Clinical prediction of falls in the elderly

Objective: To assess the ability of physical and occupational therapists engaged in rehabilitation of the elderly to predict posttreatment falls. Design: Prospective cohort study of 15 mo in duration at an urban academic medical center rehabilitation unit. A total of 165 consecutively admitted geriatric individuals were rated for fall risk by 14 physical and seven occupational therapists. Measurements included the Mini-Mental State Examination, Geriatric Depression Scale, FIM(TM), and therapists' ratings of fall likelihood. Results: Both disciplines evidenced an ability to predict who would fall in the 3 mo after discharge. Clinical judgment regarding fall risk, however, added little value over two major predictors of future falls, fall history and the presence of a neurologic condition. Conclusion: Trying to predict an infrequent future event such as falls is inherently difficult. Education regarding known fall-risk factors and inclusion of standardized measurements of physical status are recommended to potentially improve rates of detection, along with adoption of a realistic attitude regarding our abilities to forecast infrequent events.