Time to Up our Game (TUG) in the management of falls!

Debra Eagles is a Resident in Emergency Medicine at The Ottawa Hospital in Canada. Here she discusses her recent Age & Ageing paper.

Your medical student reviews a case with you.  It is a 78 year old woman who presents with right knee pain subsequent to a recent fall.  The student has taken a comprehensive falls history and physical examination.  After reviewing the knee x-ray, the student summarizes the case by stating the patient suffered a mechanical fall, luckily without evidence of fracture and can be discharged home.  But wait, you say, can she safely mobilize?  The medical student smiles triumphantly, yes, she was able to use her walker to ambulate a short distance.  Excellent, you say, she can be discharged home.  But you wonder, is there anything further you can do to determine what her risk of negative outcomes associated with falling is.

One in three people, that are 65 years of age and older, fall each year.  Some are hospitalized but the majority are discharged home.  These older community dwelling persons also suffer negative sequelae from their falls including, recurrent falls, increased fear of falling, increased social isolation and functional decline.  The Emergency Department has the opportunity to play a pivotal role in mitigating these poor outcomes.  Can a simple mobility test, such as the Timed Up and Go (TUG), help us identify higher risk patients that may benefit from further outpatient management?

This Canadian multi-centre trial of older community dwelling minor trauma patients provides the answer to that question.  The study evaluated the association between TUG scores and frailty, functional decline and future falls at three and six months.  The TUG is a simple mobility test.  The clinician measures the amount of time it takes for the patient to rise from a chair, walk 3 meters at their usual speed with their usual gait aid, return to the chair and sit down again.  The study found that TUG scores were associated with frailty at baseline and with functional decline at three and six months.  If the patient took more than 30 seconds to complete the TUG, their risk of functional decline at three months was nine times greater than patients with normal TUG scores.  This has ramifications with respect to risk of future institutionalization.  The TUG was not associated with future falls.

The Timed Up and Go is a simple test that can be used in older community dwelling minor trauma patients to identify those at higher risk of functional decline.  Early identification and referral of these patients for further evaluation at geriatric or falls clinics may optimize their long-term functioning and safety.

Read the full Age & Ageing paper Timed Up and Go predicts functional decline in older patients presenting to the emergency department following minor trauma