Characteristics of Older Adults Who Are Unable to Perform a Floor Transfer: Considerations for Clinical Decision-Making

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Background and Purpose:

The ability to get down and up from the floor or to perform a floor transfer (FT) is a vital and useful skill for older adults at risk of falling. Little is known about the health-related factors that separate older adults who can perform FT independently from those who cannot. Therefore, the specific aims of this cross-sectional study are to (1) describe and compare health-related factors among older adults who were independent, assisted, or dependent in FT performance; and (2) establish the parallel reliability between self-reported and actual performance of FT.


A total of 46 community-dwelling adults ages 65 to 96 years were recruited using a stratified sampling technique based on self-reported levels of FT ability: independent (n = 15), assisted (n = 15), or dependent (n = 15). Participants were asked to perform the actual FT test and were categorized according to test result as independent (n = 18), assisted (n = 10), or dependent (n = 17). Sociodemographic and health-related factors of participants were separated into 3 FT test outcome groups. The Kruskal-Wallis test was used to compare these factors across the 3 FT test outcome groups. The quadratic-weighted κ coefficient was calculated to determine the agreement between self-reported FT ability and FT test performance.


Significant differences were observed among the FT test outcome groups based on all sociodemographic and health-related factors (P < .05). Older adults who were dependent in FT were older and dependent in instrumental activities of daily living (IADL, 100%). Also, this group required some type of help during basic activities of daily living (ADL, 35.3%), which reflected a homebound status and the need for caregiver support, including the use of 2-handed assistive devices during ambulation. More than half the participants in this category had fallen at least once in the past 6 months. Conversely, older adults who were independent in FT were younger and living independently in the community (83.3%). The parallel reliability between the self-reported FT ability and actual FT test performance was 0.92 (95% confidence interval, 0.88-0.97).


Sociodemographic and health-related factors were significantly different among older adults who demonstrated varying abilities on the FT test. This study has shown that the self-reported FT ability and actual FT test performance represented reliable alternative forms to assess the ability to transfer from a standing to a supine position on the floor and then back to an erect position. Evaluation of FT ability and/or performance is recommended as a standard component of geriatric functional assessment to make more informed clinical decision in providing effective physical therapy interventions.

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