Equipment-free fall-risk assessments for the functionally independent elderly: A systematic review and meta-analysis

Falls are the leading causes of unintentional fatal injury occurring in the elderly worldwide. Various functional variables of instrumental tests have been used to evaluate the risks of falls. However, such tests are usually difficult to perform in the elderly and limited to environmental conditions. This study was to review whether the simple and equipment-free assessments could efficiently identify the functionally independent elderly to be fallers or non-fallers. PubMed and Scopus electronic databases systematically searched before March 2020 were included in this review. Studies were selected if they focused on the elderly aged over 65 years who can walk without assistance, adopted assessments without the need for equipment, and reported quantified assessment variables. The significance testing, sensitivity, specificity, receiver operating characteristics were evaluated. The quantitative data possible for meta-analyses were pooled to calculate the 95% confidence interval and heterogeneity among studies. Fifteen studies were selected for systematic review, of which nine were for meta-analysis. Ten assessment tests were identified. Seven of them revealed a significant difference (generally p < 0.05) between the fallers and non-fallers but did not come with high sensitivity or specificity. Three conclusive assessment tests to identify the fall risks through the meta-analysis were the alternate step, functional reach, and tandem stance tests. In conclusion, although most assessment tests demonstrated a significant difference between the fallers and non-fallers, the performance of tests for predicting fallers was less promising. The alternate step, functional reach, and tandem stance tests could be evidenced as reliably tests used in clinics or communities.