Does Timed Up and Go Still Make the Grade in Senior Communities

The longtime staple of falls risk assessments, Timed Up and Go test (TUG) has been a frequently used tool in the senior housing community. Practitioners say it is simple to perform, with little time or equipment required to complete top assessment.

While TUG does offer at least a baseline reading of a senior’s potential for falls, today’s developing technologies indicate it should no longer be implemented as the sole tool for fall risk assessment in senior care communities.

How it works

In typical practice, caregivers would implement TUG to chart the amount time needed for a senior to stand up, walk 10 feet, turn around, and return to the starting point before sitting down again.

  • The senior sits with his or her back against a chair back
  • On the “go” command, 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.

Less than perfect

While the TUG has been successfully used as a component of a fall prevention program, there are numerous of disadvantages that should be taken into consideration.

First there are concerns about cognition. In TUG, a senior needs to be able to follow a multi-step set of instructions. While seemingly straightforward, the commands to sit, stand and walk can be confusing and anxiety-causing for anyone with memory issues.

There is also the issue of “ordinary” life. TUG tests in a limited set of circumstances, hardly akin to everyday walking conditions. From day to day seniors may move about their apartments and through their communities under a broad range of conditions. They may encounter diverse floorings, such as laminate and carpeting; they may need to navigate inclines, flat surfaces and curbs. TUG can’t test for these.

There are distance limitations, too. TUG testing only measures activity within 10 feet, while real life requires greater range. Thus, while TUG can give a brief glimpse into a senior’s likelihood of falls, that picture might change at 30 or 40 or 50 feet, or even walking across an apartment. TUG won’t recognize these varied circumstances.

Finally there is the range of timing. TUG tests in just one time range: Here and now. But seniors’ circumstances are changing all the time. Afternoon gait may vary from morning. A senior who feels unwell may test quite differently from the same individual on a well day.

A new method

The solution to TUG’s shortcoming is to develop a multi-pronged approach, one that takes into account not just the role of senior community staff as testers, but also emerging falls technology, which can augment the human-administered TUG assessment. Success requires multiple participants, both human and digital.

Take for instance the recent advances in artificial intelligence, or AI. Tests have shown that AI can have a profound impact on falls prevention. When tied to a sensor array, AI can capture the warning signs of a fall, process these against a baseline of common behaviors, and broadcast automated warning to caregivers.

Such technology can give staff members real-time updates of any changes. In this way, falls prevention backed by technology can give a fuller picture, helping to keep seniors safe, while automation also drives greater staff efficiencies.


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