Guide to strength and balance service assessment tools

The patient prompt 'falls risk threshold' is loaded into BPAC to help identify suitable patients for strength and balance services.

Outcome Taranaki

For those patients who require:

• mobility assessment, please refer to TDHB Community Physiotherapy via Best Practice
• assessment for aids in their homes, please refer to TDHB Occupational Therapy via Best Practice
• assessment for domestic support and personal cares, please refer to TDHB Community Support Services via Best Practice.

If your patient has had a fall they can be referred to Habit Health for support under ACC programmes including Training for Independence, Training for Independence Advisory Short Term, Social Rehab Needs Assessment, Single Discipline. 

• Community strength and balance programme: e-referral to Green Prescription.

Outcome Tairāwhiti

• In-home falls prevention programme: e-referral to Sport Gisborne.
• Community strength and balance programme: e-referral to Enliven.

Does the patient fit the following criteria?

Age of patient is:

• 65 years and over, Māori, Pacific and Asian
• 75 years and over, other ethnicity
• Considered medically "like for age".

Is the patient in aged residential care? Yes/No. If 'Yes' proceed no further. 

If 'No' ask the following four questions.

• Have you slipped, tripped or fallen in the last year?
• Have you had to use your hands to get out of a chair?
• Have you had to stop doing some activities because you are afraid you might lose your balance?
• Do you worry about falling?

If you identify that the patient is suitable for strength and balance services, next complete the following falls risk assessment (a funded action)

Significant neurological condition

Patients with a significant neurological condition (such as Parkinsons, MS, CVA with weakness, are not eligible for strength and balance programmes).

Timed up and go

Patients aged 65 years and older who take more than 12 seconds to get up from a chair and walk 6 metres are 'at risk of falling'.

Tandem stand

Patients aged 65 years and older who cannot hold the tandem stance for at least 10 seconds are at 'increased risk of falling'.

If you feel the patient may be unstable and at a high risk of falling, or if you are unable to safely catch them, you may choose to avoid these tests.

• A patient who fails either one of the above tests and needs assistance with personal cares, or is dependent on a walking aid or has no or a mild cognitive deficit (6CIT) is suitable for referral to in-home strength and balance.
• A patient who fails either one of the above tests and is independent with personal cares, and is not dependent on a walking aid and has no cognitive deficit (6CIT) is suitable for referral to community strength and balance.

Complete 6CIT

Patients with moderate or significant cognitive deficit measured by 6CIT are not eligible for strength and balance programmes.

Falls risk assessment

Assess the following...

• Feels unsteady when standing or walking.
• Acute and /or chronic medical conditions impacting on falling.
• Medication potentially impacting on falling including OTC drugs.
• Postural hypotension.
• Any dizziness.
• Problems with heart rate or rhythm.
• 6CIT.
• Kessler 10.
• Continence issues.
• Abnormal gait.
• Feet in poor condition and/or abnormal sensation.
• Visual acuity<6/12 or no eye exam in >1 year.
• Hearing impairment.
• Risk of Vit D deficiency.
• Nutrition concerns.

Refer to GP for extended consult and/or instigate other referrals as appropriate.

Outcome Taranaki

• Community strength and balance programme.

Outcome Tairāwhiti

• In home falls prevention programme.
• Community strength and balance programme.