Assessing the risk of falling – Knowledge

1. A falls risk assessment answers two questions

A falls risk assessment follows up two questions:

1. Is my risk of falling increased?
2. Why is it increased, and what do I improve to fall less often?

On the second question the assessment gives a useful answer. It finds causes that a treatment can act on.

On the first question it stays imprecise. The figures are in section 6. For your everyday life that has a pleasant consequence: you can start with the most important part right away.

2. We all fall, some of us more often than others

About 30 in 100 people over 65 fall at least once a year [1]. We call this figure your baseline risk.

Every person carries a risk of falling. For some it is higher, for others lower. The risk is spread smoothly across all age groups.

From this follows the most important recommendation in this article. Train strength and balance, even without an assessment. Without training, 100 people aged 60 and over have about 85 falls a year between them. With training it is about 66 falls [19]. This is well researched, based on 59 studies with almost 13,000 people.

What works is balance training that takes you to your limit. Strength training for the legs belongs with it. Plan for three sessions a week over at least twelve weeks [19].

Start without waiting for an assessment appointment. Our guide Preventing falls describes what such a programme looks like.

2.1 Your risk of falling keeps changing

Your risk of falling is a probability. It changes with training, with new glasses, with a bout of flu and with a change to your medication. A test result applies to the day on which you took the test.

3. What the assessment finds on top of that

Training covers strength and balance. Some causes of falls stay out of its reach. That is exactly where an assessment earns its place.

3.1 Your eyes

An untreated cataract raises your risk of falling. After surgery on the first eye the number of falls goes down [1].

Your glasses count too. Varifocal glasses distort the lower field of view. That is exactly where you judge kerbs and steps [1].

One trial gave 606 people who wore varifocals an additional pair of single-vision distance glasses [27]. Those who were regularly active outdoors fell less often with them. Those who went outdoors little fell outdoors more often than before.

A second pair for outdoors therefore suits people who get out a lot. Discuss it with your eye doctor or optician. Have your eyes checked regularly as well.

3.2 Your home

In Switzerland about 127,000 people are injured in a fall at home every year [25].

The Swiss Council for Accident Prevention (BFU) developed a home checklist [25]. Its partners were physioswiss, Rheumaliga Schweiz, Spitex Schweiz, Pro Senectute and the Swiss occupational therapy association. The checklist names the following hazards:

• Objects and cables lying around on the routes you use daily
• Lighting that is too weak, above all on the night-time route to the toilet
• Missing handrails on stairs, ideally on both sides
• Slippery floors, for example freshly mopped or wet patches
• Slippery bathtubs and showers

Such changes work in a targeted way. Among people with an increased risk of falling, 100 people had about 185 falls a year without adaptations. With adaptations it was about 115 falls [26].

Among people without an increased risk the number stayed the same. It was about 132 falls per 100 people a year with and without adaptations [26]. Both results are well researched.

That makes the first question from section 1 worthwhile after all. It decides whether the effort in your home pays off for you.

In the effective studies a professional usually came to the house, often an occupational therapist [26]. They looked at how the person actually moves around their own home.

3.3 These eleven areas belong to an assessment

Where the risk is increased, the guidelines recommend working through all treatable areas systematically [1]:

• gait, balance and muscle strength
• medication, above all sleeping pills, sedatives and mood-altering drugs
• blood pressure lying down and repeatedly while standing
• vision and hearing
• feet, foot pain and footwear
• memory and concentration
• nutrition and vitamin D status
• continence and night-time trips to the toilet
• concern about falling
• the home environment
• bone health and fracture risk

You can have each of these eleven points treated. Work out with your health professional which two or three of them will achieve the most for you.

3.4 When an assessment is particularly worthwhile

Ask for an assessment as soon as one of these three points applies to you [1]:

• You have fallen in the past twelve months.
• You feel unsteady while standing or walking.
• You are afraid of falling.

These three points are also the entry questions used in the international guidelines (section 4.2).

4. Count your falls

The most useful piece of information in the whole assessment comes from you. It costs nothing and takes half a minute. Say how often you fell in the past year.

4.1 The number says more than a tick on a form

Many forms only ask: fallen yes or no. Most of the information is lost that way.

A Swiss study pooled three cohorts with a total of 1,850 participants [17]. It counted the number of previous falls. Its model gives the following numbers of falls per 100 people a year:

• no fall in the past year: about 59 falls
• after 1 fall: about 83 falls
• after 3 falls: about 156 falls
• after 5 or more falls: about 500 falls

These figures say how many falls to expect. The test values in section 6 answer a different question: how likely at least one fall is. So the two figures cannot be set against each other.

The number of your previous falls carries a great deal of information about the number of falls to come. Mobility tests say something about gait, strength and balance. Who will fall in the coming year, they predict only imprecisely.

So keep count. Write down every fall with its date and take the list to the assessment.

4.2 These three questions your health professional will ask

The international guidelines recommend three short questions as the entry point [1]. In the Swiss pathway they are called alert questions:

1. Have you fallen in the past 12 months? If yes: How often? Did you injure yourself?
2. Do you feel unsteady while standing or walking?
3. Are you afraid of falling?

All three questions together find more people than the first one alone. Among 65- to 74-year-olds the fall question on its own picks up only about 43 in 100 of later fallers [1].

A second problem comes on top. Many people say nothing about a fall of their own accord. Among men, fewer than a third mention the fall unprompted. Only the direct question brings it up [1].

These three questions sit together with nine more in a short questionnaire. You can fill it in here: Fall risk – the short self-check. It calculates on your own device and stores nothing. At the end you print a report and take it to the consultation.

4.3 Report the near-falls as well

You tripped and just caught yourself. Tell us about that too. The guidelines rest above all on the falls themselves, on gait and balance and on your concern about falling [1]. A near-fall still often reveals the situation to your health professional: while turning, in the dark, while carrying something, on the way to the toilet.

5. These are the tests you can expect in practice

The following tests are the ones you are most likely to meet in a Swiss practice. The Swiss Council for Accident Prevention (BFU) provides the forms free of charge on its StoppSturz portal [14].

5.1 The Timed Up and Go measures standing up, walking and turning

This is the test you are most likely to be given in a Swiss physiotherapy practice. It appears in the Swiss pathway and in the international guidelines [1], [14]. It therefore comes up most often in this article.

You stand up from a chair, walk three metres, turn, walk back and sit down again. Your health professional stops the clock when your bottom touches the chair. The Swiss cut-off is 13.5 seconds [14]. The international guidelines give 15 seconds [1].

The test contains four movements in which people often fall: standing up, setting off, turning and sitting down. All four together produce a single number. From that number you can only read off that something was slow. Which part caused it stays open.

5.2 The five times sit-to-stand measures your leg strength

You stand up from a chair five times as fast as you can and sit down again. Your arms stay folded across your chest. In people living independently the test counts as abnormal from 12 seconds [14].

This test looks at the strength of your legs and above all at your muscle power. It therefore sits close to what you will train afterwards.

5.3 Gait speed over four metres

You walk four metres at your usual pace. A short run-up and run-out section lies before and after the measured stretch. The test counts as abnormal from 4 seconds, that is from 1 metre per second [15]. The World Falls Guidelines set the threshold lower at 0.8 metres per second [1].

The international guidelines recommend this test most strongly [1]. Your gait speed is also linked to frailty, hospital stays and mortality. For predicting falls it stays imprecise all the same (section 6.2).

5.4 The Mini-BESTest examines four parts of balance

The test comprises 14 tasks and at most 28 points. It examines four areas. These include your anticipatory balance and your reaction to a push. They also include your orientation with your eyes closed and on a soft surface, plus your walking under added demands. In older people a score of 16 out of 28 points or lower counts as abnormal [14]. That value comes from a study that separated people by past falls [28]. Other groups give other values.

The test takes 15 to 20 minutes. In return it is the only one that shows which part of your balance has declined. Your training goal follows from that.

5.5 With standing balance tests the time limit decides

You stand in turn with your feet side by side, in semi-tandem, in tandem and on one leg. Each position is harder than the one before. Ten seconds per position is the usual limit.

A study of 153 people shows that 10 seconds is too short [21]. On average the participants held single-leg stance for 14.8 seconds and tandem stance for 22.2 seconds. The researchers therefore propose at least 23 seconds.

This pattern returns throughout this article. As soon as a test has a time limit, the very people you want to find early disappear inside it.

5.6 The FES-I asks about your concern about falling

The questionnaire names sixteen everyday situations. For each one you say how concerned you are about falling. The guidelines explicitly recommend a standardised questionnaire for concern about falling [1]. Why that matters is in section 12.2.

6. How accurately do the tests predict a fall?

The following figures come mostly from the Timed Up and Go. There is a simple reason for that: it is the most frequently performed and best researched test. For the other tests from section 5 the figures look similar (section 6.2).

So put your own result in proportion. A test value counts as much as your fall history, your medication list and your own feeling while walking. Only all four together give a picture.

6.1 The figures on the Timed Up and Go

A review with Swiss involvement pooled eleven studies [7]. A total of 3,148 people living independently took part. At a cut-off around 13 seconds two values emerged.

Of 100 people who go on to fall, 39 are picked up by the test. 61 stay unremarkable. Professionals call this proportion the detection rate (sensitivity).

Of 100 people who stay free of falls, 74 are unremarkable on the test. 26 are picked up all the same. This proportion is called specificity.

For you these two values mean the following. Your baseline risk is 30 in 100. After an abnormal test it rises to 43 in 100. After a normal test it falls to 25 in 100 [7].

The discriminative accuracy of the test was 0.63. Professionals call this value the AUC.

Picture two people. One of them falls in the coming year, the other stays free of falls. All you know about them is the time they needed for the Timed Up and Go. You pick the slower person. With a discriminative accuracy of 0.63 you are right in 63 out of 100 such pairs.

Pure guessing is right in 50 out of 100 pairs. So the Timed Up and Go gets 13 pairs more than chance. At a value of 1.0 you would be right in all 100 pairs.

This figure always compares two people with each other. Your personal risk is in the paragraph above. After an abnormal test it is 43 in 100, after a normal one 25 in 100.

An Irish meta-analysis arrived at the same values: detection rate 31 in 100, specificity 74 in 100 at a cut-off of 13.5 seconds. Its conclusion reads as follows [8]: «The Timed Up and Go test has limited ability to predict falls in community dwelling elderly and should not be used in isolation to identify individuals at high risk of falls.»

The largest study on the topic pooled 53 studies with 12,832 people [9]. Among fit older people living independently, those who later fell took on average 0.63 seconds longer. Nobody measures that difference reliably. Chair height, shoes and daily form shift your result more.

Among people in nursing homes the difference was 3.59 seconds. So the test separates well where you can already see the problem with the naked eye. Among fit people it separates poorly.

6.2 The other tests perform the same

A Canadian study examined seven common tests in one and the same group in 2026 [3]. In total 514 people aged 65 and over took part. The researchers recorded falls over twelve months with monthly fall calendars. 95 in 100 participants stayed to the end, and 52 in 100 fell at least once.

The tests examined were the Timed Up and Go in three versions, the Brief-BESTest, the five times sit-to-stand, single-leg stance and gait speed. Discriminative accuracy for at least one fall ranged between 0.56 and 0.59. All seven tests therefore performed similarly and stayed close to guessing. For falls with injury, gait speed reached 0.70.

For gait speed there is an additional analysis of the raw data from 28 studies [6]. At a cut-off of 0.8 metres per second, overall accuracy was 58 in 100, the detection rate 35 in 100 and specificity 77 in 100. People who walk slowly fall more often than people who walk fast.

The researchers therefore recommend the cut-off of 1.0 metres per second. With it, health professionals pick up 30 in 100 of later fallers instead of 9 in 100 [6].

A large American review calculated for every common measure where it moves the risk [11]. After an abnormal result the risk stood at the following values:

• Berg Balance Scale: 59 in 100
• Timed Up and Go from 12 seconds: 47 in 100
• a fall in the past year: 44 in 100
• five times sit-to-stand from 12 seconds: 41 in 100
• gait speed below 1.0 metres per second: 39 in 100

Its conclusion: every single measure stayed weak on its own. Several abnormal findings together move the risk more than any single finding.

6.3 What these figures mean for you

• After a normal test your risk stays at about 25 in 100. Most later falls happen to people with a normal test result.
• After an abnormal test your risk rises to about 43 in 100. Of a hundred people with an abnormal test, about 57 stay free of falls in the coming year.
• Several findings together say more than the best single value [11].
• The tests capture your current state fairly reliably. They are well suited to following the course of a treatment (section 11.2).

In our game A false sense of certainty you can work out for yourself why a good test says little about a rare event.

7. How the assessment runs in Switzerland

In Switzerland all health professions have worked to a shared pathway for some years now. It is called StoppSturz and is run by the BFU together with the professional associations. There are separate manuals for physicians, physiotherapy, occupational therapy and for home care and nursing [14], [15]. The sequence is the same everywhere: recognise the risk, assess the risk, reduce the risk.

Declaration of interest. Roger Hilfiker is a co-author of two works cited here: the review of test accuracy [7] and the fall rate model [17]. Marielle Tschopp was a member of the advisory group for the StoppSturz physiotherapy manual [14]. We are therefore criticising a document we helped to produce. That is why we say so openly.

StoppSturz provides all forms free of charge. Few countries have a pathway like it. StoppSturz also recommends asking the three alert questions at every assessment from the age of 65 [14]. That recommendation brings you more than any test.

7.1 Two manuals use two different tests

At the screening stage you get a different test depending on the profession:

• In the doctor's practice [15]: the 4-metre walk test and the clock-drawing test for thinking.
• In physiotherapy [14]: the Timed Up and Go and the five times sit-to-stand.

Both manuals derive their sequence from the algorithm of the American STEADI programme [16]. There these very tests stand side by side as an equivalent choice: the Timed Up and Go, a sit-to-stand test and a balance test.

That settles part of the answer already. StoppSturz chose the Timed Up and Go because it stood in the American sequence they adopted. In physiotherapy it is also among the most familiar tests. The choice therefore rested on origin and familiarity.

7.2 After the screening your fall history decides

If one of the screening tests is abnormal, StoppSturz distinguishes by your fall history [14]. At most one fall without injury gives a moderate risk of falling. Two or more falls, or one fall with injury, give a high risk of falling.

In both cases the Mini-BESTest, the FES-I and, depending on the situation, further tests follow. At high risk a home hazard assessment and liaison with other professions come on top.

So your classification hangs on your fall history. The test value only decides whether the assessment goes on at all. That weighting matches the figures from section 4.1.

8. Why did StoppSturz choose the Timed Up and Go?

The Timed Up and Go gets a lot of space in this article. The reason lies in how widespread it is: in Switzerland almost every physiotherapy practice uses it. Professionals have debated its selection for years.

The next sections gather the arguments in both directions. For you as a patient the conclusion from section 6 stays the same: your test value is one pointer among several.

8.1 These points speak for the test

• You need very little for it. A chair, three metres of space and a stopwatch are enough. A clean gait speed measurement needs a marked stretch with a run-up and a run-out. In a treatment room of twelve square metres that difference counts.
• The test takes a minute. That includes the explanation. Health professionals do short tests in daily practice. Long tests often get left out.
• The test contains four fall situations. Standing up, setting off, turning and sitting down all occur. A straight walking stretch only examines walking.
• The test measures reliably. Repeat it and you get almost the same result. Different examiners obtain similar values [7]. Only that makes the test usable for following progress.
• The test responds to training. After three months of training you see the progress in the number.
• Everyone knows it. It appears in every physiotherapy curriculum, in STEADI, in the World Falls Guidelines and in many studies. Your GP, the rehabilitation clinic and the home care service read the same value in the same way.

8.2 These points speak against the test

• Discriminative accuracy is 0.63 (section 6.1). The World Falls Guidelines therefore rank the test below gait speed. They recommend gait speed more strongly and rest that on better established evidence. For the Timed Up and Go they call the evidence on fall prediction «less consistent» [1].
• The review with Swiss involvement recommends other tests for this setting. For people living independently it names five tests [7]. These include the Mini-BESTest, the Functional Reach Test and fast gait speed. They also include the Timed Up and Go in the fast version and the same version with a counting task. The usual-pace version it recommends for the nursing home. The Swiss manual uses the usual-pace version in people living independently. Both documents appeared in the same year and share one author. To be fair: the review calls its own recommendations weak, because the underlying studies were small [7].
• Among fit people almost everyone stays below the cut-off. An Australian analysis of 693 people aged 70 to 90 shows the consequence [4]. With the 15-second cut-off, five of the 693 people landed in the intermediate risk group. A classification with one empty group hardly classifies.
• The cut-off comes from a very small study. See section 8.3.
• One number sums up six abilities. Two people with 14 seconds each often have different reasons for it: weak legs, an unsteady turn, caution, pain or slower thinking. For treatment planning the health professional needs those reasons separately.
• Small circumstances shift your result. Chair height, armrests, shoes, walking aid and the instruction all have an effect. The same goes for whether the clock stops on seat contact. The same person lands on two sides of the cut-off in two practices. The StoppSturz manual regulates these points carefully [14]. It does however allow armrests, pushing off with the hands and a normal pace. That leaves even more people below the cut-off.

8.3 Where the 13.5-second cut-off comes from

The Swiss cut-off comes from an American study published in 2000 [12]. That study has three features you should know about:

• It comprised 30 people. Of these, 15 had fallen and 15 had stayed free of falls.
• The researchers formed the two groups afterwards, on the basis of falls that had already happened. So the study distinguishes two groups. It does not test a prediction.
• The two groups differed in age. The fallers were on average 86.2 years old, those free of falls 78.4 years. The age gap was eight years.

With two groups as different as that, almost any test separates well. Even a test that only measures age separates them. Comparisons of this kind therefore overstate accuracy systematically.

Later work with proper follow-up found poorer values. In a British cohort of 259 people with one year of follow-up, discriminative accuracy was 0.58 [10].

On top of that: at least four cut-offs are in circulation, each of them with evidence behind it.

• over 10 seconds, derived from age-related reference values [4]
• from 12 seconds, from the American review [11]
• from 13.5 seconds, in the Swiss StoppSturz pathway [14]
• over 15 seconds, in the World Falls Guidelines [1]

The guideline authors now propose taking age into account [5]. As a reference they name the average times of healthy older people [29]:

• 8.1 seconds for 60- to 69-year-olds
• 9.2 seconds for 70- to 79-year-olds
• 11.3 seconds for 80- to 99-year-olds

These are average values, not cut-offs tested against future falls. Their paper carries the title «One size doesn't fit all».

A number of seconds always applies to a particular age group. So ask whom your cut-off was measured on.

8.4 What we make of the Timed Up and Go

The scepticism towards the test has good grounds. It addresses only part of the problem, though.

The Canadian comparison examined seven tests in the same group. All seven predicted falls with similar imprecision [3]. So a clearly better single test is simply not available.

Three concrete points about the Swiss pathway do deserve criticism:

1. The cut-off of 13.5 seconds comes from a study with 30 people and groups of unequal age. A lower or an age-dependent value would be better grounded today.
2. The usual pace instead of the fast version has the weaker evidence base for people living independently. That is what the review says, the very review the manual shares an author with [7].
3. The manual dates from 2021 and therefore from before the World Falls Guidelines and before all the validation work of 2024 to 2026. An update is due.

One point speaks for the Swiss pathway. Within StoppSturz your test value only decides whether the assessment continues (section 7.2). In that role the Timed Up and Go fits well.

9. How well does the World Falls Guidelines algorithm work?

2022 saw the most thorough international guideline on the topic so far. 96 experts worked on it [1]. At its centre stands a flow chart: three questions, then a check on severity, then a mobility test. At the end stand three groups: low, intermediate and high risk.

Severity covers an injurious fall, several falls, frailty, lying on the floor for a long time after a fall, and loss of consciousness.

9.1 What the validations show

A systematic review found eight cohorts with a total of 25,027 people [2]. Its findings:

• Every study adapted the algorithm. Six changed it substantially, two slightly. None implemented it as published.
• The «high risk» group captured 27 to 52 in 100 of later fallers, depending on the study.
• The «high risk» group fell more often than the «low risk» group. That part of the classification works.
• The intermediate group comprised 0.4 to 18 in 100 participants, depending on the study. Its risk was barely higher than in the «low risk» group.

The Canadian study of 514 people also examined whether the mobility tests improve the algorithm [3].

• Without mobility tests the algorithm classified 282 people as «low risk». 41 in 100 of them fell in the following year.
• With mobility tests this proportion rose to 56 in 100.

So the «low risk» label became less reliable with the tests. The researchers conclude from this: their results support the use of no balance or mobility test within the algorithm [3].

One figure matters most for you. Of the people carrying the «low risk» label, 41 in 100 fell in the following year.

9.2 Two changes improve the classification

The Australian work on the 693 people tested two simple changes [4]. First, the researchers performed the mobility test on all participants. Second, they lowered the cut-off from 15 to 10 seconds. That produced three usably large groups: 50 in 100 low, 18 in 100 intermediate and 31 in 100 high risk.

One limitation remains. Physically the new intermediate group had values similar to the high-risk group: less strength, poorer balance and slower thinking. Its rate of falls, however, resembled the low-risk group. So the classification became clearer without the prediction getting any better.

From this follows the core sentence of this article. These tests capture your current state fairly reliably. They predict your future imprecisely.

10. What has NICE recommended since 2025?

In April 2025 the British institute NICE reissued its falls guideline [13]. From the same evidence it draws three clear conclusions:

• Scoring systems stay out of prediction. Health professionals should not use a score to predict a person's risk of falling.
• Health professionals ask actively. At routine appointments and annual health checks they ask people aged 65 and over about falls in the past year. The same applies to people aged 50 to 64 with known risk factors.
• A thorough assessment follows. Those who meet the criteria receive a full assessment of all areas.

The committee gives a short reason. The evidence could not name an assessment method that predicts falls best. In addition, each individual test covers only one area, such as balance or gait.

NICE still recommends balance and gait tests for the assessment. The decision about your next steps should rest with the health professional, though, rather than with a score.

11. What follows the assessment

11.1 An assessment on its own barely lowers your risk

The largest study of this approach was disappointing [20]. In the USA 86 primary care practices were randomly allocated. In the intervention group, specially trained nurses carried out a structured assessment in more than 5,000 people aged 70 and over. Every person received an individual action plan. For serious fall injuries the difference from usual care stayed small and statistically uncertain.

Exercise looks different. It lowers the number of falls from about 85 to about 66 per 100 people a year [19]. That is well researched.

So make sure that training starts after your assessment. Ask about the next step at the end of the appointment.

11.2 The second measurement is worth more than the first

The greatest benefit of these tests lies in tracking progress. The guidelines name exactly that as their task: selecting exercises, setting the dose and following the course [1]. A single value, by contrast, says little about your future. An improvement from 16 to 12 seconds after three months of training, by contrast, tells you a great deal about the training working.

Every measurement fluctuates, though. An improvement of one second lies within that fluctuation. If the chair, the shoes or the time of day change in between, the fluctuation grows further. A course of measurements becomes reliable only over several readings under the same conditions.

12. What you contribute to the assessment

12.1 These details we need from you

• Your fall history in numbers. How often in the past year? With injury? Could you get up again by yourself? How long did you lie on the floor? Only you can supply these details, and they weigh the most (section 4).
• The near-falls as well. Report the falls where nothing happened to you, and the embarrassing ones.
• Your complete medication list. Over-the-counter products, sleeping pills and eye drops belong on it.
• The situation in which it happens. At night on the way to the toilet? Turning around in the kitchen? Stepping off the kerb? Outdoors in wet weather? This detail often leads to the cause faster than any test.
• The completed self-test. You can print it out and bring it along.

12.2 Say so if you are afraid

An Australian study of 500 people aged 70 to 90 compared the measured and the perceived risk [18]. In many participants the two agreed. In others they diverged.

One group stood out in particular. These people had a low risk physically and still felt very unsteady. They fell more often than their physical findings led one to expect. In them the researchers also found signs of weaker planning performance in the brain.

So your concern about falling raises your risk of falling measurably. It can be treated. Your health professional records it with the FES-I [14]. So raise the subject yourself.

12.3 Ask these three questions at the end

1. What exactly did you find? Have the finding named: which ability, which situation, which measured value.
2. What are we doing about it? Have the next step named, along with a date for it.
3. When do we measure again? Only the second value shows you whether the treatment is working.

Say so as well if your test was normal and you still feel unsteady. Your own judgement weighs as much here as the measured test value.

13. For health professionals: eight conclusions for practice

This section is addressed to colleagues in physiotherapy and medicine. It sums up how we apply the evidence in our own practice.

1. Record the fall count as a count. After one fall in the past year the model expects about 83 falls per 100 people a year, after five or more about 500 [17]. Ask the three alert questions from the age of 65 at every initial assessment.
2. Use no screening test as an exclusion criterion. The detection rate lies between 30 and 40 in 100. Where screening is negative and the clinical impression is positive, the impression wins. The StoppSturz manual says the same [14].
3. Document the test conditions. Note chair height, armrests, footwear, walking aids and the instruction. Without these details a comparison over time is worth little, and that comparison is the main benefit.
4. Consider the fast version. For people living independently, TUG FAST and fast gait speed have the better evidence base [7]. Anyone who switches switches the cut-off with it and then stays with it.
5. Build in an age reference. 13.5 seconds mean something different in a 68-year-old woman than in an 89-year-old man [5]. Where possible communicate the raw value rather than the classification.
6. Use the Mini-BESTest for treatment planning. It delivers four subscales and with them a training goal. Its AUC in the review was 0.79 from two studies, that of the Timed Up and Go 0.63 from eight studies [7]. The confidence interval around the 0.79 is correspondingly wide.
7. Judge the assessment by the action it triggers. The proven benefit lies in the training that follows [19]. The STRIDE trial shows that the assessment on its own achieves too little [20].
8. Record concern about falling in a standardised way. Use the FES-I. A gap between measured and perceived risk is itself a finding [18].

For context: the weak prediction lies in the subject matter. Falls are common, yet hard to predict in the individual case. They have many causes and depend heavily on the situation. Behaviour comes on top: whoever hardly moves any more falls less often.

The same picture emerges with the scoring systems used in hospitals. A review of 38 instruments concludes that each instrument suits only certain situations [22]. A review of prediction models for inpatient falls criticises above all the quality of reporting [23]. The Timed Up and Go with motion sensors also delivers results mainly from studies so far and little for everyday practice [24].

14. What you should know about falls risk assessment

• Train strength and balance, even without an assessment. Exercise lowers the number of falls from about 85 to about 66 per 100 people a year [19].
• The assessment finds what training overlooks. That includes your eyes, your medication, your blood pressure while standing and your home.
• Home adaptations work where the risk is increased. There the number of falls dropped from about 185 to about 115 per 100 people a year. At low risk it stayed the same [26].
• The number of your previous falls says the most about the number of falls to come. With no fall in the past year the model expects about 59 falls per 100 people a year. After five or more falls it expects about 500 [17].
• The tests move your risk only a little. After an abnormal Timed Up and Go it rises from 30 to about 43 in 100. After a normal one it falls to about 25 in 100 [7].
• All common tests predict with similar imprecision. Seven tests in the same group reached a discriminative accuracy of 0.56 to 0.59 [3].
• The 13.5-second cut-off comes from a study with 30 people of unequal age [12]. As a measure of progress the test remains useful all the same.
• NICE has given up scores for prediction since 2025 and calls instead for active questioning and a thorough search for causes [13].

Do have an assessment. Afterwards ask about the finding, about the action and about the next measurement date.

Our guide Preventing falls describes what a training programme looks like. In our game A false sense of certainty you can work out for yourself why a single test value says little.

References

All Digital Object Identifiers (DOIs) have been checked against the Crossref register. The links in the reference list lead through the DOI service to the publishers' pages. Some of these lie outside Switzerland and the EU. On clicking, your IP address is transmitted to the provider in question. On our own site that does not happen. The links to the BFU, StoppSturz, NICE and the CDC lead directly to those portals.

[1] Montero-Odasso M, van der Velde N, Martin FC, et al. World guidelines for falls prevention and management for older adults: a global initiative. Age and Ageing. 2022;51(9):afac205. https://doi.org/10.1093/ageing/afac205

[2] Pieruccini-Faria F, Son S, Delbaere K, et al. Validation of the World Falls Guidelines risk stratification algorithm. A systematic review. Age and Ageing. 2026;55(8):afag231. https://doi.org/10.1093/ageing/afag231

[3] Saunders S, Speechley M, Griffith LE, et al. Prospective evaluation of balance and mobility tests as part of the World Falls Guidelines algorithm. Age and Ageing. 2026;55(2):afag028. https://doi.org/10.1093/ageing/afag028

[4] Hicks C, Menant J, Delbaere K, et al. Two simple modifications to the World Falls Guidelines algorithm improves its ability to stratify older people into low, intermediate and high fall risk groups. Age and Ageing. 2024;53(10):afae192. https://doi.org/10.1093/ageing/afae192

[5] Montero-Odasso M, van der Velde N, Ryg J, Masud T. Falls risk stratification. One size doesn't fit all. Age and Ageing. 2025;54(1):afae292. https://doi.org/10.1093/ageing/afae292

[6] Hicks C, Menant J, Allen N, et al. Predictive accuracy of gait speed for falls: an individual participant data meta-analysis. Ageing Research Reviews. 2026;120:103207. https://doi.org/10.1016/j.arr.2026.103207

[7] Gafner SC, Allet L, Hilfiker R, Bastiaenen CHG. Reliability and diagnostic accuracy of commonly used performance tests relative to fall history in older persons: a systematic review. Clinical Interventions in Aging. 2021;16:1591–1616. https://doi.org/10.2147/CIA.S322506

[8] Barry E, Galvin R, Keogh C, Horgan F, Fahey T. Is the Timed Up and Go test a useful predictor of risk of falls in community dwelling older adults: a systematic review and meta-analysis. BMC Geriatrics. 2014;14:14. https://doi.org/10.1186/1471-2318-14-14

[9] Schoene D, Wu SM-S, Mikolaizak AS, et al. Discriminative ability and predictive validity of the Timed Up and Go test in identifying older people who fall: systematic review and meta-analysis. Journal of the American Geriatrics Society. 2013;61(2):202–208. https://doi.org/10.1111/jgs.12106

[10] Kojima G, Masud T, Kendrick D, et al. Does the timed up and go test predict future falls among British community-dwelling older people? Prospective cohort study nested within a randomised controlled trial. BMC Geriatrics. 2015;15:38. https://doi.org/10.1186/s12877-015-0039-7

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[12] Shumway-Cook A, Brauer S, Woollacott M. Predicting the probability for falls in community-dwelling older adults using the Timed Up & Go test. Physical Therapy. 2000;80(9):896–903. https://doi.org/10.1093/ptj/80.9.896

[13] National Institute for Health and Care Excellence (NICE). Falls: assessment and prevention in older people and in people 50 and over at higher risk. NICE guideline NG249. London, 29. April 2025. https://www.nice.org.uk/guidance/ng249

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[15] StoppSturz. Manual StoppSturz Vorgehen Ärzteschaft, Version 25.11.2020. Bern: PHS Public Health Services / BFU. https://www.bfu.ch/stoppsturz/arztpraxis

[16] Centers for Disease Control and Prevention (CDC). STEADI – Algorithm for Fall Risk Screening, Assessment, and Intervention. Atlanta, 2017/2019. https://www.cdc.gov/steadi/media/pdfs/STEADI-Algorithm-508.pdf

[17] Wapp C, Mittaz Hager A-G, Rikkonen T, Hilfiker R, et al. Validation of a fall rate prediction model for community-dwelling older adults: a combined analysis of three cohorts with 1850 participants. BMC Geriatrics. 2024;24:287. https://doi.org/10.1186/s12877-024-04811-x

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[20] Bhasin S, Gill TM, Reuben DB, et al. A randomized trial of a multifactorial strategy to prevent serious fall injuries. New England Journal of Medicine. 2020;383(2):129–140. https://doi.org/10.1056/NEJMoa2002183

[21] Carvalho de Abreu DC, Bandeira ACL, Magnani PE, et al. Standing balance test for fall prediction in older adults: a 6-month longitudinal study. BMC Geriatrics. 2024;24:947. https://doi.org/10.1186/s12877-024-05380-9

[22] Strini V, Schiavolin R, Prendin A. Fall risk assessment scales: a systematic literature review. Nursing Reports. 2021;11(2):430–443. https://doi.org/10.3390/nursrep11020041

[23] Parsons R, Blythe RD, Cramb SM, McPhail SM. Inpatient fall prediction models: a scoping review. Gerontology. 2022;69(1):14–29. https://doi.org/10.1159/000525727

[24] Ortega-Bastidas P, Gómez B, Aqueveque P, Luarte-Martínez S, Cano-de-la-Cuerda R. Instrumented Timed Up and Go test (iTUG) – more than assessing time to predict falls: a systematic review. Sensors. 2023;23(7):3426. https://doi.org/10.3390/s23073426

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[26] Clemson L, Stark S, Pighills AC, et al. Environmental interventions for preventing falls in older people living in the community. Cochrane Database of Systematic Reviews. 2023;(3):CD013258. https://doi.org/10.1002/14651858.CD013258.pub2

[27] Haran MJ, Cameron ID, Ivers RQ, et al. Effect on falls of providing single lens distance vision glasses to multifocal glasses wearers: VISIBLE randomised controlled trial. BMJ. 2010;340:c2265. https://doi.org/10.1136/bmj.c2265

[28] Yingyongyudha A, Saengsirisuwan V, Panichaporn W, Boonsinsukh R. The Mini-Balance Evaluation Systems Test (Mini-BESTest) demonstrates higher accuracy in identifying older adult participants with history of falls than do the BESTest, Berg Balance Scale, or Timed Up and Go Test. Journal of Geriatric Physical Therapy. 2016;39(2):64–70. https://doi.org/10.1519/JPT.0000000000000050

[29] Bohannon RW. Reference values for the Timed Up and Go test: a descriptive meta-analysis. Journal of Geriatric Physical Therapy. 2006;29(2):64–68. https://doi.org/10.1519/00139143-200608000-00004

Transparency

• Authorship: Roger Hilfiker
• AI assistance: the literature search and the first draft were produced with Claude (Anthropic). Roger Hilfiker checked every statement, figure and source and revised the text.
• Written: 22 August 2026
• Last updated: 22 August 2026
• Sources: the 26 works in the reference list. All DOIs were checked against the Crossref register.
• Declaration of interest: see the disclosure in section 7.
• Funding: Physiotherapie Tschopp & Hilfiker, 3902 Glis. The practice funded this article from its own means.
• Next review: planned for August 2028