Falls in the elderly: How to assess their balance Part 2

The next part of these series of blogs for the elderly is another type of test that does not involve walking.

It is called the Four Test Balance Scale. A study done by Melinda Gardner, David Buchner, M. Clare Robertson and A. John Campbell from the Journal Age and Ageing 2001: 30: 77-83, Titled Practical implementation of an exercise-based falls prevention programme, showed how to do this test.

It requires an individual to stand on 4 different foot positions of increasing difficulty without an assistive device. The one being assessed can be helped out to assume the position but no help can be provided once the test starts per position.

The sequence of the tests are:
1. Standing Feet together
2. Standing Semi-tandem (one foot is halfway in front of the other but still close together)
3. Standing Tandem position (one foot is in front of the other with the heel of the front foot touching the toe of the back foot)
4. One leg standing (One tested chooses which leg to stand on)

Picture reference was taken from the Journal mentioned above. Click on the link. (PDF file)
Each test should be completed for at least 10 seconds. Inability to assume or maintain that position is equivalent to a failed test stage. The one being tested should also be on bare feet.

Unlike the initial Timed "Up and Go" test which includes walking, this test is only done in a standing position. Again this give you an idea if your elderly love one already has possible problems in balance that need to be assessed by your family physician or your Physical Medicine and Rehabilitation Specialist.

For those who like to view a video of this test, it can be seen at Vimeo. However I believe it is in German language but at least you know how it is done.

Falls in the Elderly: How to Assess their Balance Part 1

Last August 2011, I was asked to give a short seminar on fall prevention in the elderly by Home Health Care. It gave me a chance to provide information on helping the allied medical and medical audience together with caregivers on taking care of the elderly. So to start this set of blogs, I initially asked myself, if I am taking care of someone in this age group, how can I know if he or she has problems in balance or mobility?

George F. Fuller, COL, MC, USA from White House Medical Clinic, Washington D.C. provided an article under American Family Physician that one way to screen the elderly is by noting if they have a history of fall within the last 6 months. If an elderly has more than 2x of occurrence of fall within 6 months an evaluation is warranted for any possible underlying problem. This may already denote a declining physical and physiological status.

Now if you like to test the mobility of an elderly, an easy way to do it is the Timed "Up and Go" Test. Wherein an individual is timed from doing this test. The patient sits on a standard armchair, stands up and walks for 3 meters (10 feet), turns around and return to a sitting position.


The individual is freely mobile if done in < 10 seconds; mostly independent if done within 11 to 20 seconds; Variable mobility if within 20 to 30 seconds and Impaired mobility if > 30 seconds. This will help you gauge if your elderly patient or love one has impaired mobility already.

Reference for Timed "Up and Go" Test is found on Table 6 of the link from Sir George Fuller's article under American Family Physician. (Click on the link above)

Next topic will be another way to test standing balance.