Fall Risk Assessment in Older Adults: Get-up-and-go Test is Most Effective
The get-up-and-go test (option C) is the most likely physical maneuver to assist in assessing the risk of future falls for a healthy 68-year-old man. 1, 2
Evidence for Get-up-and-go Test
The get-up-and-go test is specifically designed to evaluate functional mobility in older adults, which is a key predictor of fall risk. This test involves:
- Having the patient rise from a chair
- Walk 3 meters
- Turn around
- Return to the chair and sit down
The timed version of this test (TUG) has been extensively validated and:
- Correlates well with balance scales (r = -0.81) and gait speed (r = -0.61) 2
- Demonstrates high specificity (89.5%) for predicting falls 3
- Is quick, requires no special equipment, and can be easily incorporated into routine examinations 2
Why Other Options Are Less Effective
Test for nystagmus (option A): While vestibular disorders can contribute to falls, nystagmus testing alone is not a comprehensive fall risk assessment tool for the general elderly population. Guidelines do not recommend this as a primary screening tool for fall risk 1.
Test for pulsus paradoxus (option B): This test primarily assesses cardiac and respiratory conditions and has no established relationship with fall risk assessment in the elderly 1.
Lumbar spine flexibility test (option D): While mobility limitations can contribute to falls, this specific test is not identified in guidelines as a validated fall risk assessment tool 4, 1.
Evidence-Based Fall Risk Assessment
The US Preventive Services Task Force and other guidelines recommend:
- Using history of prior falls as the most consistent predictor of future falls 4, 1
- Assessing physical function or mobility limitations as key risk factors 4
- Implementing exercise interventions, particularly those focusing on balance and functional exercises, which reduce falls by 23-25% 4, 1
Clinical Application
For a healthy 68-year-old man:
- The get-up-and-go test provides objective data about functional mobility
- A TUG time ≥12.6 seconds is associated with significantly higher fall risk (adjusted OR = 3.94) 3
- The test has high specificity (89.5%) and negative predictive value (81.4%), making it particularly useful for identifying those at higher risk 3
Common Pitfalls to Avoid
- Relying solely on chronological age rather than functional assessment
- Failing to perform objective mobility testing in seemingly "healthy" older adults
- Not following up with appropriate interventions if mobility impairment is detected
- Overlooking the importance of balance and functional exercises in fall prevention
The get-up-and-go test is recommended as part of a comprehensive fall risk assessment and serves as an excellent starting point for evaluating fall risk in community-dwelling older adults like this 68-year-old man 1, 2.