The most commonly used mobility assessments for screening risk of falls among older adults are rating scales such as the Tinetti performance oriented mobility assessment (POMA). However, its correlation with falls is not always predictable and disadvantages of the scale include difficulty to assess many of the items on a 3-point scale and poor specificity. The purpose of this study was to describe the ability of the new Aachen Mobility and Balance Index (AMBI) to discriminate between subjects with a fall history and subjects without such events in comparison to the Tinetti POMA Scale.
For this prospective cohort study, 24 participants in the study group and 10 in the control group were selected from a population of patients in our hospital who had met the stringent inclusion criteria. Both groups completed the Tinetti POMA Scale (gait and balance component) and the AMBI (tandem stance, tandem walk, ten-meter-walk-test, sit-to-stand with five repetitions, 360° turns, timed-up-and-go-test and measurement of the dominant hand grip strength). A history of falls and hospitalization in the past year were evaluated retrospectively. The relationships among the mobility tests were examined with Bland–Altmananalysis. Receiver-operated characteristics curves, sensitivity and specificity were calculated.
The study showed a strong negative correlation between the AMBI (17 points max., highest fall risk) and Tinetti POMA Scale (28 points max., lowest fall risk; r = −0.78, p < 0.001) with an excellent discrimination between community-dwelling older people and a younger control group. However, there were no differences in any of the mobility and balance measurements between participants with and without a fall history with equal characteristics in test comparison (AMBI vs. Tinetti POMA Scale: AUC 0.570 vs. 0.598; p = 0.762). The Tinetti POMA Scale (cut-off <20 points) showed a sensitivity of 0.45 and a specificity of 0.69, the AMBI a sensitivity of 0.64 and a specificity of 0.46 (cut-off >5 points).
The AMBI comprises mobility and balance tasks with increasing difficulty as well as a measurement of the dominant hand-grip strength. Its ability to identify fallers was comparable to the Tinetti POMA Scale. However, both measurement sets showed shortcomings in discrimination between fallers and non-fallers based on a self-reported retrospective falls-status.
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Moore L, Turgeon AF, Sirois MJ, Lavoie A. Trauma centre outcome performance: a comparison of young adults and geriatric patients in an inclusive trauma system. Injury. 2012;43(9):1580–5.
Vlaeyen E, Deschodt M, Debard G, Dejaeger E, Boonen S, Goedemé T, Vanrumste B, Milisen K. Fall incidents unraveled: a series of 26 video-based real-life fall events in three frail older persons. BMC Geriatr. 2013;13:103.
Liem IS, Kammerlander C, Suhm N, Blauth M, Roth T, Gosch M, Hoang-Kim A, Mendelson D, Zuckerman J, Leung F, Burton J, Moran C, Parker M, Giusti A, Pioli G, Goldhahn J, Kates SL. Investigation performed with the assistance of the AOTrauma network: identifying a standard set of outcome parameters for the evaluation of orthogeriatric co-management for hip fractures. Injury. 2013;44(11):1403–12.
Kammerlander C, Gosch M, Blauth M, Lechleitner M, Luger TJ, Roth T. The tyrolean geriatric fracture center: an orthogeriatric co-management model. Z Gerontol Geriatr. 2011;44(6):363–7.
Bielza Galindo R, Ortiz Espada A, Arias Muñana E, Velasco Guzmán de Lázaro R, Mora Casado A, Moreno Martín R, Tapia Salinas B, Escalera Alonso J, Gómez Cerezo J. Opening of an acute orthogeriatric unit in a general hospital. Rev Esp Geriatr Gerontol. 2013;48(1):26–9.
Patel NK, Sarraf KM, Joseph S, Lee C, Middleton FR. Implementing the national hip fracture database: an audit of care. Injury. 2013;44(12):1934–9.
Ungar A, Rafanelli M, Iacomelli I, Brunetti MA, Ceccofiglio A, Tesi F, Marchionni N. Fall prevention in the elderly. Clin Cases Miner Bone Metab. 2013;10(2):91–5.
Tinetti ME, Kumar C. The patient who falls: it’s always a trade-off. JAMA. 2010;303(3):258–66.
Gates S, Smith LA, Fisher JD, Lamb SE. Systematic review of accuracy of screening instruments for predicting fall risk among independently living older adults. J Rehabil Res Dev. 2008;45(8):1105–16.
American Geriatrics Society. British geriatrics society, American cademy of orthopaedic surgeons panel on falls prevention. Guideline for the prevention of falls in older persons. J Am Geriatr Soc. 2001;49(5):664–72.
Nevitt M, Cummings S, Kidd S, Black D. Risk factors for recurrent non-syncopal falls. JAMA. 1989;261:2663–8.
Berg KO, Maki BE, Williams JI, Holliday PJ, Wood-Dauphinee SL. Clinical and laboratory measures of postural balance in an elderly population. Arch Phys Med Rehabil. 1992;73:1073–80.
Tinetti ME. Performance-oriented assessment of mobility problems in elderly patients. J Am Geriatr Soc. 1986;34:119–26.
Chiu AY, Au-Yeung SS, Lo SK. A comparison of four functional tests in discriminating fallers from non-fallers in older people. Disabil Rehabil. 2003;25:45–50.
Tiedemann A, Shimada H, Sherrington C, Murray S, Lord S. The comparative ability of eight functional mobility tests for predicting falls in community-dwelling older people. Age Ageing. 2008;37(4):430–5.
Kopke S, Meyer G. The Tinetti test: babylon in geriatric assessment. Z Gerontol Geriatr. 2006;39(4):288–91.
Singh DK, Pillai SG, Tan ST, Tai CC, Shahar S. Association between physiological falls risk and physical performance tests among community-dwelling older adults. Clin Interv Aging. 2015;13(10):1319–26.
Yelnik A, Bonan I. Clinical tools for assessing balance disorders. Neurophysiol Clin. 2008;38:439–45.
Alexandre TS, Meira DM, Rico NC, Mizuta SK. Accuracy of timed up and go test for screening risk of falls among community-dwelling elderly. Rev Bras Fisioter. 2012;16(5):381–8.
Panzer VP, Wakefield DB, Hall CB, Wolfson LI. Mobility assessment: sensitivity and specificity of measurement sets in older adults. Arch Phys Med Rehabil. 2011;92(6):905–12.
American Geriatrics Society. Guidelines for the prevention of falls in older persons. J Am Geriatr Soc. 2001;49(5):664–72.
Ferrucci L, Guralnik JM, Studenski S, Fried LP, Cutler GB Jr. Interventions on frailty working group. designing randomized, controlled trials aimed at preventing or delaying functional decline and disability in frail, older persons. J Am Geriatr Soc. 2004;52:625–34.
Folstein MF, Folstein SE, McHugh PR. Mini-mental state a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12:189–98.
Stel VS, Pluijm SM, Deeg DJ, Smit JH, Bouter M, Lips P. A classification tree for predicting recurrent falling in community-dwelling older persons. J Am Geriatr Soc. 2003;51(10):1356–64.
Murphy MA, Olson SL, Protas EJ, Overby AR. Screening for falls in community-dwelling elderly. J Aging Phys Act. 2003;11:66–80.
Gardner MM, Buchner DM, Robertson MC, Campbell AJ. Practical implementation of an exercise-based falls prevention programme. Age Ageing. 2001;30(1):77–83.
Chu LW, Pei CK, Chiu A, Liu K, Chu MM, Wong S, Wong A. Risk factors for falls in hospitalized older medical patients. J Gerontol Biol Sci. 1999;54:M38–43.
Dargent-Molina P, Favier F, Grandjean H, Baudoin C, Schott AM, Hausherr E, Meunier PJ, Bréart G. Fall-related factors and risk of hip fracture: the EPIDOS prospective study. Lancet. 1996;348:145–9.
Imms FJ, Edholm OG. Studies of gait and mobility in the elderly. Age Ageing. 1981;10:147–56.
der Weil Bootsma-van. A, Gussekloo J, de Craen AJM, Van Exel E, Bloem BR, Westendorp RG. Common chronic diseases and general impairments as determinants of walking disability in the oldest-old population. J Am Geriatr Soc. 2002;50:1405–10.
Podsialdo D, Richardson S. The timed up and go: a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc. 1991;39:142–8.
Piotrowski A, Cole J. Clinical measures of balance and functional assessment in elderly persons. Aust J Physiother. 1994;40:183–8.
Csuka M, McCarty DJ. Simple method for measurement of lower extremity muscle strength. Am J Med. 1985;78:77–81.
Campbell AJ, Borrie MJ, Spears GF. Risk factors for falls in a community-based prospective study of people 70 years and older. J Gerontol. 1989;44:M112–7.
Whitney SL, Wrisley DM, Marchetti GF, Gee MA, Redfern MS, Furman JM. Clinical measurement of sit-to-stand performance in people with balance disorders: validity of data for the five-times-sit-to-stand test. Phys Ther. 2005;85(10):1034–45.
Berg K, Wood-Dauphinee S, Williams JI, Maki B. Measuring balance in the elderly: preliminary development of an instrument. Physiother Can. 1989;41:304–11.
Viccaro LJ, Perera S, Studenski SA. Is timed up and go better than gait speed in predicting health, function, and falls in older adults? J Am Geriatr Soc. 2011;59:887–92.
Leong DP, Teo KK, Rangarajan S, Lopez-Jaramillo P, Avezum A Jr, Orlandini A, Seron P, Ahmed SH, Rosengren A, Kelishadi R, Rahman O, Swaminathan S, Iqbal R, Gupta R, Lear SA, Oguz A, Yusoff K, Zatonska K, Chifamba J, Igumbor E, Mohan V, Anjana RM, Gu H, Li W, Yusuf S. Prospective urban rural epidemiology (PURE) study investigators. Prognostic value of grip strength: findings from the prospective urban rural epidemiology (PURE) study. Lancet. 2015;386(9990):266–73.
Mathiowetz V, Kashman N, Volland G, Weber K, Dowe M, Rogers S. Grip and pinch strength: normative data for adults. Arch Phys Med Rehabil. 1985;66(2):69–74.
Kegelmeyer DA, Kloos AD, Thomas KM, Kostyk SK. Reliability and validity of the Tinetti mobility test for individuals with Parkinson disease. Phys Ther. 2007;87(10):1369–78.
Baker DI, King MB, Fortinsky FH, Graff LG, Gottschalk M, Acampora D, Preston J, Brown CJ, Tineti ME. Dissemination of an evidence-based multi-component fall risk assessment and management strategy throughout a geographic area. J Am Geriatr Soc. 2005;53(4):675–80.
Raîche M, Hébert R, Prince F, Corriveau H. Screening older adults at risk of falling with the Tinetti balance scale. Lancet. 2000;356(9234):1001–2.
Pape HC, Schemmann U, Foerster J, Knobe M. The aachen falls prevention scale-development of a tool for self-assessment of elderly patients at risk for ground level falls. Patient Saf Surg. 2015;14(9):7.
Conflict of interest
Matthias Knobe, Meike Giesen, Sarah Plate, Gertraud Gradl-Dietsch, Benjamin Bücking, Daphne Eschbach, Walter van Laack, and Hans-Christoph Pape declare that they have no competing interests. No funds were received by any of the authors in support of this study.
This study was approved by the Institutional Review Board at the RWTH Aachen University (Ethical Approval EK 171/14).
Informed consent was obtained from each participant and participation was voluntary.
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Knobe, M., Giesen, M., Plate, S. et al. The Aachen Mobility and Balance Index to measure physiological falls risk: a comparison with the Tinetti POMA Scale. Eur J Trauma Emerg Surg 42, 537–545 (2016). https://doi.org/10.1007/s00068-016-0693-2
- Ground-level falls
- Co-managed care
- Fall prevention
- Mobility tests
- Tinetti test