While Timed Up and Go is valued in part for its ease and simplicity, that ease is also responsible for limitations in its predictive value. The limitations of Timed Up and Go beg the question of whether viable alternatives or supplements to TUG exist. Medical professionals have in fact developed other means of assessing fall risk.
The Berg Balance Test
The Berg Balance test is specifically designed to gauge balance. It involves a series of tasks, ranging from standing up from a seated position to balancing on one foot. A slightly modified version of the Berg Balance test has been adapted to serve as a fall risk assessment test and can be conducted in spaces smaller than required for Timed Up and Go. However this test, like Timed Up and Go, only captures the senior’s performance at a given point in time, and the length of time it takes to complete the test (15 to 20 minutes ) makes it impractical to conduct periodically on a frequent basis. This test also does not take into account the judgement of healthcare professionals or the history of the senior who is being tested.
Get Up and Go
Get Up and Go (or GUG) is very similar to Timed Up and Go, but instead relies on a professional’s personal assessment of the senior’s mobility rather than a recorded figure. Like Timed Up and Go, a patient is asked to get up from a seated position, walk three meters, and return to his or her seat. However, with the Get Up and Go test, the recorded time to complete the test is not considered. Instead, the professional conducting the test rates the senior’s performance on a scale of one to five – one being “normal”, and five being “ severely abnormal.”
The Dynamic Gait Index
The Dynamic Gait Index “uses eight test items to measure a person’s ability to accommodate to changes in environment, speed, and head position during gait. This test is designed to demand many of the adjustments to gait that should occur when walking in the community or home, including walking with horizontal and vertical head turns, walking while speeding up and slowing down, walking over and around objects, and ascending and descending stairs.”
For senior care providers, ambient (or passive) sensor based monitoring is the latest and most effective way to supplement the evaluations like TUG that they already perform. Essentially, these technologies perform what amounts to a TUG test on a 24/7 basis, in addition to monitoring many other indicators that could suggest something is amiss.
Sensors, which are installed in resident’s living spaces, monitor the resident’s gait, the amount of time taken to transit from one location to another in the living space, and countless other indicators such as those noted in the aforementioned Washington State University study. By detecting deviations from norms using artificial intelligence software, the technology is able to tell providers when a resident is at an increased risk of falling.
While fall prevention is always the goal, it is important to detect falls quickly should they occur. Many communities count on on emergency pull cords, buttons, or pendants for fall detection. These devices rely on the resident to actively declare there has been a fall, which may not be possible if the senior has been incapacitated by the incident. In such cases, a resident who has fallen may not be detected until he or she is checked on, possibly leaving the resident injured and alone for hours. Ambient sensor-based monitoring can detect falls instantly. It can also tell providers what happened that led to the fall because all data is stored for later analysis.
There are limitations and benefits to each fall risk assessment. As opposed to relying on a single solution, it is likely in the best interest of seniors and their communities to look at falls in a more holistic way. A holistic approach to fall risk assessment, which supplements Timed Up and Go with a professional’s expert judgment and technical solutions, can drastically reduce the frequency of falls in senior living facilities.