Validation of World Guideline gait speed and TUG cut-offs for fall risk stratification in ambulatory nursing home residents aged ≥ 80 years: a multicenter cross-sectional diagnostic study.

BACKGROUND

Falls are highly prevalent among nursing home residents, particularly among adults aged ≥ 80 years. The World Guidelines for Falls Prevention and Management recommend gait speed ≤ 0.8 m/s and Timed Up and Go (TUG) > 15 s as risk thresholds; however, their discriminatory validity in ambulatory institutionalized populations remains insufficiently examined.

OBJECTIVE

To validate the discriminatory performance and clinical utility of guideline-recommended gait speed (≤ 0.8 m/s) and TUG (> 15 s) thresholds for fall risk stratification among ambulatory nursing home residents aged ≥ 80 years.

METHODS

In this multicenter cross-sectional diagnostic accuracy study, 132 ambulatory nursing home residents aged ≥ 80 years were recruited from four care homes in Shanghai. Gait speed, TUG performance, and 12-month retrospective fall history were assessed by trained staff. Logistic regression models were developed using a 7:3 derivation–validation split. Model performance was evaluated using area under the receiver operating characteristic curve (AUC), calibration statistics, Brier scores, and decision curve analysis (DCA).

RESULTS

Forty-eight participants (36.4%) reported at least one fall in the past year. In the gait speed model, slower gait speed was significantly associated with higher fall risk (OR = 0.078), with moderate discrimination in both the derivation (AUC = 0.799) and validation cohorts (AUC = 0.794). The TUG model demonstrated comparable discrimination (AUC = 0.771 and 0.783 in derivation and validation cohorts, respectively), with prolonged TUG time associated with increased fall risk (OR = 1.096). Both models showed good calibration (Brier scores = 0.168–0.195). Decision curve analysis indicated positive net clinical benefit across clinically relevant threshold ranges.

CONCLUSIONS

World Guideline gait speed and TUG thresholds demonstrated acceptable discriminatory performance among ambulatory nursing home residents aged ≥ 80 years. These simple mobility assessments may support fall risk stratification within this ambulatory institutional subgroup; however, findings should not be generalized to residents with advanced frailty or dependence on assistive devices.