Accuracy of Physical Function-based Fall Risk Assessments Among Community-Dwelling Older Adults: An ROC Analysis Original Research
Main Article Content
Keywords
Screening, Fall Prevention, Balance
Abstract
Introduction: Physical function assessments, such as the Timed-Up-and-Go (TUG) and Short Physical Performance Battery (SPPB), are commonly used to evaluate fall risk among older adults, yet they may misclassify individuals. Center-of-pressure postural sway path length (PS) is a criterion for assessing fall risk, but it is unclear how TUG and SPPB compare. This study examined the sensitivity, specificity, and accuracy of these three assessments in classifying older adults as high or low fall risk.
Methods: We conducted a cross-sectional study of 234 community-dwelling older adults (women=203, age=75.0±7.0 years, height=159±7.9cm, Body Mass Index=30.0±6.3kg/m²). Cut off values for SPPB (<7 out of 12), TUG (≥20 seconds), and PS (>30 cm) were used to categorize participants as high or low fall risk. McNemar tests were used to compare fall risk assessment between assessments.
Results: Participants had a mean TUG time of 10.2±6.3 seconds, SPPB score of 8.7±2.3, and PS of 34.7±21.3cm. Both TUG (high risk=10, low risk=224; X²=95.9, p<0.001) and SPPB (high risk=40, low risk=194; X²=55.7, p<0.001) significantly differed in fall risk assessment compared to PS (high risk=115, low risk=119). Compared to postural sway, TUG had a sensitivity of 4.3%, specificity of 95.8%, and accuracy of 50.9%. Similarly, SPPB had a sensitivity of 23.5%, specificity of 89.1%, and accuracy of 56.8%.
Conclusions: TUG and SPPB both demonstrated low sensitivity and accuracy, suggesting that they may be better as measures of physical function rather than fall risk. Clinicians may benefit from using PS or other criterion measures to screen for fall risk.
References
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29. Baratloo A, Hosseini M, Negida A, El Ashal G. Part 1: Simple definition and calculation of accuracy, sensitivity and specificity. Emerg (Tehran). Spring 2015;3(2):48-9.
30. Pettersson B, Nordin E, Ramnemark A, Lundin-Olsson L. Neither Timed Up and Go test nor Short Physical Performance Battery predict future falls among independent adults aged >/=75 years living in the community. J Frailty Sarcopenia Falls. Jun 2020;5(2):24-30. doi:10.22540/JFSF-05-024
31. Power V, Van De Ven P, Nelson J, Clifford AM. Predicting falls in community-dwelling older adults: a systematic review of task performance-based assessment tools. Physiother Pract Res. 2014;35:3-15. doi:10.3233/PPR-130027
32. Ashley MJ, Gryfe CI, Amies A. A longitudinal study of falls in an elderly population II. Some circumstances of falling. Age Ageing. 1977;6(4):211-220. doi:10.1093/ageing/6.4.211
33. Lauretani F, Ticinesi A, Gionti L, et al. Short-Physical Performance Battery (SPPB) score is associated with falls in older outpatients. Aging Clin Exp Res. Oct 2019;31(10):1435-1442. doi:10.1007/s40520-018-1082-y
34. Hauer K, Lamb SE, Jorstad EC, Todd C, Becker C. Systematic review of definitions and methods of measuring falls in randomised controlled fall prevention trials. Age Ageing. 2006;35(1):5-10. doi:10.1093/ageing/afi218
35. van Gameren M, Voorn PB, Bossen D, et al. The Short Physical Performance Battery does not correlate with daily life gait quality and quantity in community-dwelling older adults with an increased fall risk. Gait Posture. 2024/10/01/ 2024;114:78-83. doi:https://doi.org/10.1016/j.gaitpost.2024.09.005
36. Lafontant K, Blount A, Suarez JRM, et al. Comparing sensitivity, specificity, and accuracy of fall risk assessments in community-dwelling older adults. Clin Interv Aging. 2024;19:581-588. doi:10.2147/CIA.S453966
37. Montero-Odasso M, van der Velde N, Martin FC, et al. World guidelines for falls prevention and management for older adults: a global initiative. Age Ageing. Sep 2 2022;51(9)doi:10.1093/ageing/afac205
38. Shumway-Cook A, Brauer S, Woollacott M. Predicting the probability for falls in community-dwelling older adults using the Timed Up & Go Test. Phys Ther. Sep 2000;80(9):896-903.
39. Brodie MA, Coppens MJ, Ejupi A, et al. Comparison between clinical gait and daily-life gait assessments of fall risk in older people. Geriatr Gerontol Int. Nov 2017;17(11):2274-2282. doi:10.1111/ggi.12979
2. Vaishya R, Vaish A. Falls in older adults are serious. Indian J Orthop. Feb 2020;54(1):69-74. doi:10.1007/s43465-019-00037-x
3. Pauelsen M, Nyberg L, Roijezon U, Vikman I. Both psychological factors and physical performance are associated with fall-related concerns. Aging Clin Exp Res. Sep 2018;30(9):1079-1085. doi:10.1007/s40520-017-0882-9
4. Ho H-H, Fang IY, Yu Y-C, et al. Is functional fitness performance a useful predictor of risk of falls among community-dwelling older adults? Arch Public Health. 2021/06/18 2021;79(1):108. doi:10.1186/s13690-021-00608-1
5. Beauchet O, Fantino B, Allali G, Muir SW, Montero-Odasso M, Annweiler C. Timed Up and Go test and risk of falls in older adults: a systematic review. J Nutr Health Aging. Dec 2011;15(10):933-8. doi:10.1007/s12603-011-0062-0
6. Veronese N, Bolzetta F, Toffanello ED, et al. Association between Short Physical Performance Battery and falls in older people: the Progetto Veneto Anziani Study. Rejuvenation Res. Jun 2014;17(3):276-84. doi:10.1089/rej.2013.1491
7. Goble DJ, Baweja HS. Postural sway normative data across the adult lifespan: results from 6280 individuals on the Balance Tracking System balance test. Geriatr Gerontol Int. Aug 2018;18(8):1225-1229. doi:10.1111/ggi.13452
8. Singh DK, Pillai SG, Tan ST, Tai CC, Shahar S. Association between physiological falls risk and physical performance tests among community-dwelling older adults. Clin Interv Aging. 2015;10:1319-26. doi:10.2147/CIA.S79398
9. Control CfD, Prevention. STEADI algorithm for fall risk screening, assessment, and intervention among communitydwelling adults 65 years and older. Centers for Disease Control (https://www. cdc. gov/steadi/pdf/STEADI …; 2019.
10. Williams-Roberts H, Arnold C, Kemp D, Crizzle A, Johnson S. Scoping review of clinical practice guidelines for fall risk screening and assessment in older adults across the care continuum. Can J Aging. 2021;40(2):206-223. doi:10.1017/S0714980820000112
11. Elder NM, Bambach KS, Gregory ME, Gulker P, Southerland LT. Are geriatric screening tools too time consuming for the emergency department? A workflow time study. J Geriatr Emerg Med. 2021;2(6):1-5.
12. Johnston YA, Bergen G, Bauer M, et al. Implementation of the Stopping Elderly Accidents, Deaths, and Injuries initiative in primary care: an outcome evaluation. Gerontologist. Nov 16 2019;59(6):1182-1191. doi:10.1093/geront/gny101
13. Stevens JA, Smith ML, Parker EM, Jiang L, Floyd FD. Implementing a clinically based fall prevention program. Am J Lifestyle Med. Jan-Feb 2020;14(1):71-77. doi:10.1177/1559827617716085
14. Goble DJ, Rauh MJ, Baweja HS. Normative data for the BTrackS Balance Test Concussion-Management Tool: results from 10045 Athletes Aged 8 to 21 Years. J Athl Train. Apr 2019;54(4):439-444. doi:10.4085/1062-6050-178-18
15. Estévez-Pedraza ÁG, Martínez-Méndez R, Portillo-Rodríguez O, Parra-Rodríguez L. Portable device for the measurement and assessment of the human equilibrium. Ann Biomed Eng. 2021;49:933-945.
16. Estévez-Pedraza ÁG, Martínez-Méndez R, Portillo-Rodríguez O, Rodríguez-Arce J, Parra-Rodríguez L. Portable electronic device to assess the human balance using a minimum number of sensors. Biomed Phys Eng Express. 2020;6(1):015027.
17. Visser JE, Carpenter MG, van der Kooij H, Bloem BR. The clinical utility of posturography. Clin Neurophysiol. Nov 2008;119(11):2424-36. doi:10.1016/j.clinph.2008.07.220
18. Johansson J, Nordstrom A, Gustafson Y, Westling G, Nordstrom P. Increased postural sway during quiet stance as a risk factor for prospective falls in community-dwelling elderly individuals. Age Ageing. Nov 1 2017;46(6):964-970. doi:10.1093/ageing/afx083
19. Wisniowska-Szurlej A, Cwirlej-Sozanska A, Wilmowska-Pietruszynska A, Sozanski B. The use of static posturography cut-off scores to identify the risk of falling in older adults. Int J Environ Res Public Health. May 26 2022;19(11)doi:10.3390/ijerph19116480
20. Thiamwong L, Xie R, Park J-H, Lighthall N, Loerzel V, Stout J. Optimizing a technology-based body and mind intervention to prevent falls and reduce health disparities in low-income populations: protocol for a clustered randomized controlled trial. JMIR research protocols. 2023;12(1):e51899.
21. Levy SS, Thralls KJ, Kviatkovsky SA. Validity and reliability of a portable Balance Tracking System, BTrackS, in older adults. J Geriatr Phys Ther. 2018;41(2):102-107. doi:10.1519/jpt.0000000000000111
22. SPPB Guide. Novartis Pharmaceuticals Corporation. 2021.
23. Goble DJ, Baweja HS. Normative data for the BTrackS Balance Test of postural sway: Results from 16,357 community-dwelling individuals who were 5 to 100 years old. Phys Ther. Sep 1 2018;98(9):779-785. doi:10.1093/ptj/pzy062
24. Banarjee C, Suarez JRM, Lafontant K, et al. Multimodal factors affect longitudinal changes in dynamic balance in community-dwelling older adults. Clin Interv Aging. 2025:335-348.
25. Suarez JRM, Lafontant K, Blount A, Park J-H, Thiamwong L. Recreating Fall Risk Appraisal matrix using R to support fall prevention programs. JAMIA open. 2024;7(3):ooae088.
26. Harris PA, Taylor R, Minor BL, et al. The REDCap consortium: Building an international community of software platform partners. J Biomed Inform. Jul 2019;95:103208. doi:10.1016/j.jbi.2019.103208
27. Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. Apr 2009;42(2):377-81. doi:10.1016/j.jbi.2008.08.010
28. The jamovi project. Version 2.5.6. 2023. https://www.jamovi.org
29. Baratloo A, Hosseini M, Negida A, El Ashal G. Part 1: Simple definition and calculation of accuracy, sensitivity and specificity. Emerg (Tehran). Spring 2015;3(2):48-9.
30. Pettersson B, Nordin E, Ramnemark A, Lundin-Olsson L. Neither Timed Up and Go test nor Short Physical Performance Battery predict future falls among independent adults aged >/=75 years living in the community. J Frailty Sarcopenia Falls. Jun 2020;5(2):24-30. doi:10.22540/JFSF-05-024
31. Power V, Van De Ven P, Nelson J, Clifford AM. Predicting falls in community-dwelling older adults: a systematic review of task performance-based assessment tools. Physiother Pract Res. 2014;35:3-15. doi:10.3233/PPR-130027
32. Ashley MJ, Gryfe CI, Amies A. A longitudinal study of falls in an elderly population II. Some circumstances of falling. Age Ageing. 1977;6(4):211-220. doi:10.1093/ageing/6.4.211
33. Lauretani F, Ticinesi A, Gionti L, et al. Short-Physical Performance Battery (SPPB) score is associated with falls in older outpatients. Aging Clin Exp Res. Oct 2019;31(10):1435-1442. doi:10.1007/s40520-018-1082-y
34. Hauer K, Lamb SE, Jorstad EC, Todd C, Becker C. Systematic review of definitions and methods of measuring falls in randomised controlled fall prevention trials. Age Ageing. 2006;35(1):5-10. doi:10.1093/ageing/afi218
35. van Gameren M, Voorn PB, Bossen D, et al. The Short Physical Performance Battery does not correlate with daily life gait quality and quantity in community-dwelling older adults with an increased fall risk. Gait Posture. 2024/10/01/ 2024;114:78-83. doi:https://doi.org/10.1016/j.gaitpost.2024.09.005
36. Lafontant K, Blount A, Suarez JRM, et al. Comparing sensitivity, specificity, and accuracy of fall risk assessments in community-dwelling older adults. Clin Interv Aging. 2024;19:581-588. doi:10.2147/CIA.S453966
37. Montero-Odasso M, van der Velde N, Martin FC, et al. World guidelines for falls prevention and management for older adults: a global initiative. Age Ageing. Sep 2 2022;51(9)doi:10.1093/ageing/afac205
38. Shumway-Cook A, Brauer S, Woollacott M. Predicting the probability for falls in community-dwelling older adults using the Timed Up & Go Test. Phys Ther. Sep 2000;80(9):896-903.
39. Brodie MA, Coppens MJ, Ejupi A, et al. Comparison between clinical gait and daily-life gait assessments of fall risk in older people. Geriatr Gerontol Int. Nov 2017;17(11):2274-2282. doi:10.1111/ggi.12979
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Apr 29, 2025
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Accuracy of Physical Function-based Fall Risk Assessments Among Community-Dwelling Older Adults: An ROC Analysis: Original Research. (2025). Research in Health and Medicine, 5(1). https://doi.org/10.53520/rdhs2025.104142
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Author Biographies
Estefania Zamarripa, Institute of Exercise Physiology and Rehabilitation Science; College of Nursing, University of Central Florida, Orlando, FL, USA
Kinesiology Undergraduate Research Assistant
Kworweinski Lafontant, Institute of Exercise Physiology and Rehabilitation Science; College of Nursing, University of Central Florida, Orlando, FL, USA
Kinesiology PhD Student
David H. Fukuda, Institute of Exercise Physiology and Rehabilitation Science, University of Central Florida, Orlando, FL, USA
Professor of Kinesiology
Jeffrey R. Stout, Institute of Exercise Physiology and Rehabilitation Science; College of Nursing; Disability, Aging, and Technology Cluster, University of Central Florida, Orlando, FL, USA
Professor of Kinesiology
Ladda Thiamwong, College of Nursing; Disability, Aging, and Technology Cluster, University of Central Florida, Orlando, FL, USA
Professor of Nursing