Downton Fall Risk Index to identify patients with a high risk of falling

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SBU Enquiry Service

Consists of structured literature searches to highlight studies that can address questions received by the SBU Enquiry Service from Swedish healthcare or social service providers. We assess the risk of bias in systematic reviews and when needed also quality and transferability of results in health economic studies. Relevant references are compiled by an SBU staff member, in consultation with an external expert when needed.


What systematic reviews and scientific studies are there on Downton Fall Risk Index to identify risk of falling in hospitalised patients?

Identified literature

Eight systematic reviews with a high risk of bias were identified [1-8]. Nine primary studies were identified [9-17]. These were not assessed for risk of bias.


  1. Aranda-Gallardo M, Morales-Asencio JM, Canca-Sanchez JC, Barrero-Sojo S, Perez-Jimenez C, Morales-Fernandez A, et al. Instruments for assessing the risk of falls in acute hospitalized patients: a systematic review and meta-analysis. BMC health services research 2013;13:122.
  2. da Costa BR, Rutjes AW, Mendy A, Freund-Heritage R, Vieira ER. Can falls risk prediction tools correctly identify fall-prone elderly rehabilitation inpatients? A systematic review and meta-analysis. PloS one 2012;7:e41061.
  3. Lee J, Geller AI, Strasser DC. Analytical review: focus on fall screening assessments. PM & R : the journal of injury, function, and rehabilitation 2013;5:609-21.
  4. Majkusová K, Jarošová D. VALIDITY OF TOOLS FOR ASSESSING THE RISK OF FALLS IN PATIENTS. Central European Journal of Nursing & Midwifery 2017;8:697-705.
  5. Myers H. Hospital fall risk assessment tools: a critique of the literature. International Journal of Nursing Practice (Wiley-Blackwell) 2003;9:223-35.
  6. Oliver D, Daly F, Martin FC, McMurdo ME. Risk factors and risk assessment tools for falls in hospital in-patients: a systematic review. Age and ageing 2004;33:122-30.
  7. Park SH. Tools for assessing fall risk in the elderly: a systematic review and meta-analysis. Aging clinical and experimental research 2018;30:1-16.
  8. Scott V, Votova K, Scanlan A, Close J. Multifactorial and functional mobility assessment tools for fall risk among older adults in community, home-support, long-term and acute care settings. Age and ageing 2007;36:130-9.
  9. Aranda-Gallardo M, Enriquez de Luna-Rodriguez M, Vazquez-Blanco MJ, Canca-Sanchez JC, Moya-Suarez AB, Morales-Asencio JM. Diagnostic validity of the STRATIFY and Downton instruments for evaluating the risk of falls by hospitalised acute-care patients: a multicentre longitudinal study. BMC health services research 2017;17:277.
  10. Bueno-Garcia MJ, Roldan-Chicano MT, Rodriguez-Tello J, Merono-Rivera MD, Davila-Martinez R, Berenguer-Garcia N. Characteristics of the Downton fall risk assessment scale in hospitalised patients. Enfermeria clinica 2017;27:227-34.
  11. Bugdayci D, Paker N, Dere D, Ozdemir E, Ince N. Frequency, features, and factors for falls in a group of subacute stroke patients hospitalized for rehabilitation in Istanbul. Archives of gerontology and geriatrics 2011;52:e215-9.
  12. Nilsson M, Eriksson J, Larsson B, Oden A, Johansson H, Lorentzon M. Fall Risk Assessment Predicts Fall-Related Injury, Hip Fracture, and Head Injury in Older Adults. J Am Geriatr Soc 2016;64:2242-50.
  13. Nyberg L, Gustafson Y. Using the Downton index to predict those prone to falls in stroke rehabilitation. Stroke 1996;27:1821-4.
  14. Saverino A, Benevolo E, Ottonello M, Zsirai E, Sessarego P. Falls in a rehabilitation setting: functional independence and fall risk. Europa medicophysica 2006;42:179-84.
  15. Vassallo M, Poynter L, Sharma JC, Kwan J, Allen SC. Fall risk-assessment tools compared with clinical judgment: an evaluation in a rehabilitation ward. Age and ageing 2008;37:277-81.
  16. Vassallo M, Sharma JC, Briggs RSJ, Allen SC. Characteristics of early fallers on elderly patient rehabilitation wards. Age & Ageing 2003;32:338-42.
  17. Vassallo M, Stockdale R, Sharma JC, Briggs R, Allen S. A comparative study of the use of four fall risk assessment tools on acute medical wards. J Am Geriatr Soc 2005;53:1034-8.
Published: Report no: ut202005 Registration no: SBU 2019/496
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