Diagnostic Accuracy of Fall Risk Screening Tools in Older Individuals: A Systematic Review With Bivariate...

To evaluate the diagnostic accuracy of the most commonly used fall risk screening tools in older individuals from different settings.

Systematic review and meta-analysis of diagnostic accuracy studies.

A total of 53 studies involving 21,554 adults aged ≥60 were included: 24 studies in community settings (n = 9358), 6 in institutional or long-term care settings (n = 733), 22 in hospital settings (n = 10,245), and 2 with mixed populations (n = 1218).

CINAHL, Cochrane library, EMBASE, PubMed, and Web of Science, 5 electronic databases were searched from inception to April 2025. A bivariate random-effects model was fitted separately for each screening tool to jointly model sensitivity and specificity, and to derive pooled estimates and summary receiver operating characteristic curves. Sensitivity, specificity, and diagnostic odds ratio were also independently synthesized for each tool using univariate random-effects meta-analyses of proportions. Threshold effects were tested, and methodological quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool.

Nine fall risk screening tools were evaluated. The Mini Balance Evaluation Systems Test (Mini-BESTest) [area under the curve (AUC) = 0.793] and Berg Balance Scale (BBS) (AUC = 0.774) showed overall relative higher diagnostic accuracy, whereas St. Thomas's Risk Assessment Tool in Falling Elderly Inpatients (AUC = 0.754) and the Hendrich II Fall Risk Model (AUC = 0.734) demonstrated acceptable diagnostic accuracy in hospitalized settings.

No single screening tool showed sufficient diagnostic accuracy to be recommended as a standalone instrument for identifying fall risk in older adults. However, Mini-BESTest and BBS demonstrated relatively higher overall diagnostic performance and may be prioritized in clinical practice among 9 tools evaluated in this study.