Does the timed up and go test predict future falls among British community-dwelling older people? Prospective cohort study nested within a randomised controlled trial

Abstract

BackgroundFalling is common among older people. The Timed-Up-and-Go Test (TUG) is recommended as a screening tool for falls but its predictive value has been challenged. The objectives of this study were to examine the ability of TUG to predict future falls and to estimate the optimal cut-off point to identify those with higher risk for future falls.MethodsThis is a prospective cohort study nested within a randomised controlled trial including 259 British community-dwelling older people ≥65 years undergoing usual care. TUG was measured at baseline. Prospective diaries captured falls over 24 weeks. A Receiver Operating Characteristic curve analysis determined the optimal cut-off point to classify future falls risk with sensitivity, specificity, and predictive values of TUG times. Logistic regression models examined future falls risk by TUG time.ResultsSixty participants (23%) fell during the 24 weeks. The area under the curve was 0.58 (95% confidence interval (95% CI) = 0.49-0.67, p = 0.06), suggesting limited predictive value. The optimal cut-off point was 12.6 seconds and the corresponding sensitivity, specificity, and positive and negative predictive values were 30.5%, 89.5%, 46.2%, and 81.4%. Logistic regression models showed each second increase in TUG time (adjusted for age, gender, comorbidities, medications and past history of two falls) was significantly associated with future falls (adjusted odds ratio (OR) = 1.09, 95% CI = 1.00-1.19, p = 0.05). A TUG time ≥12.6 seconds (adjusted OR = 3.94, 95% CI = 1.69-9.21, p = 0.002) was significantly associated with future falls, after the same adjustments.ConclusionsTUG times were significantly and independently associated with future falls. The ability of TUG to predict future falls was limited but with high specificity and negative predictive value. TUG may be most useful in ruling in those with a high risk of falling rather than as a primary measure in the ascertainment of risk.

Timed Up and Go predicts functional decline in older patients presenting to the emergency department following minor trauma

“…It is unclear what the optimal cut point is. It may vary depending on the outcome and the study population [24,27,28]. We chose to use <10 seconds as this is what was originally described by Podsiadlo et al [6].…”

Timed Up And Go Risk Predictor Of Falls In Elderly People Residing In The Community?

“…A survey of 259 elderly people in a British community showed that the TUG's ability to predict future falls was limited and may be more useful in people at high risk for falls rather than as a primary measure in risk assessment [13]. In another study, the authors suggest that TUG is not useful for predicting falls in healthy and active elderly, indicating it for those with impairment in health status and functional capacity [14].…”

Mobility, balance and frailty in community‐dwelling older adults: What is the best 1‐year predictor of falls?

“…10,11 In fact, nowadays more authors argue that the multifactorial nature of falls requires the development of a comprehensive tool able to accurately detect older adults at risk of falling. 10,12 Consistent with this vision, the construct of frailty has been associated with increased risk of adverse events, such as falls, in older adults. [13][14][15] Frailty is a dynamic and multidimensional condition, defined as a loss of reserve in one or more domains (physical, psychological and social) of individual functioning.…”

“…Recently, different studies reported a limited ability of these instruments, used in isolation, to predict falls in older adults . In fact, nowadays more authors argue that the multifactorial nature of falls requires the development of a comprehensive tool able to accurately detect older adults at risk of falling …”