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Information Reviewed: A Review of Balance Instruments for Older Adults
Author(s): S.L. Whitney, J.L. Poole, and S.P. Cass
Source: The American Journal of Occupational Therapy 52(8), 666-671
Date: 1998
Type: Journal article

An estimated 50% of adults 65 years of age or older and 40% of adults over age 80 have one or more falls each year. Not only do falls cause injury and lead to loss of independence, they are a leading cause of death in these age groups. Fear of falling, too, often restricts daily living activities. Risk factors for falls include medical conditions, fear of falling itself, poor lighting, loose rugs, slippery surfaces, mobility problems, and others.

Because balance also is a leading risk factor in falls, these researchers reviewed balance tests that may help identify those at risk for falling, but urged others also to look at a person's environment and daily living activities. To be judged, a test had to be developed within the last 10 years, usable in the home or occupational therapy clinic, reliable, valid, inexpensive, and easy to administer. Six tests met the criteria:

  • Berg Balance Scale, a 14-item test that focuses on reaching, bending, transferring, standing, rising, and other functional tasks for a total of 56 points.
  • Clinical Test of Sensory Interaction and Balance, which measures static balance under three visual and two supported tests. This is a clinical version of a more sophisticated test known as the Equitest.
  • Functional Reach Test, which measured the difference in inches between a person's arm length and how forward a person can reach with the shoulder flexed 90 degrees while maintaining a fixed base of support while standing. It also includes reaching to both sides and behind.
  • Tinetti Balance Test of the Performance-Oriented Assessment of Mobility Problems consists of 28 points regarding balance while standing and moving.
  • Timed Up and Go Test measures the time it takes to rise to standing from a chair, walk three meters, turn, walk back to the chair, and sit down.
  • Physical Performance Test measures standing and moving balance, feeding, and writing. Most of the 16 items are timed.

    These tests do not require training to administer and last from one to 15 minutes. Items typically needed for the tests are few, such as a stopwatch, chair, bed, ruler, paper and pen. All tests proved to be valid measures of balance. The Berg, Tinetti, and Physical Performance Test evaluated a variety of balance aspects, while the Functional Reach, Timed Up and Go, and Clinical Test measured more specific balance factors.

    Because balance is an interplay of skeletal, neuromuscular, and sensory systems, one single test may not be able to predict falls. The person's environment and activity patterns should also be examined, too, when trying to measure the risk of falls. #49

    Whitney, S. L., Poole, J. L. , & Cass, S. P. (1998). A review of balance instruments for older adults. The American Journal of Occupational Therapy 52(8), 666-671.

    Keyword: Mobility

    Copyright. The Rehabilitation Research and Training Center on Independent Living.

  • Reviewer: Cindy Higgins

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