Using the timed up and go test to stratify elderly inpatients at risk of falls

OBJECTIVE: To determine whether the Timed Up and Go Test is useful at stratifying acutely unwell elderly inpatients according to their risk for subsequent falls. DESIGN: Prospective cohort study. SETTING: Multidisciplinary acute care unit for the elderly at Liverpool Hospital, in Sydney, Australia. PARTICIPANTS: A total of 2388 consecutive admissions to the unit of mean age 82 years. INTERVENTION: The Timed Up and Go, administered on admission to the unit, and two modifications (an ordinal scale and a dichotomous scale, both incorporating patients unable to complete the Timed Up and Go) were evaluated. MAIN OUTCOME MEASURES: Number of falls, and reasons for the inability to complete the Timed Up and Go. RESULTS: During a median length of stay of nine days, 180 patients had at least one fall. The Timed Up and Go was unable to identify those patients who subsequently fell (P = 0.78). When the Timed Up and Go was modified to include the majority of patients unable to complete the test, both the ordinal (range of values 1-8, odds ratio (OR) 1.12, 95% confidence interval (95% CI) 1.03-1.21, P = 0.01) and dichotomous (OR 1.59, 95% CI 1.09-2.32, P = 0.02) modifications significantly predicted falls in multivariate analyses. Patients unable to do the Timed Up and Go due to non-physical disability had the highest fall rate (11%), followed by those with physical disability (9%), while those able to do the Timed Up and Go had the lowest fall rate (6%) (P< 0.001). Acutely unwell, immobile patients with dementia and delirium were not at excessive risk of falls. CONCLUSION: In the acute care setting, the value of the Timed Up and Go lies in the inability to complete the test, and the reasons for this inability, rather than the time recorded.