Table 4.

Potential measurement instruments and approaches for multifactorial falls risk assessment

Domains for assessment	Fall risk factor	Measurement/approach
Mobility	Balance	Screen for balance disorders for example by Tandem Stand, One Leg stand. If indicated, perform full assessment in structured manner, for example by Berg Balance Scale, Tinetti test, POMA (subscale balance), Mini-BEST test. Consider referral to physiotherapist.
	Gait	Assess both qualitatively and quantitatively using 4-m walking length (<0.8 m/s), POMA (subscale gait), Dual Task test, Functional Gait Assessment. Screen for mobility problems using a structured approach for example by Short Physical Performance Battery (SPPB), Timed Up and Go (TUG), Get Up and Go including qualitative assessment).
	Muscle strength	Screen quantitatively using for example CST or handgrip strength If indicated assess structurally specific muscle groups (MRC-scale)
	Walking aid	If applicable, assess for appropriateness and proper of use of walking aid including potential mechanical deficits.
	Footwear and foot problems	Screen for potential inappropriate footwear (including bare footedness) Assess for potential foot problems. Consider referral to podiatrist.
	Fear of falling	Assess Fear of (concerns about) Falling, preferably in structured manner, for example by Falls Efficacy Scale (FES-I) or short FES-I If indicated: assess for anxiety disorder, preferably by HADS. Consider referral to specialist.
Sensory function	Dizziness/vestibular	Screen with history taking and on indication perform Dix-Hallpike, Head Impulse Test. Consider referral to ENT/ORL specialist.
	Vision	Assess subjective vision problems (history taking). Objective assessment of visual problems and acuity and appropriate use of glasses (including check multi−/bifocal glasses) If indicated, refer to ophthalmologist or optometrist
	Hearing	Assess subjective hearing problems (history taking). Objective assessment of hearing problems. If indicated, refer to audiologist or ENT/ORL specialist.
Activities of daily living	Functional ability	Assess Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) in structured manner, preferably by modified Katz (community dwellers) or NEADL or Barthel (personal care, also suitable for care home residents)
Cognitive function	Cognition	Screen for cognitive disorders including executive functioning for example by using clock drawing test or Montreal Cognitive Assessment (MoCA) or Trail Making Test Part B (TMT-B). If indicated, further assessment and additional testing, e.g. full neuropsychological test battery.
	Delirium	Assess presence of delirium, preferably structured by, e.g. 4AT Delirium Assessment Tool (4AT), Delirium Observation Screening Scale (DOS) or Confusion assessment method (CAM), with clinical judgement.
	Behaviour	Assess behaviour, preferably structured.
Autonomic function	Orthostatic Hypotension	Measure blood pressure first supine (after minimum of 5 minutes of bed rest) and repeatedly upon standing. Preferably continuously, or alternatively at 1 minute intervals up to minimal 3 minutes and optimally 5 minutes , check for symptom recognition.
	Urinary incontinence	Assess with the 3IQ screening test. Additional testing and/or referral to urologist/gynaecologist.
Disease history	Cardiovascular disorders	Assess by focused history taking about cardiovascular symptoms, history of cardiovascular disease, focused cardiovascular physical examination, measurement of orthostatic hypotension (see below for details), 12-lead surface electrocardiogram. If indicated, further assessment (may include tilt table testing including carotid sinus massage, ambulatory rhythm monitoring and/or blood pressure monitoring). Consider referral to cardiologist or syncope specialist.
	Contributing diseases/atypical disease presentation	Perform a clinical geriatric assessment (history taking, physical examination, laboratory measurements, additional testing when indicated) with specific attention towards diabetes mellitus, osteoarthritis, neurological disorders including PD, polyneuropathy and stroke, cardiovascular diseases (see above), cognition (see above), depressive disorders (see below), delirium, anaemia, electrolyte disorders, thyroid disease, frailty, sarcopenia and fracture risk (osteoporosis). Assess for potential atypical disease presentation of acute conditions such as pneumonia, especially in acute care setting.
	Parkinson Disease	Assess mobility problems (gait and balance control, strength, see above) including FOG, cognition including dual tasking (DT) (see above) and orthostatic hypotension (see above).
	Depressive disorders	Screen for depressive disorder (minimally 2 screening questions) for example by Geriatric Depression Scale (GDS). Consider referral to specialist.
Medication history	Medication	Perform a structured medication review that entails considering deprescribing of psychotropic, cardiovascular and other FRIDs, for example by applying STOPPFall or STEADI instrument.
Nutrition history	Nutritional status	Screen for malnutrition for example by MNA, Malnutrition Universal Screening Tool (MUST), Malnutrition Screening Tool (MST); for obesity; for sarcopenia (including sarcopenic obesity); for vitamin deficiencies (vitamin D see below; vitamin B1, B12, folic acid) and for substance abuse as well as light-moderate alcohol use.
	Vitamin D	Assess vitamin D status in community dwellers based on local guidelines. If at high risk for deficiency (care home residents, home bound) measurement is not indicated as standard supplementation applies.
Environmental risk	Environment	Recommended assessment tools for hazards are Westmead Home Safety Assessment and the Falls Behavioural Scale for the Older Person. In LMIC non-occupational therapists and self-administered home hazard assessment checklists are available