Assessing falls in the elderly: should we use simple screening tests or a comprehensive fall risk evaluation?

The risk for falling increases in the older population, resulting in an increase in serious outcomes and associated health care costs. Incorporating a falls assessment measure into the routine clinical evaluation is important for early identification of elders who are at greater risk for falls and provide information that can guide interventions. This article reviews a sample of available falls assessment approaches that are targeted to community dwelling older adults, ranging from simple questionnaires to more functional-based assessments. Newer high-tech and laboratory-based procedures still under development also are discussed. Finally, additional factors related to older individuals, specifically cognition- and emotion-based features that can impact falls risk are discussed as related to their importance for consideration in routine falls assessments. This paper summarizes information to help guide the clinician in choosing the most appropriate currently available tool. As many of these measures are similar in their sensitivity and specificity, decisions on which approach to take in many cases may have to be informed also by the clinic setting and existing resources available to the clinician.

Neuropsychological predictors of complex obstacle avoidance in healthy older adults.

Global cognitive impairment in older adults has been associated with a greater risk of falling, and tripping has been implicated as an important factor in a large percentage of these falls. In order to evaluate the role of specific cognitive domains in tripping and falling, 23 healthy older adults completed basic and complex obstacle avoidance tasks, as well as a battery of neuropsychological tests. Using multiple regression analysis, a select pattern of neuropsychological measures was found to predict the decrement in performance evident as avoidance task complexity increased. Whereas measures of problem solving, response inhibition, general anxiety, and variability in attention were found to be significant predictors (in that order) of the relative decline in successful obstacle avoidance, measures of visuo-spatial discrimination and memory did not.