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STRATIFY Risk Assessment Tool
STRATIFY: Answer Yes/No to 5 risk factors. Score 1 point for every Yes. A total score of 2 or more indicates high risk.
Assess 5 Risk Factors
1. Past Falls
Did the patient present to hospital with a fall, or have they fallen since admission?
2. Agitation
Is the patient agitated (hyperactive delirium, wandering)?
3. Visual Impairment
Is the patient visually impaired to the extent that everyday function is affected?
4. Frequent Toileting
Is the patient in need of especially frequent toileting (e.g., urgency, diuretics, diarrhea)?
5. Transfer and Mobility
Does the patient have a transfer and mobility score of 3 or 4 (unable or requires major help)?
Guidelines & Evidence
Clinical Details
Section 1
When to Use
When to Use
Routine inpatient fall risk screening in acute and subacute hospital wards.
Particularly validated and widely adopted in the UK National Health Service (NHS) and European healthcare systems.
Identifying older adults who require immediate bedside fall prevention protocols.
Simplicity and Speed
Unlike the Morse Fall Scale, the STRATIFY tool consists of just 5 simple yes/no questions, making it one of the fastest inpatient fall risk tools for busy nursing staff to complete during shift handovers.
Section 2
Formula & Logic
Scoring
5 Yes/No items. Score 1 point for every "Yes".
Total score: 0–5
Score ≥ 2 indicates High Risk for falls.
The 5 Items
Past Falls
Did the patient present to hospital with a fall, or have they fallen since admission?
Agitation
Is the patient agitated?
Visual Impairment
Is the patient visually impaired to the extent that everyday function is affected?
Toileting
Is the patient in need of especially frequent toileting?
Transfer and Mobility
Does the patient have a transfer and mobility score of 3 or 4 (unable or requires major help)?
Section 3
Pearls/Pitfalls
Focus on Acute Brain Failure
The inclusion of "Agitation" directly captures hyperactive delirium, which is the leading cause of unassisted bedside falls (e.g., trying to climb over bed rails) in hospitalised older adults.
Section 4
Next Steps
Management
Section 5
Evidence Appraisal
Primary Reference
Development and evaluation of evidence based risk assessment tool (STRATIFY) to predict which elderly inpatients will fall: case-control and cohort studies.
Oliver D et al. • BMJ.. 1997;315(7115):1049-53. Foundational UK study deriving the 5-point model.
Section 6
Origins
David Oliver
Developed by geriatrician David Oliver at Guy's and St Thomas' Hospitals in London. The goal was to create an evidence-based tool derived entirely from local inpatient epidemiology, replacing subjective nursing judgements about who was likely to fall.
