Althea Vol 4 No 1 full text.indd
Althea Medical Journal. 2017;4(1)
83
Fall Risk Based on Timed Up and Go Test in Elderly at Nursing Home in
West Java, Indonesia
Thiruchelvam Selvadurai,1 Tertianto Prabowo,2 Yuni S.Pratiwi3
1Faculty of Medicine Universitas Padjadjaran, 2Department of Physical Medicine and
Rehabilitation Faculty of Medicine Universitas Padjadjaran/Dr. Hasan Sadikin General Hospital
Bandung, 3Department of Anatomy, Biology Cell and Physiology Faculty of Medicine Universitas
Padjadjaran
Abstract
Background: Falls are major cause of morbidity and mortality in elderly patients. Mobility assessment is
important in preventing falls in elderly. This study was conducted to determine the level of fall risk in
elderly people at Karitas Cimahi Nursing Home, West Java, Indonesia by using ‘timed up and go test’(TUG).
Methods:This cross-sectional descriptive study was conducted at Karitas Cimahi Nursing Home from June–
November 2013. The risk of falls was categorized into two; high and low risk of falls. High risk of falls
indicated when the participants complete the TUG test with time taken >10 seconds, and low risk of falls
indicated when the time taken is <10 seconds. To identify the level of fall risk in elderly people the test
which is recommended by the American Geriatric Society was used. The sampling technique used was total
sampling. Data was analyzed and presented by using frequency tables.
Results: From a total of 32 elderly population at Karitas Cimahi Nursing Home, a total of 20 participated in
this study. The ‘Timed up and go test’ result for all the participants were >10 seconds.
Conclusions: The level of fall risk in elderly people at Karitas Cimahi Nursing Home based on the test
showed that all participants, both male and female, regardless of using assistive device have high level risk
of falls. [AMJ.2017;4(1):83–6]
Keywords: Elderly, risk of falls, ’timed up and go test’
Correspondence: Thiruchelvam Selvadurai, Faculty of Medicine, Universitas Padjadjaran, Jalan Raya Bandung-
Sumedang Km.21, Jatinangor, Sumedang, Indonesia, Phone: +62 87827785882 Email: thiruchelvam2186@hotmail.com
Introduction
An increasing number of elderly occurred
worldwide as a part of health improvement
impact. Statistics showed that there were
estimated 35 million people aged 65 and above
in the year 2000. This number is estimated
to increase to 70 million in the year 2030.
The group of frail elderly people is the most
vulnerable and also causes the most expenses
for treatment, medication, long term care
and medical illness. These are also the main
causes which lead many researchers to carry
out ample of studies to enhance the quality of
healthy life among elderly people.1
The most common reason that causes injury
to elderly individuals are falls.2 Every year one
out of three elderly aged 65 and above falls
while elderly above 80 years old falls one out
of two.3
Furthermore, a frequently used tool is
the timed up and go test (TUG), which is
recommended by the American Geriatrics
Society to do screening for risk of falling.4
A lower cut off point of 10 seconds is the
best time which have predictive value of
sensitivity 71% and specificity 86%.5 This
test has a meaningful information for further
care management especially in community
dwelling or residential care facilities.
The main purpose of this study was to
identify the level of fall risk among elderly
people at Karitas Cimahi Nursing Home based
on TUG.
Methods
A descriptive cross-sectional study was
carried out at Karitas Cimahi Nursing Home,
Indonesia from June–November 2013.
Primary data collection was done by total
sampling from elderly people who lived
Althea Medical Journal. 2017;4(1)
84 AMJ March 2017
there. The total population at Karitas Cimahi
Nursing Home was 32 participants and out
of that only 20 participants could fulfill the
inclusion and exclusion criteria of the study.
The inclusion criteria of this study was
participants regardless of male or female
who were 60 years old and above without any
physical injuries. The exclusion criteria were
any elderly subject who could not respond to
verbal instructions or were unable to walk. This
study was approved by the Health Research
Ethics Committee of the Faculty of Medicine
Universitas Padjadjaran. The participants gave
their consent on participation.
All subjects were identified by filling
an identity form that had their name,
age and gender. Subjects were given
adequate explanation about the test and
also demonstration by the researcher by
performing the TUG test. Participants were
allowed to wear glasses if they had visual
problems.
In the TUG test, an armchair of standard
height was used and a distance of 3 meters
was marked with a line of tape on the floor. The
starting position was sitting with hands resting
on the arms of the chair. The participants
crossed the line before turning around and
walked back to sit in the chair again. They
were instructed to perform the TUG test at
their normal speed and they performed one
trial before they were timed. The timing of
the TUG test started when the participant
got up from the chair and stopped when the
participant’s buttocks touch the seat of the
chair again. Throughout the test, local nurses
were required to accompany the participants
to prevent any complication of falls.
The risk of falls is categorized into high
risk of falls which is indicated when the
participants complete the test with time taken
more than 10 seconds and low risk of falls
indicated when the time taken was less than
10 seconds.
The data was collected and analysed using
appropriate computer software. The results
were shown as the frequency of high risk of
falls and frequency of low risk of falls among
elderly people in the form of table.
Results
The total elderly people population at
Karitas Cimahi Nursing Home was 32 people;
specifically 8 males and 24 females. Out of 32
participants only 20 fulfilled the inclusion and
exclusion criteria. From these 20 participants,
4 of them were males and 16 were females.
Table 2 TUG Test Result
Gender TUG Score (Second)
Level of Risk
High Risk Low Risk
Male 16.61 4 0
Female 24.47 16 0
Total 20 0
Note: TUG = Timed Up and Go
Table 1 Characteristic of Respondents
Characteristic n(20)
Age Range Age=62 to 93
Gender
Male 4
Female 16
Table 3 TUG Test Results with and without Using Assistive Device
Assistive device TUG Score (Seconds) Risk Fall Classification
Male Using=0
High risk
Not Using=4 16.61
Female Using=2 63.26
High risk
Not Using=14 18.93
Note: TUG = Timed Up and Go
Althea Medical Journal. 2017;4(1)
85Thiruchelvam Selvadurai, Tertianto Prabowo, Yuni S.Pratiwi: Fall Risk Based on Timed Up and Go Test in
Elderly at Nursing Home in West Java, Indonesia
All participants were found to be having
risk of falls with mean TUG score >10 seconds
regardless of their gender. Female participants
showed higher risk of falls compared to male
(Table 2).
Participants who use an assistive device to
walk had a higher risk than those didn’t use
the assistive device. There was a prominent
difference in the time taken for participants
from the same gender but using an assistive
device (Table 3).
Discussion
The characteristics of the risk of fall in elderly
people at Karitas Cimahi Nursing Home based
on TUG test showed that all participants had
high risk of falls.
There were several factors that might
influence this result outcome in Karitas
Cimahi Nursing Home. Firstly, the average
age group of elderly who lives here was 75.1.
Risk of falls increases with increase of aging,
thus most of the participants in this study had
higher risk of falls. Falls is a main problem
in elderly people especially in women.6 In
this Karitas Cimahi Nursing Home most of
the elderly were females, thus this age group
had higher risk of falls. Furthermore, there
was lack of physical activities in this nursing
home because there was no routine exercise
program other than outdoor activities such
as sunbathing. Most of the time, the elderly
people would be doing their routine activities
while sitting, not moving around. This showed
that most of the elderly here had less mobility,
which contributed to higher risk of falls.
Physical activities will increase the muscle
strength which are also important to maintain
a proper gait and balance of an individual.
Reduction in muscle strength will eventually
leads to poor daily living activity, decrease
physical strength and prominent disturbance
of good quality of life of elderly people.7 Thus,
decreased muscle strength and problem in
gait and balance result in high risk of falls.
Furthermore, disorders of gait and balance
contributes about 3 times the risk of falling.8
The time taken to heal from fall related injury
is long, especially for elderly people who will
experience prolonged immobility.9
Nutritional factors also contributes to the
high risk of falls here. Most of the meals for
the elderly here were normal food such as
rice, chicken and vegetables. These meals
excluded milk or special formulated milk
which contains vitamin D or calcium which is
essential for strengthening the bone in elderly
people’s body. At this nursing home a medical
check up was performed every once in a
month by local doctors and nurses. The check
up only included taking blood pressure, pulse
rate, blood sugar level, cholesterol and also
dental check ups. Special health care checkups
namely for falls risk, gait and balance, and
muscle strength, were given less priority.
For those who were using assistive walking
devices, the devices must be bought by some
elderly people themselves here and some were
sponsored.
Thus, all these factors contributed to the
high risk of falls among elderly people at
Karitas Cimahi Nursing Home. In this study, it
showed that even if the participant was older
than the others, his or her TUG score did not
indicate that the higher the age, the higher the
TUG score.
Falls is the main reason for high mortality
and morbidity in elderly people.1 A study
stated that an enviromental hazard, tripping
over an object and fall records the highest
cause for falling, followed by slipping.3 The
elderly people who are staying at a nursing
home have prevalence of falls more than
those who are living with communitee.10
In a previous study, it is stated that elderly
people staying in residential care facilities are
often frail because of multiple causes such as
intake of medicines, lack of muscle strength,
susceptible to sickness which contributes to
unstability and falls.3 Although risk of falls
increase with age but this statement can be
argued because the risk of falls also depends
on many other factors for example such as
genetic, environment, nutritional status, and
many more.
Overall from this study, all the participants
had risk of falls at Karitas Cimahi Nursing
Home. It is therefore suggested that the
management of this nursing home should give
more importance in preventing the incidence
of falls among the elderly. This nursing home
should also make sure that elderly people
were given opportunity to do sufficient and
pertinent exercise at least for approximately
30 minutes for daily basis. This will increase
the muscle strength and increase bone mass
thus preventing falls. Thorough check up for
visual function should also be performed
regularly for the elderly at this nursing
home. For example, check for the presence
of cataract, glaucoma, regular check up with
ophtalmologist is essential as it can prevent
the incidence of falls.
The management of Karitas Cimahi Nursing
Home should be aware of environmental
Althea Medical Journal. 2017;4(1)
86 AMJ March 2017
hazards. The elderly’s daily living space should
be safe. It should have good lighting and
substantial grab bars. Slippery carpet should
be avoided and the bathroom should have non-
skid mats and raised toilet seat. This recorded
information will be beneficial for the upcoming
researchers who will conduct further studies
at Karitas Cimahi Nursing Home.
The limitation of this study is that the
population was only from one elderly nursing
home, thus it could not represent the total
elderly population of Indonesia. For further
analysis the risk of falls of the individual
elderly in this nursing home, upcoming
researchers should conduct a cohort study
so that the individual at risk of falls can be
followed up for a long period of time. This
study concludes that all the subjects in Karitas
Cimahi Nursing Home have high risk of falls so
the recommendation is more studies should
be conducted at many other nursing homes
(Panti Jompo) so that we can identify the
individual with high risk of falls and prevent
the incidence of falls.
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