3 Limitations of Timed Up and Go Fall Risk Assessments

The Timed Up and Go test (TUG) is familiar to anyone involved in senior care. Long a mainstay of falls risk assessment, this simply allows caregivers to perform anevaluation of a senior’s likelihood of falling.

  • The senior sits with his or her back against a chair back
  • On the “go” Mark the individual rises, walks about 10 feet at a comfortable pace, turns, returns to the chair and sits down
  • Timing begins at “go” and stops when the individual is seated
  • Those who take longer than 12 seconds to complete circuit are estimated to be at high risk for falling.

This routine has served its purpose for a long time, but there are shortcomings, and emerging technologies may present a better option. Where exactly does TUG fall short? Consider…

1. A true test?

By its nature the TUG test will explore falls likelihood under a very narrow set of circumstance that hardly resemble the situations a senior likely will encounter in ordinary daily life.”

Certainly it is a common enough thing for a person to rise from a seated to a standing position and even take a few steps. But to immediately reverse course and return to the same seat? Less common. Moreover, TUG asks the senior to complete this task under a time constraint. Certainly, it is not a race, but the senior will be acutely aware of the seconds sweeping by. It creates an untoward stress.

Under such circumstances it’s hard to imagine TUG presents a true and accurate picture of falls likelihood.

2. How far to go?

Distance is another factor impacting the accuracy of TUG. Here the senior is asked to travel just 10 feet out and the same distance back. This could happen in real life, but so could many other scenarios. Perhaps the senior will travel some distance and find no comfortable stopping point. Maybe a corridor stretches 30 or 40 feet, or more.

Distance is a real concern, given the uncertainties that may face a senior in daily life. Senior housing operators encourage those with adequate mobility to get out and about, to engage in little trips to keep mind and body sharp. But is someone who successfully navigates the TUG circuit really able meander through the mall? It doesn’t take much to appreciate the differences.

3. What time is it now?

The question may seem of little significance. TUG isn’t looking for a senior’s ability to gauge the time of day, after all. It’s about balance, gait, general mobility. It’s a practical test of skills.

But wait. Consider an individual’s demeanor before and after that first cup of coffee. Look at his or her physical comfort at 10 in the morning and 2 in the afternoon, when the post-lunch sluggishness sets in, regardless of age. Likewise, a senior who feels unwell may test quite different from the same individual on a well day. TUG tests in the present moment, but real life presents a range of circumstances. What time is it now? The answer can make a big distance when it comes to falls evaluation.

A new plan

The solution to TUG’s shortcoming includes the use of artificial intelligence, or AI. When tied to a sensor array, AI can capture the warning signs of a fall and send an automated warning to caregivers.

Given real-time updates of potential problems, staff members can better act to prevent negative incidents. While TUG may help to paint a broad picture, sensors and software together can reveal an individual’s situation in the here-and-now, while it is still possible to take preventive action.

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