Publication Date

5-1-2009

Degree Type

Master's Project

Degree Name

Master of Science (MS)

Department

Nursing

First Advisor

Diane Stuenkel

Second Advisor

Karen Ketner

Abstract

Falls represent a sizeable public health issue that has serious health-related consequences for both the individual and the medical system at large. Falls are one of the most common events that threaten the independence of older persons with one third of falls occurring in persons over the age of 65 and over 50% in persons over the age of 80 years (2). During an office appointment, senior adults are screened routinely for blood pressure, weight, medication adherence and lab result follow-up. One assessment that is commonly overlooked is evaluating seniors for fall risk. The purpose of this study was to explore the use of the "Get Up and Go" test (GUGT) as a routine screening measure for community dwelling seniors. The research questions addressed were: 1) Is self-reported fall history related to GUGT scores in community dwelling seniors? 2) Is age related to the GUGT scores for a sample of community-dwelling seniors?; and 3) Is age related to self-reported fall history for a sample of community-dwelling seniors? Recruitment of community-dwelling seniors occurred during a 3-month period at a primary care office setting in the urban San Francisco Bay area. A convenience sample of community-dwelling seniors (N=39) were recruited to participate in the study. All participants were age 65 or older, did not have a history of cognitive or neurological deficits, and were able to ambulate without the use of an assistive device such as a cane, walker or wheelchair. Participants reported fall occurrences for the last 12 months and performed the GUGT. This study did not find statistical relevance between GUGT pass or fail status and fall history. Two groups of participants are of particular interest. Nine participants with a positive fall history were able to pass the GUGT and 8 seniors who reported no fall history failed the GUGT. Consistent with previous studies (12), one fall does not necessarily signify musculoskeletal or neurological deficits and is usually related to environmental hazards. Furthermore, previous studies have shown that a single fall report is a poor predictor of fall risk and that the number of reported falls by patients is not a reliable number due to the patient under-estimating or under-reporting fall occurrences. These findings suggest that fall history may not be a sensitive measure capable of identifying all at risk seniors. Thus if only fall history is used to identify risk, then some at risk community-dwelling seniors will not be identified while others may be identified by fall history but do not exhibit mobility deficits. The relative ease in which the GUGT was performed, with minimum cost, strengthens the position that the GUGT should be performed as part of an annual examination for patients who are over the age of 65. The GUGT results can then become the "sixth vital sign" for patients over the age of 65 with the initial GUGT result establishing baseline results for future patient fall risk evaluation. Given this evidence, it can be concluded that at the very least, both fall history and the GUGT test should be performed annually on community-dwelling seniors over the age of 65.

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