Characteristics of older adults who are unable to perform a floor transfer: considerations for clinical decision-making

Key points

1. 01Dependent floor-transfer performers had a median age of 82, versus 69 for independent performers
2. 02All adults dependent in floor transfer were also dependent in instrumental ADLs, and 35.3% needed help with basic ADLs
3. 03More than half of floor-transfer-dependent adults had fallen at least once in the past 6 months
4. 04Self-reported floor transfer ability matched actual test outcome in about 90% of cases (kappa 0.92, 95% CI 0.88-0.97)
5. 05Floor transfer dependence clustered with polypharmacy, high comorbidity burden, use of two-handed assistive devices, and homebound status

How it was conducted

Design

Cross-sectional study

Participants

45 community-dwelling adults aged 65-96 years, recruited in Brooklyn, New York, October-December 2015

Sampling

Stratified by self-reported floor transfer ability into three groups: independent, assisted, and dependent (15 per group at recruitment)

Primary assessment

Actual floor transfer test under normal conditions (no support) and modified conditions (chair allowed); categorized as independent, assisted, or dependent

Comparisons

Kruskal-Wallis test used to compare sociodemographic and health-related factors across three floor transfer test outcome groups

Reliability measure

Quadratic-weighted kappa coefficient comparing self-reported floor transfer ability with actual test performance

What they found

• 18 of 45 participants (40%) performed the floor transfer test independently, 10 (22.2%) required self-assistance, and 17 (37.8%) were unable to complete it
• Median age was 82 years in the dependent group, 72 years in the assisted group, and 69 years in the independent group; difference was statistically significant (H[2] = 12.34, P = .00)
• 100% of floor-transfer-dependent adults were also dependent in instrumental ADLs; 35.3% were dependent in basic ADLs
• 100% of floor-transfer-independent adults were independent in IADLs; 94.4% were independent in basic ADLs
• 100% of the dependent and assisted groups had 3 or more chronic medical diagnoses; the independent group had a median of 2 diagnoses
• 100% of the dependent and assisted groups were polypharmacy users (4 or more medications); the independent group averaged 3.7 medications
• 58.8% of the dependent group had fallen at least once in the past 6 months; 41.2% were multiple fallers
• 94.4% of floor-transfer-independent adults were non-fallers in the past 6 months
• 52.9% of the dependent group used two-handed assistive devices indoors; 88.2% used them outdoors
• 83.3% of the independent group required no caregiver support; 64.7% of the dependent group needed at least daily caregiver support
• Parallel reliability between self-reported floor transfer ability and actual floor transfer test performance was 0.92 (95% CI, 0.88-0.97)
• ADL status, IADL status, number of chronic diagnoses, number of medications, number of ED visits, hospitalizations, fall history, assistive device use, ambulatory status, and caregiver support all differed significantly across groups (P < .05)

Limitations

• Convenience sample of 45 participants from a single urban area limits generalizability
• Retrospective self-report of falls, hospitalizations, emergency visits, and diagnoses is susceptible to recall bias
• Many participants in the dependent and assisted groups were former patients of the principal investigator, introducing possible selection bias
• Psychosocial factors such as depression, motivation, and self-efficacy were not assessed and may have influenced floor transfer performance

Why it matters

For patients

Older adults who struggle to get up from the floor are likely to have multiple health problems and higher fall risk, and should ask their physical therapist about floor transfer training as part of routine care.

For clinicians

Floor transfer testing or a single self-reported question can efficiently identify highly dependent older adults in community or home care settings, guiding more intensive evaluation and backward-chaining rehabilitation programs.

For readers

This study provides the first comprehensive profile of health characteristics associated with floor transfer dependency in older adults, supporting its inclusion as a standard geriatric functional assessment item.