🧭 Risk of falls: how to assess it simply in clinical practice?

🔎 Introduction
The risk of falls is a major concern in prevention, rehabilitation, and primary care, particularly for older adults.
Every year, millions of patients fall, sometimes with serious consequences for their independence, quality of life, and even mortality.
But how can this risk be assessed quickly, without requiring numerous lengthy or time-consuming assessments?

👉 This article offers a clear synthesis of clinical methods for screening and monitoring fall risk, based on current data from the literature.

Why assess the risk of falling?

• More than 2 million falls per year among people over 65
• Net increase after 75–80 years
• Strong association with:
  • loss of strength
  • balance disorders
  • fear of falling
  • nervous breakdown
  • chronic comorbidities

👉Early detection allows action to be taken before a fall.

The risk of falling: a multifactorial problem

The risk of falling is never linked to a single factor.

It combines:

• physical factors (strength, balance, mobility)
• functional factors (transfers, stairs)
• psychological factors (fear of falling, confidence)
• Contextual factors (environment, polypharmacy)

👉 Hence the importance of simple but targeted tests. What clinical tests can be used to screen for the risk of falls?

What clinical tests are needed to screen for the risk of falls?

In practice, some tests are particularly relevant:

• Timed Up and Go (TUG)
• 5x Sit-to-Stand (5xSTS)
• Single-leg balance
• Walking speed
• Four Square Step Test (FSST)

These tests are:

• quick
• validated
• easy to reproduce
• suitable for the office, home or facility

👉 They allow for effective initial screening.

Screening vs. follow-up: a key distinction

Not all tests serve the same purpose:

• Some are excellent at identifying a risk
• Others are better suited for tracking over time

Reliability (test-retest, ICC) is a key criterion for:

• to objectify progress
• adjust the support
• document the results

👉 A relevant assessment often combines several tools.

And what about the questionnaires?

Some questionnaires do not directly assess falls, but:

• the fear of falling
• depression
• fragility
• health perception

These dimensions play a major role in the actual risk of falling.

Towards a comprehensive and structured approach

The recommendations converge towards:

1. a simple screening
2. a targeted functional assessment
3. the identification of associated factors
4. an individualized plan

👉 This is the logic that guides modern clinical tools.