Multidimensional risk score to stratify community-dwelling older adults by future fall risk using the Stopping Elderly Accidents, Deaths and Injuries (STEADI) framework

2020 ◽  
pp. injuryprev-2020-044014
Author(s):  
Brian C Helsel ◽  
Karen A Kemper ◽  
Joel E Williams ◽  
Khoa Truong ◽  
Marieke Van Puymbroeck
Keyword(s):  
Older Adults ◽  
High Risk ◽  
Predictive Model ◽  
Fall Risk ◽  
Fear Of Falling ◽  
Alternative Interpretation ◽  
Community Dwelling ◽  
Point Method ◽  
Risk Estimates ◽  
Stratification Method

BackgroundThe Stopping Elderly Accidents, Deaths and Injuries (STEADI) screening algorithm aligns with current fall prevention guidelines and is easy to administer within clinical practice. However, the stratification into low, moderate and high risk categories limits the meaningful interpretation of the fall-related risk factors.MethodsBaseline measures from a modified STEADI were used to predict self-reported falls over 4 years in 3170 respondents who participated in the 2011–2015 National Health and Aging Trends Study. A point method was then applied to find coefficient-based integers and 4-year fall risk estimates from the predictive model. Sensitivity and specificity estimates from the point method and the combined moderate and high fall risk STEADI categories were compared.ResultsThere were 886 (27.95%) and 387 (12.21%) respondents who were classified as moderate and high risk, respectively, when applying the stratification method. Falls in the past year (OR: 2.16; 95% CI: 1.61 to 2.89), multiple falls (OR: 2.94; 95% CI: 1.89 to 4.55) and a fear of falling (OR: 1.77; 95% CI: 1.45 to 2.16) were among the significant predictors of 4-year falls in older adults. The point method revealed integers that ranged from 0 (risk: 27.21%) to 44 (risk: 99.71%) and a score of 10 points had comparable discriminatory capacity to the combined moderate and high STEADI categories.ConclusionCoefficient-based integers and their risk estimates can provide an alternative interpretation of a predictive model that may be useful in determining fall risk within a clinical setting, tracking changes longitudinally and defining the effectiveness of an intervention.

scholarly journals EXPERIENCES AND FACILITATORS OF FALLS PREVENTION AMONG ETHNICALLY DIVERSE OLDER ADULTS: A QUALITATIVE STUDY

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S854-S854
Author(s):  
Ladda Thiamwong ◽  
Norma E Conner
Keyword(s):  
Older Adults ◽  
Fall Prevention ◽  
Fall Risk ◽  
Fear Of Falling ◽  
Ethnically Diverse ◽  
Role Identity ◽  
Community Dwelling ◽  
Falls Prevention ◽  
Facilitators And Barriers ◽  
And Behaviors

Abstract Background: Falls increase as people age and decrease the quality of life. Even though fall interventions have received great attention, fall incidence rates have still arisen. In order for older adults to reap the benefits of evidence-based fall interventions, a challenge of implementation in the real world and right context must be met. Understanding experiences, facilitators, and barriers of fall prevention among four major ethnic groups in the Unites States could be extremely valuable. Objective: The aim of this study was to describe experiences and highlight facilitators and barriers on fall and fear of falling interventions among ethnically diverse community-dwelling older adults. Methods: Four ethnically specified (African American, Asian, Hispanic and Non-Hispanic White) focus groups were conducted. A total of 28 older adults and four family caregivers were interviewed. Interviews covered experiences on falls and fear of falling, attitudes, factors, consequences, risk assessment, and interventions. Data were organized and analyzed with the NViVo software. Results: Falls related experiences and behaviors were multifaceted and varied. Three themes related to falls experiences and behaviors were identified, 1) falls prevention versus fear of falling amplification; 2) role identity, culture and family considerations; and 3) take care of you, take care of me. Facilitators of fall prevention were integration of individual learning within a group meeting, providing appropriate assistive devices and promoting environmental safety. Barriers were inconsistent fall risk assessments, low fall risk awareness and acknowledgment, and balance and visual impairment.

scholarly journals 111 Disparities between Actual and Perceived Fall Risk Affect Participation in 5 Fall Prevention Interventions

2019 ◽  
Vol 48 (Supplement_4) ◽  
pp. iv18-iv27
Author(s):  
Pey June Tan ◽  
Silvia Sim ◽  
Noor Hafizah Ismail ◽  
Jagadish Mallya ◽  
Angelique Chan ◽  
...  
Keyword(s):  
Older Adults ◽  
Fall Prevention ◽  
Fall Risk ◽  
Help Seeking ◽  
Fear Of Falling ◽  
Community Dwelling ◽  
Falls Prevention ◽  
Risk Level ◽  
Prevention Interventions ◽  
Aware Group

Abstract Introduction Older adults have been found to under- or overestimate their fall risk. However, no studies have investigated implications on help-seeking behaviours in falls prevention. This study examines how disparities between actual and perceived fall risk affects participation in 5 fall prevention interventions among community-dwelling older adults in Singapore. Methods This was a cross-sectional survey of a nationally representative sample of community-dwelling adults aged ≥60 years in Singapore identified by stratified random sampling. Having previous falls in the past 12 months (faller/non-faller) indicated actual fall risk. Level of fear-of-falling (cut-off ≥23 on 16-item Falls Efficacy Scale International) was used as perceived fall risk (high/low). Four profiles based on combinations of actual and perceived risk were associated with participation in 5 fall prevention interventions in a multiple logistic regression. The model was adjusted for age, gender, ≥2 comorbidities and knowledge that the intervention is to prevent falls. Results Final analysis included 549 older adults (mean age 70.6±6.9 years, 61% females). Majority (46%) were in the Vigorous group (no falls, low fear), 35% Anxious (no falls, high fear), 11% Frail Aware (falls, high fear) and 8% Stoics (falls, low fear). Only those in Anxious and Frail Aware group were significantly more likely to have talked to a healthcare professional on strategies to avoid falls [OR 1.8 (1.1-3.1) and 3.2 (1.6-6.4) respectively] and made home modifications [OR 1.9 (1.3-2.8) and 2.0 (1.1-3.6)] after adjustments. No association was found for participation in exercise, medication review and falls education. Discussion Individual profiles with high fear-of-falling component have different help-seeking behaviours compared to those with low fear regardless of history of falls. However, individuals in Frail Aware group have higher likelihood to uptake the interventions compared to Anxious group. Future research should examine other drivers of behaviour that will influence participation in other interventions.

scholarly journals Development and validation of a robotic multifactorial fall-risk predictive model: A one-year prospective study in community-dwelling older adults

PLoS ONE ◽  
2020 ◽  
Vol 15 (6) ◽  
pp. e0234904
Author(s):  
Alberto Cella ◽  
Alice De Luca ◽  
Valentina Squeri ◽  
Sara Parodi ◽  
Francesco Vallone ◽  
...  
Keyword(s):  
Older Adults ◽  
Prospective Study ◽  
Predictive Model ◽  
Fall Risk ◽  
Community Dwelling ◽  
One Year ◽  
Development And Validation ◽  
Community Dwelling Older Adults

scholarly journals THE RELATIONSHIP OF FRAILTY, FEAR OF FALLING, AND DEPRESSION WITH HRQOL IN HIGH-RISK OLDER ADULTS

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S877-S877
Author(s):  
Michelle A McKay ◽  
Linda Copel ◽  
Catherine Todd-Magel
Keyword(s):  
Risk Factors ◽  
Older Adults ◽  
High Risk ◽  
Physical Functioning ◽  
Fear Of Falling ◽  
Well Being ◽  
Community Dwelling ◽  
Mental Functioning ◽  
Community Dwelling Older Adults ◽  
The Relationship

Abstract One in four older adults fall every year. Falls result in negative outcomes including decreased health-related quality of life (HRQoL). Frailty, fear of falling, depression, and HRQoL are not routinely screened in high-risk community-dwelling older adults. Continued study of modifiable fall risk factors is warranted due to varied reported prevalence rates, inconsistent definitions and the persistent high rate of falls resulting in poor HRQoL. The purpose of the study was to determine the relationship between frailty, fear of falling, and depression with physical and mental functioning and well-being measures of HRQoL in community-dwelling older adults 55 years of age and older. A cross-sectional correlational design and chart review were conducted. The sample consisted of 84 primarily African American (81%) nursing home eligible members of the Program for All-Inclusive Care for the Elderly (PACE) program. Data were analyzed with correlational statistics, multiple linear, and hierarchical regression models. Physical functioning and well-being measures were significantly decreased when compared to the general population. Increased frailty, fear of falling, and depression were associated with decreased physical and mental well-being. In the regression model, frailty and fear of falling were significant predictors of decreased physical functioning and well-being, and depression was a significant predictor of decreased mental functioning and well-being. This study provides clarification of the relationship between frailty, fear of falling, and depression with HRQoL in high-risk older adults. Screening for common modifiable risk factors can assist in the development of targeted interventions and treatments to improve HRQoL in high-risk older adults.

scholarly journals Use of the Berg Balance Scale for Predicting Multiple Falls in Community-Dwelling Elderly People: A Prospective Study

2008 ◽  
Vol 88 (4) ◽  
pp. 449-459 ◽  
Author(s):  
Susan W Muir ◽  
Katherine Berg ◽  
Bert Chesworth ◽  
Mark Speechley
Keyword(s):  
Older Adults ◽  
High Risk ◽  
Predictive Validity ◽  
Fall Risk ◽  
Berg Balance Scale ◽  
Community Dwelling ◽  
Health Concern ◽  
Likelihood Ratios ◽  
Discriminative Ability ◽  
Balance Scale

Background and Purpose Falls are a significant public health concern for older adults; early identification of people at high risk for falling facilitates the provision of rehabilitation treatment to reduce future fall risk. The objective of this prospective cohort study was to examine the predictive validity of the Berg Balance Scale (BBS) for 3 types of outcomes—any fall (≥1 fall), multiple falls (≥2 falls), and injurious falls—by use of sensitivity, specificity, receiver operating characteristic (ROC) curves, area under the curve, and likelihood ratios. Subjects and Methods A sample of 210 community-dwelling older adults received a comprehensive geriatric assessment at baseline, which included the BBS to measure balance. Data on prospective falls were collected monthly for a year. The predictive validity of the BBS for the identification of future fall risk was evaluated. Results The BBS had good discriminative ability to predict multiple falls when ROC analysis was used. However, the use of the BBS as a dichotomous scale, with a threshold of ≤45, was inadequate for the identification of the majority of people at risk for falling in the future, with sensitivities of 25% and 45% for any fall and for multiple falls, respectively. The use of likelihood ratios, maintaining the BBS as a multilevel scale, demonstrated a gradient of risk across scores, with fall risk increasing as scores decreased. Discussion and Conclusion The use of the BBS as a dichotomous scale to identify people at high risk for falling should be discouraged because it fails to identify the majority of such people. The predictive validity of this scale for multiple falls is superior to that for other types of falls, and the use of likelihood ratios preserves the gradient of risk across the whole range of scores.

scholarly journals Differences in fear of falling and fall risk indicators among white and black older adults: a cross sectional study

2019 ◽  
Author(s):  
Allison Anne Bay ◽  
Smrithi Ramachandran ◽  
Hayley A. Silverstein ◽  
Jiayang Song ◽  
Ariel R. Hart ◽  
...  
Keyword(s):  
Older Adults ◽  
Gait Speed ◽  
Fall Risk ◽  
Fear Of Falling ◽  
Community Dwelling ◽  
Wilcoxon Test ◽  
Risk Indicators ◽  
Physical Component Score ◽  
Component Score ◽  
Community Dwelling Older Adults

Abstract Background Falling among older adults is common and can cause chronic health complications. This study investigated differences between White and Black community-dwelling older adults in fall history, fear of falling, and indicators of fall risk.Methods All assessments and analyses were conducted in a clinical laboratory at Emory University in the Department of General Medicine and Geriatrics on 84 diverse community-dwelling older adults (White, n=37; Black, n=47). Statistical analyses included one-way ANOVA for continuous variables, the Fisher exact test for categorical variables, the Mann-Whitney-Wilcoxon test for ordinal variables, and an ordinal logistic regression model to examine which factors predicted fear of falling. Measures included fall history, fear of falling, and fall risk indicators. The Montreal Cognitive Assessment, Activities-Specific Balance Confidence Score, Gait Speed, Short Form 12 Physical Component Score and Mental Component Score, fear of falling and quality of life rating scales and demographics questionnaires were administered.Results Falls history was not significantly different between groups. Black participants had significantly fewer years of education (p=.007), lower MoCA scores (p=0.002), and slower fast gait speed (p=0.032) than White participants. However, Black participants reported significantly less fear of falling (p=0.043). Race (Black/White) (p=<0.001), sex (p=0.028), preferred gait speed (p=0.036), and a dichotomous variable of use of assistive device for walking (p=0.023) were significant predictors of fear of falling in the logistical model.Conclusions These factors may explain the observed differences in fear of falling observed between white and black groups in this study. This work offers an explanation of possible factors related to the well-documented yet poorly understood fact that while Black older adults have more risk factors for falling, White older adults tend to fall more frequently and are more afraid of falling.

Measuring fear of falling among high-risk, urban, community-dwelling older adults

2016 ◽  
Vol 37 (6) ◽  
pp. 489-495 ◽  
Author(s):  
Sherry A. Greenberg ◽  
Eileen Sullivan-Marx ◽  
Marilyn (Lynn) S. Sommers ◽  
Jesse Chittams ◽  
Pamela Z. Cacchione
Keyword(s):  
Older Adults ◽  
High Risk ◽  
Fear Of Falling ◽  
Urban Community ◽  
Community Dwelling ◽  
Community Dwelling Older Adults

Identification of Optimal Foot Tactile Sensation Threshold for Detecting Fall Risk Among Community-Dwelling Older Adults

2021 ◽  
Author(s):  
Feng Yang
Keyword(s):  
Older Adults ◽  
High Risk ◽  
Fall Risk ◽  
Community Dwelling ◽  
Sensory Loss ◽  
Tactile Sensitivity ◽  
Regression Analyses ◽  
Risk Of Falls ◽  
Logistical Regression ◽  
Community Dwelling Older Adults

Abstract Objective Foot tactile sensitivity loss, commonly assessed by monofilaments, is a fall risk factor among older adults. The broadly used threshold of the monofilament for fall risk assessment in older adults is 5.07. However, this threshold originates from assessing foot ulceration risk in people with peripheral neuropathy. The primary purpose of this study was to identify the optimal filament size and its cutoff number of sensitive sites that can be used to best identify a high risk of falls in terms of the foot tactile sensitivity for community-dwelling older adults. Methods In this cross-sectional study, the foot tactile sensitivity was assessed by a 6-piece Semmes-Weinstein monofilament kit at 9 sites per foot among 94 older adults, including 38 fallers and 56 nonfallers. The number of sensitive sites was determined for each monofilament size as the cutoff. Logistical regression analyses were used to determine the monofilament size and number of sensitive sites best able to differentiate fallers from nonfallers. Results Fallers showed overall worse foot tactile sensory measurements than nonfallers. Logistical regression analyses identified 4.31 as the best monofilament size and 7 as the number of sensitive sites to differentiate fallers from nonfallers with an accuracy of 72.3%. Conclusion The 4.31 monofilament could be the best filament to detect the risk of falls among older adults in terms of tactile sensory loss. Inability to feel the pressure from the 4.31 filament at more than 7 sites could indicate a high risk of falls. Impact These findings could help physical therapists and other rehabilitation professionals improve decision making in detecting older adults with a high risk of falls, thus facilitating the effort of fall prevention in older adults.

Sign in / Sign up

Export Citation Format

Share Document