falls among the elderly constitute a significant health problem , as approximately every 
 third person over 65 and every second individual over 85 falls at least once a year1 , 2 . 

the multi - disease phenomenon may significantly negatively affect functional dexterity in the 
 elderly and result in gait and balance impairment .
various consequences of somatic diseases , 
 combined with reduced dexterity and physical activity , influence the quality of life in 
 older adults , especially those who have already lost independence for activities of daily 
 living ( adl ) , and are residents of nursing homes .
their independence is usually lower and 
 they belong to the group at high risk of falling .
thus , fall risk assessment should include 
 various tests for static and dynamic balance .
the physical and functional consequences of falls ( fractures , soft tissue injury , premature 
 institutionalization , and death ) have been well documented .
long - term consequences may 
 include loss of independence , restriction of physical activity , lowered quality of life , 
 increased social isolation , or depression3 , 4 .
fear of falling affects psychological 
 well - being and constitutes an independent risk factor for reduced mobility and lowered 
 quality of life5 .
numerous methods have been developed to evaluate balance and risk of falling among older 
 adults , including the timed up and go ( tug ) test , tinetti performance oriented mobility 
 assessment ( poma ) test , berg balance test ( bbs ) , and one - legged stance test ( olst ) .
these 
 tests assess various parameters , especially standing balance , stepping ability , general 
 function , reaction time , lower limb strength , dual tasking , gait variability , gait cadence , 
 and vision ( visual acuity , contrast , and field)6 .
they may also identify those at risk of falling who require 
 lifestyle interventions , including exercises and home environment safety modifications7 , 8 .
a 
 physiotherapist , as a member of the geriatric team , should implement adequate preventive and 
 therapeutic measures .
the aim of the study was to determine which gait and balance tests generated the most 
 reliable results for assessment of risk of falling , based on the number of falls over the 
 last 12 months .
the study was conducted in accordance with the 
 declaration of helsinki and the local ethics committee approved the study protocol ( no . 

this study was conducted in 5 nursing homes in poznan , poland . out of 400 
 individuals ( aged > 65 )
, a group of 153 residents who were able to walk a distance of 3  m 
 unaided or using orthopedic equipment ( i.e. , performed the tug test ) and scored > 18 
 points on the mini - mental sate examination ( mmse ) were identified .
patient characteristics 
 are presented in table 1table 1.patient characteristicscharacteristicsmalefemalenumber of patients 31122age ( years)mean  sd73.0  8.077.6  8.1median ( range)72 ( 6581)77 ( 6594)educationprimary school ( completed 7 years)639vocational school ( completed 3 years)1414high school ( completed 4 years)755university degree ( completed 5 years)414number of diseasesdegenerative disease1476stroke411hypertension1659osteoporosis27diabetes mellitus 517ischemic heart disease 646visually impaired316others1586number of medicationsmean  sd3.2  3.42.7  3.7median ( range)1 ( 09)1 ( 014)barthel scale ( points)mean  sd96.2  6.489.8  13.2median ( range)100 ( 85100)95 ( 45100)mmse score ( points)mean  sd25.4  2.826.5  3.1median ( range)25.5 ( 1930)27
( 1930)number of falls over the last 12 monthsmean  sd1.03  1.61.01  1.7median ( range)0 ( 06)0 ( 08 ) .
comprehensive geriatric assessment was performed in 153 subjects to determine 
 the program of rehabilitation .
various scales were used , including the barthel scale to 
 measure adl performance , ( 020 points : very dependent , 2185 : moderately dependent , 86100 : 
 independent)9 .
the mmse was used to 
 evaluate cognitive function10 , which in 
 older adults aids in design of the physiotherapy treatment .
the scale assesses 5 areas of 
 cognitive function : orientation , registration , attention and calculation , recall , and 
 language .
tests to predict the risk of falling have been used to evaluate balance in the elderly ; for 
 example , tug assesses proactive balance .
the patient is instructed to rise from the chair 
 ( approximate seat height of 46  cm ) , walk at a comfortable and safe pace to a line on the 
 floor 3  m away , then turn and walk back to the chair and sit down again .
patients should wear their usual 
 footwear and may use their customary walking aid ( cane or walker ) , if necessary11 .
a score of < 10  s is normal , 1120 s 
 signifies subjects with frailty syndrome or slight disability , and a score of > 20  s 
 indicates that the individual requires a significant amount of help from others while 
 walking , and usually heralds the need to implement an intervention . a tug score of 13.5 
poma consists of 2 parts for assessment of balance and gait , and 
 is frequently used to evaluate balance in elderly populations .
scores of 2619 reveal the presence of a problem , which might 
 lead to a fall , whereas a score of 2628 is normal12 .
it consists of 14 
 items , with a maximum total score of 56 points .
bbs scores have been identified for the ability to walk without an 
 aid ( 49/56 points ) and the ability to walk without a 4-wheeled walker ( 43/56 points)14 .
steady - state balance may also be 
 evaluated with the use of olst , which is used as a screening method to determine balance 
 impairment in elderly populations . the person is instructed to stand on one leg without 
 support of the upper extremities .
the maximum test time is 30 s. in this study , the participants were instructed 
 to keep their eyes open .
normal ranges with the eyes open are : 6069 years : 22.5  8.6 s , 
 and 7079 years : 14.2  9.3 s15 .
gehlsen 
 and whaley demonstrated that people who fall usually score lower on this test , whether with 
 the eyes open or closed ( 10.9  s vs. 18.7  s , p<0.001 , and 3.6  s vs. 5.2  s , p<0.05)16 . in this study ,
the results were analyzed 
 according to the number of falls during the last 12 months .
quantitative variables are presented as mean and standard deviation . due to the 
 non - parametric distribution of some variables , median and range of parameters
were taken 
 into account . the mann - whitney test , spearman s rank correlation coefficient , and the deming 
 linear regression ( because parameters were in different units : points and seconds ) were used 
 in the analysis
the results of the tests are presented in table 
 2table 2.gait and balance assessmentparametersresultsfallersnon- fallersage ( years)mean76.67  8.3 78.7  7.975.2  8.3 * median 76.57974range6594   6594 6591 tug ( sec)mean18.6  9.3 20.75  9.2 16.5  9.1 * median 161614range552 548052poma ( pts)mean20.4  5.7 19.1  5.7 21.4  5.4 * median 222023range428428828bbs ( pts)mean41.3  12.738.9  13.443.1  11.9 * * median 454446range056056456olst ( sec)mean5.3  7.83.5  6.06.6  8.6 * * median 204range030027s030sn=71 , * p<0.01 , * * p<0.05 . out of 153 subjects ,
only 46% were deemed eligible for the olst test . deming 
 linear regression ( n=153 ) revealed statistically significant correlations between the number 
 of falls , longer results for tug r=0.27 ( p<0.001 ) , and lower scores for poma r=0.24 
 ( p<0.001 ) and olst r=0.17 ( p<0.01 ) .
table 
 3table 3.correlation between number of falls in males and females , age and tests 
 results genderage ( years)tug ( sec)poma ( pts)bbs ( pts)olst ( sec)male ( n=31)r=0.5046*r=0.5627**r=0.3739***r=0.3450r=0.4027***female ( n=122)r=0.1811***r=0.2393*r=0.2294***r=0.1380r=0.1314*p<0.01 , * * p<0.001 , * * * p<0.05 presents results after the study group was subdivided according to gender .
a 
 statistically significant correlation between age and the number of falls in males 
 ( p<0.01 ) and females ( p<0.05 ) was detected with spearman s correlation .
a high 
 correlation was also found between the number of falls and both longer tug results ( males 
 p<0.001 , females p<0.01 ) and lower poma scores ( males p<0.05 , females p<0.05 ) . 

no correlation was found between gender and the bbs score , whereas results of the olst test 
 correlated with gender only in the case of males ( p<0.05 ) .
n=71 , * p<0.01 , * * p<0.05 * p<0.01 , * * p<0.001 , * * * p<0.05
based on the results , the evaluation of balance in fallers and non - fallers among elderly 
 residents of nursing homes showed that all tests , i.e. , tug , poma , bbs , and olst , enabled 
 adequate assessment of balance and identification of patients in need of interventions to 
 prevent falls . in nursing homes , it is essential to apply tests that will identify people 
 who need services to prevent falls .
the olst was least useful , as it could only be conducted 
 in 46% of the subjects .
the difference between fallers and non - fallers was statistically 
 significant in a comparison of tug ( p<0.01 ) and poma ( p<0.01 ) results . for bbs and 
 olst ,
a difference was present at a level of significance of p<0.05 . compared with 
 non - fallers , tug ,
poma , bbs , and olst scores in fallers were 4.25  s longer , 2.3 points 
 lower , 4.2 points lower , and 3.1  s shorter , respectively .
also evaluated 
 balance in fallers vs. non - fallers , but used bbs and computerized dynamic posturography 
 ( cdp ) .
the bbs and cdp results in fallers were significantly lower compared to 
 non - fallers17 .
this study confirmed that the risk of falling increases with age in both males and females 
 over 65 .
nakano et al . demonstrated that female patients in their 70s show a significant 
 decline in functionality , i.e. , physical performance and balance , as compared to their male 
 peers .
older females display greater loss of muscle mass and muscle strength , which 
 predisposes to frailty syndrome18 . 

duckham et al . showed that males over 65 had significantly greater rates of outdoor falls 
 while engaging in recreational or vigorous activities . in turn , older females tended to have 
 significantly higher rates of indoor falls , which more often proved to be injurious19 .
this study found a correlation between 
 the number of falls in the 12 months before the study and the score for the tug test 
 ( p<0.001 ) , followed by poma ( p<0.001 ) and olst ( p<0.01 ) .
king et al . investigated 
 patients with parkinson s disease , who might have difficulty turning over , and also found 
 tug to be superior to poma and bbs20 .
on 
 the other hand , chiu et al . compared 4 functional tests , i.e. , bbs , poma , the elderly 
 mobility scale ( ems ) , and tug , in fallers and non - fallers and concluded that bbs proved to 
 be the most reliable in discriminating between fallers and non - fallers21 .
some authors are of the opinion that standing balance is 
 only one of the myriad competencies that contribute to an individual s ambulatory ability . 

bbs evaluates the dynamic aspects of balance , and thus it could be used to influence 
 decisions about an individual s ambulation status or serve as targets for intervention 
 strategies13 , 14 .
regardless , bbs should be combined with other balance tests in 
 patients after stroke13 .
sibley et al . 
 showed that in canada 70% of physiotherapists use olst and bbs to evaluate balance , whereas 
 tug is used by only 56.9% of physical therapy practitioners , mainly due to lack of time 
 during their work and lack of sufficient knowledge22 .
the use of balance tests in their work also depends on the goal of 
 such an assessment .
tug evaluates the basic level of activity , whereas bbs supplies 
 information about more complex balance - related problems .
barry et al . , in a systematic 
 review and meta - analysis , showed that tug has limited ability to predict falls among 
 community - dwelling older adults , and should not be used alone to identify individuals at 
 high risk of falling23 . on the other 
 hand , zasadzka et al .
the abovementioned 
 tests will enable physiotherapists working with elderly residents of nursing homes to 
 identify individuals who require prophylactic measures to prevent falls , including 
 introduction of exercises that improve gait , balance , muscle strength , and coordination . 
 according to schoene et al .
, sensorimotor training with pneumatic compressors , balance 
 platforms , and diversified exercises , including balance and aerobic exercises , should be 
 included25 .
based on the findings of 
 the present study , it seems advisable to use 2 or more tests to assess the risk of falling 
 in elderly residents of nursing homes . as indicated by the results , tug and poma
are the 
 most useful tools to screen for balance and gait impairment in this population .
 [ purpose ] the risk of falls in the elderly is an important 
 public health problem . 
 suitable tests may help detect those at risk of falling . 
 this study 
 determined which balance test for older adults generates the most reliable results in 
 terms of fall risk assessment , based on the number of falls over the last 12 months . 
 
 [ subjects and methods ] a total of 153 individuals ( 31 males , 122 females , aged 76.67  
 8.3  years ; median 76.5 , range 6594 ) were investigated . 
 the subjects were subdivided 
 between fallers ( a fall over the last 12 months ) and non - fallers ( no falls over the last 
 12 months ) . 
 all participants were assessed with the following : barthel scale , mini - mental 
 state examination , timed up and go , tinetti performance - oriented mobility assessment ) , 
 berg balance test , and one - legged stance test . [ results ] statistically significant 
 differences were detected between fallers and non - fallers in tug , poma , bbs , and olst 
 scores . 
 the number of falls correlated positively with the results for tug , poma , and 
 olst . 
 [ conclusion ] tug and poma were the most useful screening tests for balance and gait 
 impairment in elderly nursing home residents . 
 two or more tests should be performed for 
 more precise assessment of the risk of falling . 
INTRODUCTION
SUBJECTS AND METHODS
RESULTS
DISCUSSION