced Hypertension

(Williams & Prost, 2017)

8/23/2018 18

• )+*(<=

*> By Hannah Williams and Evan Prost >?.when screening for exercise;induced hypertension during the STEADI screening process:

1.

Take baseline vital signs when participants register or enter the fall screening station.

2.

Save the thirty second chair test (TSCT)for the last of the 3 STEADI tests since it is the most likely to provoke adverse cardiovascular signs/symptoms.

3.

Take vitals immediately after finishing the TSCS, and show the person a Borg RPE scale.

4.

If there is an abnormal vital sign response (hypertensive or hypotensive), continue to monitor vitals every 5 minutes until stabilized, while also observing for any adverse signs or symptoms. Consult or refer to PCP as appropriate.

Exercise;Induced Hypertension

(Williams & Prost, 2017)

Cognitive Screening

+(+,(-) .% By Jennifer Blackwood & Alison Martin

▶ “Older adults with impaired cognition are twice as likely

to fall as cognitively intact peers.”

▶ “The influence of cognition on falls risk is not isolated to

those with advance cognitive loss (i.e. dementia or Alzheimer disease) and mild deficits in cognition have also been associated with an increased falls risk.”

▶ Survey results regarding falls risk assessment: ▶ 32.7% screened cognition ▶ 67.3% did not screen cognition

Blackwood & Martin 2016

Cognitive Screening

+(+,(-) .% By Jennifer Blackwood & Alison Martin

▶ “Of those who did screen, either 1 domain (orientation)

was screened or a tool used for dementia (MMSE) was

• performed. These tests did not screen executive

function.”

▶ “Despite the popularity of the A&Ox3;4 screen, no

evidence exists which standardizes the administration of the tool.”

▶ Person place time (x3), circumstance or event (x4) ▶

“The MMSE is valid and reliable screening tool for dementia but it does discriminate between those with mild cog impairment/early Alzheimer's and their cog intact peers.

Blackwood & Martin 2016

8/23/2018 19

Other Considerations

+(+,(-) .% By Jennifer Blackwood & Alison Martin >?.

▶

“Incorporating cognitive screening data into falls risk assessments can help create customized interventions, which take into account both the physical and cognitive demands to best address risk factors.”

▶

Use screening tools that screen for mild cog impairment that are publicly available/free and have standardized instructions.

▶ Saint Louis University Mental Status (SLUMS) Examination ▶ http://aging.slu.edu/index.php?page=saint;louis;university;mental; status;slums;exam ▶ Montreal Cognitive Assessment Tool ▶ http://www.mocatest.org/pdf_files/test/MoCA;Test;English_7_1.pdf

Blackwood & Martin 2016

Questions and Follow Up

• If you have any questions, please feel free

to reach out the GSIG by emailing us at: aptamagsig@gmail.com

• Reach out and let us know how your

event went!

• Send us photos so we can post them to
• ur social media accounts or tag us in

your posts!

Social Media

Spread the word!

#MovementMatters #BetterBalanceforBetterHealth LinkedIn: APTAMA Twitter: @aptaofma Facebook: @APTAofMA Instagram: @aptaofma_today

8/23/2018 20

References

▶

Agency for Healthcare Research and Quality. (2013). Preventing Falls in Hospitals. Tool 3F: Orthostatic Vital Sign Measurement. Retrieved from https://www.ahrq.gov/professionals/systems/hospital/fallpxtoolkit/fallpxtk; tool3f.html

▶

Ability Lab. (2018). Retrieved from https://www.sralab.org/rehabilitation; measures

▶

Airex AD. (n.d.). Airex balance pad [Image]. Retrieved from https://www.my; airex.com/module/public/assets/d/d7d71b87e16de3eaff5522c9716ebcc6.jpg

▶

Anacker, S. L. and Di Fabio, R. P. (1992). "Influence of sensory inputs on standing balance in community;dwelling elders with a recent history of falling." Phys Ther 72(8): 575;581; discussion 581;574.

▶

Blackwood J. & Martin A. (2016). Screening for cognitive impairment as a part of falls risk assessment in physical therapist practice. 0:1;6. doi: 10.1519/JPT.0000000000000098

▶

Berg K, Wood;Dauphinee S, Williams JI, & Maki, B (1992). Measuring balance in the elderly: validation of an instrument. !". July/August supplement 2:S7;11

▶

Bohannon, R. W. (1997). Comfortable and maximum walking speed of adults aged 20;79 years: reference values and determinants. ##$%(1): 15;19.

▶

Bohannon RW. (2006). Reference values for the five‐repetition sit‐to‐stand test: a descriptive metaanalysis of data from elders. & 103(1):215‐222.

▶

Brandeis University. (n.d.). Berg balance Scale. Retrieved from https://www.brandeis.edu/roybal/docs/Berg;Balance;Scale_Website.pdf

▶

Buatois S, Miljkovic D, Manckoundia P, Gueguen R, Miget P, Vancon G et al. (2008). Five times sit to stand test is a predictor of recurrent falls in healthy community‐living subjects aged 65 and older. # 56(8):1575‐1577.

▶

Centers for Disease Control and Prevention. (2015). A CDC Compendium of Effective Fall Interventions: What Works for Community;Dwelling Older Adults. Retrieved from https://www.cdc.gov/homeandrecreationalsafety/pdf/falls/CDC_Falls_Compe ndium;2015;a.pdf#nameddest=appendixb

▶

Centers for Disease Control and Prevention. (2017). STEADI ; Older Adult Fall

• Prevention. Retrieved from https://www.cdc.gov/steadi/index.html

▶

Childers, C. (2017). Are we using the right approach to fall prevention? ' 24(3): 17;19.

References Continued

▶

Davalos;Bichara, M., Lin, F. R., Carey, J. P., Walston, J. D., Fairman, J. E., Schubert, M. C., … Agrawal, Y. (2013). Development and Validation of a Falls Grading Scale. ($))*+, ,%(2), 10.1519/JPT.0b013e31825f6777. http://doi.org/10.1519/JPT.0b013e31825f6777

▶

Di Fabio, R. and Anacker, S. (1996). "Identifying fallers in community living elders using a clinical test of sensory interaction for balance." European journal of physical medicine & rehabilitation 6(2): 61;66.

▶

Dite, W. & Temple, V. A. (2002). White Paper: Walking Speed: the Sixth Vital Sign. 32(2): 2;5. Figure 1.

▶

Fritz S & Lusardi M. (2009). White paper: “walking speed: the sixth vital sign” 2(2):46–49. doi: 10.1519/00139143; 200932020;00002.

▶

Guralnik, J. M., L. Ferrucci, et al. (2000). "Lower extremity function and subsequent disability: consistency across studies, predictive models, and value

• f gait speed alone compared with the short physical performance battery."

#- 55(4): M221;31.

▶

Horak, F. B. (1987). "Clinical measurement of postural control in adults." 67(12): 1881;1885.

References Continued

8/23/2018 21

▶

Jones, C., Rikli, R., et al. (1999). A 30;s chair;stand test as a measure of lower body strength in community;residing older adults. ./ 01 70(2): 113.

▶

Lee LL, Arthur A, Avis M. Using self;efficacy theory to develop interventions that help older people overcome psychological barriers to physical activity: a discussion paper. Intl J Nurs Stud. 2008;45(11):1690;1699. doi: 10.1016/j.ijnurstu.2008.02.012 Lusardi, M. M., Fritz, S., Middleton, A., Allison, L., Wingood, M., Phillips, E., … Chui, K. K. (2017). Determining Risk of Falls in Community Dwelling Older Adults: A Systematic Review and Meta;analysis Using Posttest Probability. 2)(1), 1–36. http://doi.org/10.1519/JPT.0000000000000099. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5158094/

▶

Lerner;Frankiel M, Varcas S, Brown M, Krusel L, Schoneberger W. Functional community ambulation: what are your criteria? ! & 1986;6:12; 15.

▶

Merriam;Webster (2017). Dictionary: Advocacy. From: https://www.merriam; webster.com/dictionary/advocacy and https://www.merriam; webster.com/dictionary/advocate

References Continued References Continued

▶

Moyer, H. (2018, August 2). Re: AGPT Balance and Falls SIG August Monthly Challenge!

▶

Oxford Dictionary (2017). Dictionary: Advocate. From: https://en.oxforddictionaries.com/definition/advocate

▶

Perry J, Garrett M, Gronley JK, Mulroy SJ. Classification of walking handicap in the stroke population. 1995;26:982;989.

▶

Peters, Denise & Fritz, Stacy & Krotish, Debra. (2012). Assessing the Reliability and Validity of a Shorter Walk Test Compared With the 10;Meter Walk Test for Measurements of Gait Speed in Healthy, Older Adults. (2001). 36. doi. 10.1519/JPT.0b013e318248e20d.

▶

Podsiadlo, D. & Richardson, S. (1991). The timed "Up & Go": a test of basic functional mobility for frail elderly persons. # 39(2): 142;148.

▶

Prevention of Falls Network Europe (ProFaNE). (2011). Falls Efficacy Scale International (FES;I). Retrieved from http://www.profane.eu.org/fesi.html

References Continued

▶

Ricci, N. A. & de Faria Figueiredo Goncalves, D., Colmbra, A.M. & Combria I.B. (2009). Sensory interaction on static balance: a comparison concerning the history of falls of community;dwelling elderly. 3(2): 165;171

▶

Rossiter;Fornoff J, Walf S, Wolfson L. (1995). A cross;sectional validation study of the FICSIT common data base static balance measures. The journals of gerontology. Series A, Biological sciences and medical

• sciences. 50(6): M291;7.

▶

Shumway;Cook, A., Brauer, S., et al. (2000). Predicting the probability for falls in community;dwelling older adults using the Timed Up & Go Test. 80(9): 896;903

▶

Springer, B.A., Marin, R., Cyhan, T. & Roberts, H. Gill, N. W. (2007). Normative values for the unipedal stance test with eyes open and closed. ,), 8;15.

▶

Steffen, T. M., Hacker, T. A., et al. (2002). Age; and gender;related test performance in community;dwelling elderly people: Six;Minute Walk Test, Berg Balance Scale, Timed Up & Go Test, and gait speeds. . 82(2): 128;137.

▶

. 86: 1636;1640.

8/23/2018 22

References Continued

▶

Studenski S, Perera S, Wallace D, et al. Physical performance measures in the clinical setting. J # 2003;51:314;322.

▶

The Consensus Committee of the American Autonomic Society and the American Academy of Neurology. Consensus statement on the definition of orthostatic hypotension, pure autonomic failure, and multiple system atrophy. (1996). ' 46:1470.

▶

Thomas, J. I. & Lane, J. V. (2005). "A pilot study to explore the predictive validity of 4 measures of falls risk in frail elderly patients." #4 &.Yardley, L, Beyer, N, Hauer, K, Kempen, G, Piot;Ziegler, C & Todd, C. (2005). Development and initial validation of the Falls Efficacy Scale;International (FES;I). ##. 34(6): 614;619. Doi: https://doi.org/10.1093/ageing/afi196

▶

University of Missouri. (n.d.) Retrieved from http://geriatrictoolkit.missouri.edu/5x;STS.rtf