A Systematic Review of Stair Fall Risk Assessment Instruments in Older Adults.

Objective: To systematically identify and critically appraise stair-related fall-risk assessment instruments for older adults and summarize evidence on their measurement properties and clinical applicability. Data Sources: PubMed, CINAHL, Web of Science, and Cochrane Library were searched from inception through October 2025. Reference lists of included studies and relevant reviews were also screened. Study Selection: Studies were eligible if they included adults aged 60 years or older and evaluated stair-related assessment instruments with at least 1 reported psychometric property. Studies of general fall-risk tools without a stair-specific component, biomechanical studies without a structured assessment instrument, and nonoriginal publications were excluded. Data Extraction: Two reviewers independently screened studies, reviewed full texts, and extracted data using a standardized form. Methodological quality and measurement property findings were evaluated using COnsensus-based Standards for the selection of health Measurement INstruments Risk of Bias standards and criteria for good measurement properties. Data Synthesis: After deduplication, 855 records were screened, 60 full-text articles were assessed, and 10 studies, including 1778 participants, were included. Participants had mean ages ranging from 61.4 to 82.7 years, with reported ages from 65 to 97 years. Studies were conducted in community, clinical, outpatient rehabilitation, and research settings. Instruments were primarily performance-based stair tests, along with 1 clinician-rated observational tool and self-report measures of stair self-efficacy. Reliability and construct validity were the most frequently examined and most consistently supported measurement properties, particularly among performance-based and selected observational instruments. Evidence for predictive validity and responsiveness was limited, with relatively stronger support for stair-negotiation time-based measures. Measurement error was commonly reported but frequently judged indeterminate. No instrument demonstrated comprehensive evaluation across all major measurement properties. Conclusions: Stair-related assessment instruments for older adults show uneven psychometric support. Current evidence most strongly supports selected performance-based and observational measures as complementary components of multifactorial fall-risk assessment rather than stand-alone tools for prognosis or longitudinal monitoring.