A mobility screen test allows the observer to see an elder's level of mobility and develop a fall risk score. Fall risk scores can help pinpoint elders who are at risk for falls and illustrate where fall prevention interventions can make a big difference.
Instructions for mobility screen test:
- Ask elder to perform the following maneuvers and score each maneuver. If elder uses cane or walker, allow him/her to use device during maneuvers.
- Fall risk score is calculated as follows: Low fall risk (all maneuvers are normal); "at risk for falls" (one or more adaptive or abnormal maneuvers).
Maneuvers:
| Maneuver | Normal | Adaptive | Abnormal |
| Sitting Balance Ask elder to sit comfortably in straight-backed chair. |
Steady, stable |
Holds onto chair to keep upright Leans or slides down in chair. |
|
| Rising Balance Ask elder to rise from chair, without use of armrest support. |
Able to rise without using armrests. | Needs armrests or walking aid to rise and/or moves forward in chair before rising. | Multiple attempts required or unable to rise without human assistance. |
| Standing Balance- Eyes Open Ask elder to stand still for 3-5 seconds. |
Steady, able to stand without support. | Steady but needs walking aid or other object for support. | Any sign of unsteadiness. |
| Standing Balance-Eyes Closed Ask elder to remain standing with eyes closed for 3-5 seconds |
Steady, able to stand without support. | Any sign of unsteadiness. | |
| Walking Balance Ask elder to walk straight path (10 feet). |
Walks without hesitation, deviation of straight path or shuffling gait. | Any sign of hesitation, path deviation or shuffling gait. | |
| Turning Balance Ask elder to turn around and return back to the chair. |
Steady, no staggering or need to hold onto objects/furnishings for support. | Any sign of unsteadiness or holding onto objects/ furnishings for support. | |
| Sitting Balance Ask elder to sit back down in the chair. |
Able to sit down without using armrests. | Needs to use armrests to guide self into chair | Plops into chair or unable to sit down without human assistance. |
(*) Adapted from: Tinetti ME. Performance-Oriented Assessment of Mobility Problems in Elderly Patients. JAGS 1986; 34:119-126; and Tideiksaar R. Falls in Older Persons (3rd Edition). Health Professions Press, pg 177.
This and other helpful fall risk assessment tools are available as a printable pdf file.
Posted October 2005
Last Updated October 2009
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