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Table 1 Summary of included reviews

From: Predicting falls in older adults: an umbrella review of instruments assessing gait, balance, and functional mobility

Type of review Author (Date)
Country of lead author
Reported primary objective Study population and setting Number of studies reporting on falls Gait, balance and functional mobility assessment Reported key conclusions
Narrative Reviews Ambrose et al. (2015) [19]
USA
To identify the epidemiology, aetiology and risk factors of fall-related fractures in older people Not stated and no details provided on characteristics 11 Tinetti, BBS, stride length, motion centre, TUG, 5 chair stand Clinician screening to prevent falls is recommended to identify impairments in gait and balance
Nakamura et al. (1998) [20]
USA
To review, compare and contrast the five most frequently cited scales of balance (Performance Oriented Assessment of Balance, “Get Up and Go”, Berg Balance Scale, Functional Reach Test) and Falls Efficacy (Falls Efficacy Scale) to assist clinicians in selecting an appropriate instrument for use with older adults in a clinical or research setting. Older adults.
No further details provided
Not reported Tinetti, Get Up and Go, Functional Reach Test, the Falls Efficacy Scale, BBS Administration time for these scales range from 3 minutes to 15–20 minutes. These scales do not require the use of expensive equipment; they require minimal space and no special training for the health care professional.
Stasny et al. (2011) [21]
USA
To assess the ability of the Activities-specific Balance Confidence (ABC) scale to predict the fall risk in older community-living adults. Community-dwelling older adults with age range of 60–99 years 3 Activities-specific Balance Confidence Scale Two papers showed an association between ABC scores and falls, while the third showed no associations. There is limited evidence that the ABC scale alone can predict falls.
Systematic Reviews without meta-analysis Abellan Van Kan et al. (2009) [22]
France
To examine if gait speed, assessed at usual pace and over a short distance, may have the capacity to identify autonomous community-dwelling older people at risk of adverse outcomes, and if gait speed might be used as a single-item tool instead of more comprehensive but time-consuming assessment instruments. Community-dwelling older adults 4 Gait Speed Gait speed was an independent predictor of falls or falls related femoral neck fracture in all dour studies
Bayot et al. (2020) [23]
France
To better define the role of DT in assessing the fall risk in healthy older adults, without cognitive impairment (i.e., mild cognitive impairment, dementia or neurological conditions) and/or known gait disorders. Primarily community-dwelling healthy adults without cognitive impairment adults 30 Dual tasking Promising added value of dual tasks including turns and other transfers, such as in the Timed Up and Go test, for prediction of falls.
Beauchet et al. (2011) [24]
France
To assess the association and the predictive ability of the TUG time performance on the occurrence of falls among individuals aged 65 years and older. All 70 years and over
Community-dwelling population (n = 7), inpatient population (rn = 3), sheltered housing (n = 1)
11 Timed Up and Go Although retrospective studies found that the TUG time performance is associated with a past history of falls only one prospective study found a significant association with falls.
Di Carlo et al. (2016) [25]
Italy
Aim of this study was to provide a comprehensive review of the psychometric features of the Mini-BESTest when administered to patients with balance dysfunction All settings, adult with balance disorders most commonly reported in studies (n = 19, 79%) 24 Mini-Best Test The results support the reliability, validity, and responsiveness of this instrument and it can be considered a standard balance measure.
Dolatabadi et al. (2018) [26]
Canada
Systematic review of quantitative measures of gait and balance related to the prediction of falls, with a focus on older adults with dementia. All settings. Older adults with diagnosis of dementia 15 TUG, 180 turn, BBS, PPT, 6 min walk, tandem gait, dynamic/static balance, POMA, mCTSIB, Romberg test, Functional Reach Test, grip strength, 4 step balance, SPPB Limitations of gait and balance are association with increased risk of falls in cognitively intact people. The characteristics most predictive of a fall are still unclear.
Eagles et al. (2018) [27]
Canada
To identify mobility assessments that are used in ED patients of 65 years and older and determine whether mobility test measures are associated with reported outcomes of hospitalization, repeat visits to the ED, future falls, or frailty. 65 years and over undergoing mobility assessment in ED 3 TUG, Tandem Gait, Gait abnormality No association with TUG and frailty and no falls results given despite outcome of falls reported. No association with tandem gait and future falls.
Ganz (2007) [28]
USA
To identify the prognostic value of risk factors for future falls among older patients. Community dwelling older people 15 Anterior postural sway, self-perceived mobility, tandem stand, tandem walk, 10 m walk The presence of at least 6 of 7 gait or balance abnormalities led to an increased risk of a fall (LR, 1.9; 95% CI, 1.4–2.6)
Lee et al. (2013) [29]
USA
To review the current evidence for fall risk screening assessments Community-dwelling (n = 12) inpatient medical and surgical wards (n = 13), rehabilitation setting (n = 6) 31: Timed Up and Go Test), Functional Gait Assessment, St Thomas Risk Assessment Tool, Hendrich fall risk model II, 10-Minute Walk Test, Berg Balance Scale, and Step Test Timed Up and Go Test with a cut off > 12.34 seconds and Functional Gait Assessment among community-dwelling older people. St Thomas Risk Assessment Tool in medical inpatients < 65 years old and surgical inpatients; Hendrich fall risk model II in medical inpatients. 10-Minute Walk Test in patients in post-stroke rehabilitation and Berg Balance Scale or the Step Test in patients in post-stroke rehabilitation who had fallen during their inpatient stay
Lima et al. (2018) [11]
Brazil
To verify whether the BBS can predict falls risk in older adults Community dwelling older adults (n = 5), older adults needing home care (reviews = 1), outpatients of geriatric clinic (n = 1) residential home (ns = 1). 8 BBS The evidence to support the use of BBS to predict falls is insufficient, and should not be used alone to determine the risk of falling in older adults
Marin-Jimenez et al. (2022) [30]
Spain
To investigate the predictive validity of motor fitness and flexibility test in relation to health outcomes in adults and older adults Healthy community-based population older than 18 years.
Sub population > 65 years old
25 studies, 2 systematic reviews included falls or hip fracture Gait speed test (13 studies+ 2 sys review), postural balance tests (13 + 1 review, adults over 40 so not included), and TUG (10 studies + 1 sys review, adults over 40 so not included) Strong evidence for slower gait predicting falls in adults over 60 years (seven studies+ seven studies from systematic reviews)
Three studies did not find an association between gait speed test and falls.
Omana et al. (2021) [31]
Canada
Systematically review the existing literature on the falls-related diagnostic test properties of the Functional Reach Test (FRT), single-leg stance test (SLST), and Tinetti Performance-Oriented Mobility Assessment (POMA) in older adults across settings and patient populations Participants aged 60 years or more community-dwelling older adults 21 met the inclusion criteria (12 POMA, 8 FRT, 6 SLST) Functional Reach Test (FRT), single-leg stance test (SLST), and Tinetti Performance-Oriented Mobility Assessment (POMA). All the clinical tests of balance demonstrated an overall low diagnostic accuracy and a consistent inability to correctly identify fallers. None of these tests individually are able to predict future falls in older adults.
Muir-Hunter et al. (2016) [32]
UK
To evaluate the association between dual-task testing protocols and future fall risk Community-dwelling participants aged 60 years and over. 10 Dual task Changes in gait under dual-task testing are associated with future fall risk, and this association is stronger than that for single-task conditions.
Neuls et al. (2011) [33]
USA
To determine the ability of the Berg Balance Scale (BBS) to predict falls in the older people with and without pathology. Specifically, to determine the cut off score that is most predictive of falls in the older adults and the sensitivity and specificity of the BBS in predicting falls. 5 studies of healthy older adults and 4 of adults with neurological disorders 9 BBS The Berg Balance Scale alone is not useful for predicting falls in the older adults; it should be used in conjunction with other tests or measures.
Pamoukdjian et al. (2015) [34]
France
To review the use of gait speed as a single frailty marker in older adults and to then discuss its contribution in geriatric oncology as a simple screening test for frail patients requiring a CGA (however, studies included are on community-dwelling adults, not on geriatric patients) Living in a community setting, independent in walking 46 Gait Speed Gait speed over a short distance is a simple, reliable, reproducible and inexpensive tool to predict falls and other adverse outcomes associated with frailty. Recommend evaluating gait speed over a distance of 4 m with a threshold of 1 m/s in a single measure as a screening tool for frailty in older patients with cancer (aged 65 years and older); those with gait speed < 1 m/s over a 4 m distance should be then assessed with a CGA.
Scott et al. (2007) [35]
Canada
To conduct a systematic review of published studies that test the validity and reliability of fall-risk assessment tools for use among older adults Community (14 studies and 23 measures), home-support (4 studies and 4 measures), long-term care (6 studies, 10 measures), acute care (12 studies, 8 measures) 34 38 different tools were assessed in the 34 articles included in this review There were several fall-risk assessment tools that were tested in prospective studies in different settings (community, supportive housing, long-term care, acute care). Most prospective studies assessed fall-risk assessment tools in the community setting. Yet, few tools were tested more than once or in more than one setting. Therefore, no single tool can be recommended for implementation in all settings
Yang et al. (2015) [36]
Hong Kong
To evaluate the evidence related to the psychometric properties of dual-task balance assessments in older adults. Primarily community dwelling
Mean age ranged from 69.4–81.1 years
23 Force platform Both static and walking balance assessment tools had good reliability but were not useful to predict falls. In most of the studies, the participants were living independently and had normal cognition. The psychometric properties of dual-task assessment tools may differ depending on the cognitive status
Zijlstra (2008) [37]
The Netherlands
To evaluate whether dual-task balance assessments have an “added value” over single-task balance assessments. Community, nursing homes, senior residences, community-centers for older adults, institutions, Alzheimer Care Units, residential care facilities and not reported in a few studies with both young and older adults 19 Dual balance tasks Two prospective studies suggested that dual balance tasks may have added value for fall prediction over single balance tasks.
Meta-analysis Barry et al. (2014) [10]
Ireland
To examine the predictive value of the test to identify individuals at risk of falling Community- dwelling older adults 25 studies (meta-analysis on 10 data sets) TUG Logistic regression analysis indicated that the TUG score is not a significant predictor of falls (OR = 1.01, 95% CI 1.00–1.02, p = 0.05)
Beauchet et al. (2009) [24]
France
To examine the relationship between the occurrence of falls and changes in gait and attention-demanding task performance whilst dual tasking amongst older adults 65 years and over; mean age ranged from 68.4–85 years. Included community –dwelling, senior housing facilities, inpatient facilities. 15 Dual task walking Out of 3 retrospective and 8 prospective studies, two and six studies, respectively, showed a significant relationship between changes in gait performance under dual task and history of falls. The pooled odds ratio for falling was 5.3 (95%CI, 3.1–9.1) when subjects had changes in gait or attention-demanding task performance whilst dual tasking.
Chantanachai et al. (2021) [38]
Australia
To identify risk factors for prospectively ascertaining falls Older people with cognitive impairment living in the community 16 TUG, gait speed, TUG-DT, pOMA, 5xSTS, static and leaning balance, limb strength, physical profile assessment, dual tasking Mean difference in meta-analysis fallers vs non fallers
TUG 2.20 (−1.42, 5.82) (4. studies)
Gait speed −0.07 (−0.28,-0.06) (4 studies, (p = 0.46)
Poor balance 0.62(0.45,0.79) (n = 590) p < 0.005
Balance impairment is a risk factor for falls in people with cognitive impairment living in the community.
With less certainty, mobility and gait speed may be important risk factors for falls in this population.
No met-analysis on sit-to-stand and POMA.
Chen-Ju Fu et al. (2021) [39]
Taiwan
A systematic review with meta-analysis
To review whether the simple and equipment-free assessments could efficiently identify the functionally independent elderly to be fallers or non-fallers Elderly aged over 65 years who can walk without assistance Fifteen studies were selected for systematic review, of which nine were for meta-analysis 5-time sit-to-stand test, alternate step test, one leg stance test, functional reach test, tandem stance test, stair ascent and stair descent test, ten-step test, minimal chair height standing test, half-turn test, and maximum step length test It was concluded that the 5-time sit-to-stand test was mostly used to assess the risk of falling in elderly. Although most assessment tests demonstrated significant difference between the fallers and non-fallers, the performance of those tests for identifying fallers were less promising.
Kozinc et al. (2020) [40]
Slovenia
Comprehensive comparison of the diagnostic balance tests used to predict falls and for distinguishing older adults with and without a history of falls Older adults 60 years and over Mean age 74.06 ± 5.75 years.
No detail on settings.
67 Single-leg stance test, body sway measures), dual body sway test and cognitive tests. Among the non-instrumented tests, the single-leg stance test appears to be the most promising for discrimination between fallers and non-fallers.
Single less stance: < 1.02 seconds – 67% sensitivity and 89% specificity
Lusardi et al. (2017) [9]
USA
Evaluate predictive ability of performance based measures for assessing fall risk by calculating and comparing PoTP values) and to explore the usefulness of PoT using results from multiple measures Range: 65 years or over. Mean age not reported. Community-dwelling older adults. 59 56 measures.
In particular, 7 performance-based measures: The Berg Balance Scale (BBS), the single-task Timed Up and Go (TUG) test, the Single-limb stance (SLS), the 5 times sit-to-stand test (5TSTS), The Performance-Oriented Mobility Assessment (POMA, Tinetti), the Self-selected walking speed (SSWS), the dynamic gait index
No single test or measure demonstrated strong PoTP values. 5 performance-based measures may have clinical usefulness in assessing risk of falling on the basis of cumulative PoTP. Berg Balance Scale score (<=50 points), Timed Up and Go times (> = 12 seconds), and 5 times sit-to-stand times (> = 12) seconds are currently the most evidence-supported functional measures to determine individual risk of future falls
Menant et al. (2014) [41]
Australia
To determine whether dual task walking paradigms involving a secondary cognitive task have greater ability to predict falls than single walking tasks Community dwelling older adults and residents of an old age residential home, senior housing facilities or intermediate care hostels, geriatrics and Alzheimer’s care unit inpatients, geriatric out patients. 15 studies included participants with no cognitive impairment. 33 (30 in meta-analysis) Single and dual task tests of gait speed Findings indicate single and dual task tests of gait speed are equivalent in the prediction of falls in older people and sub-group analyses revealed similar findings for studies that included only cognitively impaired participants, slow walkers or used secondary mental-tracking or verbal fluency tasks
Muir et al. (2010) [42]
Canada
Summarize the evidence linking balance impairment as a risk factor for falls in community-dwelling older adults Community-dwelling older adults 60 years and over 23 Tandem stand, tandem walk, one leg stand, Forward Reach Test, Performance Oriented
Mobility Assessment (POMA), Berg Balance Scale, Timed Up & Go Test, Romberg Test, and body sway.
Statistically significant associations for increased falls risk identified for tandem stand, tandem walk, one leg stand, POMA and body sway.
Park (2018) [12]
South Korea
To compare the diagnostic accuracy of several currently available fall risk assessment tools developed for the older people; to identify the assessment tools most frequently used to discriminate fallers and non-fallers and the assessment tools having the highest predictive validity; to provide scientific evidence for selecting the best tool to use in practice Older adults admitted to acute care hospitals; community-dwelling older adults; older adults in the long-term care setting. This review only included studies of people aged 60 years 33 26 tests were assessed in the 33 included studies; of these, the tests used in two or more studies were: Berg Balance Scale, Downton Fall Risk Index, Hendrich II Fall Risk Model, Mobility Interaction Fall chart, St. Thomas’s Risk Assessment Tool in Falling Inpatients (STRATIFY), Timed Up and Go test, Tinetti Balance scale. Of the 26 tools assessed, the Berg Balance Scale has a specificity of 0.9; it is the most useful in identifying the older adults at low falls risk
Rosa et al. (2019) [43]
Brazil
To identify evidence about the usefulness of the Functional Reach Test to evaluate dynamic balance and risk of falling; to verify the FRT assessment method and other variables (anthropometric, physical) that could interfere with the test results; to establish normative values for the FRT in older adults with no specific health condition. Community-dwelling (n = 31), nursing homes (n = 3), inpatient (n = 2), outpatients (n = 1) 40 (5 prospective studies included in meta-analysis) Functional Reach Test This meta-analysis provides normative values for the Functional Reach Test (FRT) (26.6 cm among community-dwelling older adults) as 15.4 cm [95%CI: 13.47;17.42] for non-community older adults (n = 5 studies). The meta-analysis revealed that FRT was not capable of predicting falls (p = 0.098). There is evidence to support the use of the FRT to assess dynamic balance but not to support its use to predict falls.
Schoene et al. (2013) [13]
Australia
To investigate the discriminative ability and diagnostic accuracy of the Timed Up and Go Test (TUG) as a clinical screening instrument for identifying older people at risk of falling Independent community-dwelling (n = 40), long term care residents (n = 4), day care attendees (n = 10, outpatient clinics (n = 2), day hospitals (n = 2), geriatric inpatient (n = 4) 53 TUG The Timed Up and Go Test (TUG) is not useful for discriminating fallers from non-fallers in healthy, high-functioning older people. It is of more value in less-healthy, lower-functioning older people.