scholarly journals Development and validation of a mHealth falls risk screening app (FallSA©) among Malaysian Community Dwelling Older Persons (Preprint)

2020 ◽  
Author(s):  
Devinder Kaur Ajit Singh ◽  
Jing Wen Goh ◽  
Muhammad Iqbal Shaharudin ◽  
Suzana Shahar
Keyword(s):  
Risk Assessment ◽  
Predictive Validity ◽  
Fall Risk ◽  
Concurrent Validity ◽  
Older Persons ◽  
Screening Tool ◽  
Community Dwelling ◽  
Discriminative Ability ◽  
Validity Test ◽  
Falls Risk

BACKGROUND Recent falls prevention guidelines recommend early routine falls risk assessment among older persons. OBJECTIVE The purpose of current study was to develop a Falls Screening Mobile Application (FallSA©), determine its acceptance, concurrent validity, test-retest reliability, discriminative ability and predictive validity as a self-screening tool to identify falls risk among Malaysian older persons. METHODS FallSA© acceptance was tested among 15 participants (mean age: 65.93±7.42 years); its validity and reliability among 91 participants (mean age: 67.34±5.97); discriminative ability and predictive validity among 610 participants (mean age: 71.78±4.70). Acceptance of FallSA© was assessed using a questionnaire and it was validated against a comprehensive falls risk assessment tool, Physiological Profile Assessments (PPA). Participants used FallSA© to test their falls risk repeatedly twice between an hour. Its discriminative ability and predictive validity were determined by comparing participants fall risk scores between fallers and non-fallers and prospectively through a 6 months follow-up respectively RESULTS The findings of our study showed that FallSA© had a high acceptance level with 80% older persons agreeing on its suitability as a falls self-screening tool. Concurrent validity test demonstrated a significant moderate correlation (rs= 0.518, P<0.001) and agreement (K= 0.516, P<0.001) with acceptable sensitivity (80.4%) and specificity (71.1%). FallSA© also had good reliability (ICC: 0.948, CI: 0.921-0.966) and an internal consistency (α= 0.948, P<0.001). FallSA© score demonstrated a moderate to strong discriminative ability in classifying fallers and non-fallers. FallSA© had a predictive validity of falls with positive likelihood ratio of 2.27, pooled sensitivity of 82% and specificity of 64%, and AUC of 0.802. CONCLUSIONS These results suggest that FallSA© is a valid and reliable fall risk self-screening tool. Further studies are required to empower and engage older persons or care givers in the use of FallSA© to self-screen for falls and thereafter to seek early prevention intervention. CLINICALTRIAL NA

scholarly journals Correction: A Mobile App (FallSA) to Identify Fall Risk Among Malaysian Community-Dwelling Older Persons: Development and Validation Study (Preprint)

2021 ◽  
Author(s):  
Devinder Kaur Ajit Singh ◽  
Jing Wen Goh ◽  
Muhammad Iqbal Shaharudin ◽  
Suzana Shahar
Keyword(s):  
Risk Assessment ◽  
Predictive Validity ◽  
Fall Risk ◽  
Concurrent Validity ◽  
Older Persons ◽  
Screening Tool ◽  
Mobile App ◽  
Discriminative Ability ◽  
Fall Risk Assessment ◽  
Validity Test

BACKGROUND Recent falls prevention guidelines recommend early routine fall risk assessment among older persons. OBJECTIVE The purpose of this study was to develop a Falls Screening Mobile App (FallSA), determine its acceptance, concurrent validity, test-retest reliability, discriminative ability, and predictive validity as a self-screening tool to identify fall risk among Malaysian older persons. METHODS FallSA acceptance was tested among 15 participants (mean age 65.93 [SD 7.42] years); its validity and reliability among 91 participants (mean age 67.34 [SD 5.97] years); discriminative ability and predictive validity among 610 participants (mean age 71.78 [SD 4.70] years). Acceptance of FallSA was assessed using a questionnaire, and it was validated against a comprehensive fall risk assessment tool, the Physiological Profile Assessment (PPA). Participants used FallSA to test their fall risk repeatedly twice within an hour. Its discriminative ability and predictive validity were determined by comparing participant fall risk scores between fallers and nonfallers and prospectively through a 6-month follow-up, respectively. RESULTS The findings of our study showed that FallSA had a high acceptance level with 80% (12/15) of older persons agreeing on its suitability as a falls self-screening tool. Concurrent validity test demonstrated a significant moderate correlation (r=.518, P<.001) and agreement (k=.516, P<.001) with acceptable sensitivity (80.4%) and specificity (71.1%). FallSA also had good reliability (intraclass correlation .948; 95% CI .921-.966) and an internal consistency (α=.948, P<.001). FallSA score demonstrated a moderate to strong discriminative ability in classifying fallers and nonfallers. FallSA had a predictive validity of falls with positive likelihood ratio of 2.27, pooled sensitivity of 82% and specificity of 64%, and area under the curve of 0.802. CONCLUSIONS These results suggest that FallSA is a valid and reliable fall risk self-screening tool. Further studies are required to empower and engage older persons or care givers in the use of FallSA to self-screen for falls and thereafter to seek early prevention intervention.

scholarly journals A Mobile App (FallSA) to Identify Fall Risk Among Malaysian Community-Dwelling Older Persons: Development and Validation Study

10.2196/23663 ◽  
2021 ◽  
Vol 9 (10) ◽  
pp. e23663
Author(s):  
Devinder Kaur Ajit Singh ◽  
Jing Wen Goh ◽  
Muhammad Iqbal Shaharudin ◽  
Suzana Shahar
Keyword(s):  
Risk Assessment ◽  
Predictive Validity ◽  
Fall Risk ◽  
Concurrent Validity ◽  
Older Persons ◽  
Screening Tool ◽  
Mobile App ◽  
Discriminative Ability ◽  
Fall Risk Assessment ◽  
Validity Test

Background Recent falls prevention guidelines recommend early routine fall risk assessment among older persons. Objective The purpose of this study was to develop a Falls Screening Mobile App (FallSA), determine its acceptance, concurrent validity, test-retest reliability, discriminative ability, and predictive validity as a self-screening tool to identify fall risk among Malaysian older persons. Methods FallSA acceptance was tested among 15 participants (mean age 65.93 [SD 7.42] years); its validity and reliability among 91 participants (mean age 67.34 [SD 5.97] years); discriminative ability and predictive validity among 610 participants (mean age 71.78 [SD 4.70] years). Acceptance of FallSA was assessed using a questionnaire, and it was validated against a comprehensive fall risk assessment tool, the Physiological Profile Assessment (PPA). Participants used FallSA to test their fall risk repeatedly twice within an hour. Its discriminative ability and predictive validity were determined by comparing participant fall risk scores between fallers and nonfallers and prospectively through a 6-month follow-up, respectively. Results The findings of our study showed that FallSA had a high acceptance level with 80% (12/15) of older persons agreeing on its suitability as a falls self-screening tool. Concurrent validity test demonstrated a significant moderate correlation (r=.518, P<.001) and agreement (k=.516, P<.001) with acceptable sensitivity (80.4%) and specificity (71.1%). FallSA also had good reliability (intraclass correlation .948; 95% CI .921-.966) and an internal consistency (α=.948, P<.001). FallSA score demonstrated a moderate to strong discriminative ability in classifying fallers and nonfallers. FallSA had a predictive validity of falls with positive likelihood ratio of 2.27, pooled sensitivity of 82% and specificity of 64%, and area under the curve of 0.802. Conclusions These results suggest that FallSA is a valid and reliable fall risk self-screening tool. Further studies are required to empower and engage older persons or care givers in the use of FallSA to self-screen for falls and thereafter to seek early prevention intervention.

scholarly journals 21 Fall Risk Assessment Outcomes in Community Dwelling Elderly Patients on Warfarin (FRAIL-W)

2019 ◽  
Vol 48 (Supplement_4) ◽  
pp. iv6-iv8
Author(s):  
Syarifah Nurul Ain ◽  
Liew Houng Bang ◽  
Premala Subramaniam ◽  
Ho Hee Kheen
Keyword(s):  
Risk Factors ◽  
Risk Assessment ◽  
Elderly Patients ◽  
Fall Risk ◽  
Warfarin Therapy ◽  
Community Dwelling ◽  
Bleeding Complications ◽  
Fall Risk Assessment ◽  
Falls Risk ◽  
Severity Of Injury

Abstract Background Elderly patients on warfarin are prone to experience severe bleeding complications when they fall. In warfarin clinic, they are not routinely screened for falls risk before starting on warfarin therapy. The purpose of our study was to determine the incidence of fall and its associated factors, severity of injury following fall and grading of falls risk among community dwelling elderly patients on warfarin in two tertiary hospitals in Sabah. Methods This is a cross-sectional study conducted in warfarin outpatient clinic, Hospital Queen Elizabeth and Hospital Queen Elizabeth II for 10 weeks (Mac-May 2019). Inclusion; patients aged ≥60 years old, on lifelong warfarin therapy. Exclusion; dementia, psychosis, severe cognitive impairment, institutionalised, inability to stand. Face-to-face interviews were done using Falls Risk for Older People – Community (FROP-Com) and Timed Up and Go (TUG) test. Results Out of 162 patients, majority were males (65.4%), Chinese (50.6%), married (93.2%), stays with family (96.9%) and had secondary education (42.6%). Mean age was 70 years old. 82.1% of them had atrial fibrillation; 63.2% had low CHA2DS2VASC score (less than 4) and 91.7% had low HAS-BLED score (less than 3). 22 patients (13.6%) experienced actual fall in past 12 months; only 1 patient experienced major injury. FROP-Com showed majority 133 patients (82.1%) were at low risk of fall. Risk factors of fall include polypharmacy and comorbidity affecting balance and mobility. Mean TUG test score was high; 13.7 seconds. Conclusion Fall incidence among patients on warfarin is substantial. Risk factors include polypharmacy and comorbidity affecting balance and mobility. This interim analysis showed majority patients had low fall risk (82.1% on FROP-Com, 58.0% on TUG test). Among fallers, FROP-Com risk score was moderate-high in 10 patients (45.5%). Further analysis could reveal potential value of these tests in refining fall risk assessment in this group of patients.

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 Screening Community-Living Older Adults for Protein Energy Malnutrition and Frailty: Update and Next Steps

2019 ◽  
Vol 45 (3) ◽  
pp. 640-660 ◽  
Author(s):  
Johanna T. Dwyer ◽  
Jaime J. Gahche ◽  
Mary Weiler ◽  
Mary Beth Arensberg
Keyword(s):  
Older Adults ◽  
Predictive Validity ◽  
Screening Tool ◽  
Protein Energy Malnutrition ◽  
The United States ◽  
Community Dwelling ◽  
Screening Tools ◽  
World Health ◽  
Community Settings ◽  
Protein Energy

Abstract Protein-energy malnutrition (PEM)/undernutrition and frailty are prevalent, overlapping conditions impacting on functional and health outcomes of older adults, but are frequently unidentified and untreated in community settings in the United States. Using the World Health Organization criteria for effective screening programs, we reviewed validity, reliability, and feasibility of data-driven screening tools for identifying PEM and frailty risk among community-dwelling older adults. The SCREEN II is recommended for PEM screening and the FRAIL scale is recommended as the most promising frailty screening tool, based on test characteristics, cost, and ease of use, but more research on both tools is needed, particularly on predictive validity of favorable outcomes after nutritional/physical activity interventions. The Malnutrition Screening Tool (MST) has been recommended by one expert group as a screening tool for all adults, regardless of age/care setting. However, it has not been tested in US community settings, likely yields large numbers of false positives (particularly in community settings), and its predictive validity of favorable outcomes after nutritional interventions is unknown. Community subgroups at highest priority for screening are those at increased risk due to prior illness, certain demographics and/or domiciliary characteristics, and those with BMI < 20 kg/m2 or < 22 if > 70 years or recent unintentional weight loss > 10% (who are likely already malnourished). Community-based health professionals can better support healthy aging by increasing their awareness/use of PEM and frailty screening tools, prioritizing high-risk populations for systematic screening, following screening with more definitive diagnoses and appropriate interventions, and re-evaluating and revising screening protocols and measures as more data become available.

scholarly journals FALLS AND NUTRITIONAL RISK AMONG RURAL STATE RESIDENTS

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S471-S471
Author(s):  
Mariana Wingood ◽  
Nancy M Gell ◽  
Emily Tarleton
Keyword(s):  
Food Insecurity ◽  
Fall Risk ◽  
Screening Tool ◽  
Metropolitan Areas ◽  
Community Dwelling ◽  
Nutritional Risk ◽  
Rural Residents ◽  
Fall Risk Factor ◽  
Fall Rates ◽  
Nutritional Data

Abstract Vermont continues to have one of the nation’s highest fall rates and its rurality may be a contributing factor. The purpose of our study was to compare fall history and nutritional risk (a fall risk factor also associated with rurality) in participants from rural and metropolitan areas. We collected data at statewide community-based fall risk screenings. During the events, nutritional data was collected using the DETERMINE Your Nutritional Health Screening Tool Questionnaire. We used descriptive statistics (chi2) to examine the relationship between fall history, nutritional risk, and rurality. From 123 subjects, 67% were classified as rural residents. There was no relationship between fall history and nutritional risk (p=0.6). Compared to rural residents, a significantly higher percentage of those living in metropolitan areas reported falls (54% versus 35% p=0.05). However, metropolitan residents were not at higher nutritional risk (49% versus 54%, p=0.61). National nutritional risk rates are lacking, but food insecurity is associated with nutritional risk. Our overall reported high nutritional risk (20%) is higher than the prevalence of food insecurity, both nationally (11%) and in Vermont (9%). In conclusion, we did not identify a relationship between fall history and nutritional risk. We did find a higher percentage of metropolitan residents reporting falls. Furthermore, we identified that DETERMINE is a feasible nutritional screening tool to use at fall risk screenings. It can be used to identify community-dwelling older adults at nutritional risk, but it may not have the sensitivity to identify an association between nutritional risk and falls.

scholarly journals Functional Gait Assessment: Concurrent, Discriminative, and Predictive Validity in Community-Dwelling Older Adults

2010 ◽  
Vol 90 (5) ◽  
pp. 761-773 ◽  
Author(s):  
Diane M. Wrisley ◽  
Neeraj A. Kumar
Keyword(s):  
Older Adults ◽  
Predictive Validity ◽  
Fall Risk ◽  
Small Sample Size ◽  
Small Sample ◽  
Community Dwelling ◽  
Cutoff Score ◽  
Gait Assessment ◽  
Functional Gait ◽  
Community Dwelling Older Adults

BackgroundThe Functional Gait Assessment (FGA) is a reliable and valid measure of gait-related activities.ObjectiveThe purpose of this study was to determine the concurrent, discriminative, and predictive validity of the FGA in community-dwelling older adults.DesignThis was a prospective cohort study.MethodsThirty-five older adults aged 60 to 90 years completed the Activities-specific Balance Confidence Scale (ABC), Berg Balance Scale (BBS), Dynamic Gait Index (DGI), Timed “Up & Go” Test (TUG), and Functional Gait Assessment (FGA) during one session. Falls were tracked by having participants complete a monthly fall calendar for 6 months. Spearman correlation coefficients were used to determine concurrent validity among the ABC, BBS, TUG, DGI, and FGA. To determine the optimum scores to classify fall risk, sensitivity (Sn), specificity (Sp), and positive and negative likelihood ratios (LR+ and LR−) were calculated for the FGA in classifying fall risk based on the published criterion scores of the DGI and TUG and for the FGA, TUG, and DGI in identifying prospective falls. Receiver operator curves with area under the curve were used to determine the effectiveness of the FGA in classifying fall risk and of the DGI, TUG, and FGA in identifying prospective falls.ResultsThe FGA correlated with the ABC (r=.053, P&lt;.001), BBS (r=.84, P&lt;.001), and TUG (r=−.84, P&lt;.001). An FGA score of ≤22/30 provides both discriminative and predictive validity. The FGA (scores ≤22/30) provided 100% Sn, 72% Sp, LR+ of 3.6, and LR− of 0 to predict prospective falls.LimitationsThe study was limited by the length of time of follow-up and the small sample size that did not allow for evaluation of criterion scores by decade.ConclusionsThe FGA with a cutoff score of 22/30 is effective in classifying fall risk in older adults and predicting unexplained falls in community-dwelling older adults.

scholarly journals International classification of function, disability and health framework for fall risk stratification in community dwelling older adults

2017 ◽  
Vol 3 (1) ◽  
Author(s):  
Majumi M. Noohu ◽  
Aparajit B. Dey ◽  
Shashi Sharma ◽  
Mohammed E. Hussain
Keyword(s):  
Older Adults ◽  
Risk Assessment ◽  
Odds Ratio ◽  
Fall Risk ◽  
Adjusted Odds Ratio ◽  
Community Dwelling ◽  
Disability And Health ◽  
Fall Risk Assessment ◽  
Community Dwelling Older Adults

Falls is an important cause for mortality and morbidity in older adults. The fall risk assessment is an integral component of fall prevention in older adults. The international classification of function, disability and health (ICF) can be an ideal comprehensive model for fall risk assessment. There is lack of information relating ICF and fall risk assessment in community dwelling older adults. In this study we tried to assess the fall risk using different domains of ICF using various clinical tools. A total of 255 subjects were recruited through convenient sampling method from geriatric clinic (OPD) of All India Institute of Medical Sciences, New Delhi. The study was single session cross-section design. The body mass index (BMI), grip strength, depression score (Geriatric depression scale:short form; GDS-S) and co morbidities were used to assess body function and structure domain, timed up and go (TUG), Berg balance scale (BBS) and elderly fall screening test (EFST) scores were used for activity domain, selfreported cause of fall, medications and uses of assistive device for environmental factors. Then the association of body function and structure, activity and environmental factors were determined with falls. There was an association of fall in analysis in subjects with no fall and one or more falls for, BMI, grip strength (kg), GDS-S score, no. of co morbidities, chronic pain, TUG, BBS, TUG (s), BBS, EFST, slip/trip, walking cane, hypoglycemic and antihypertensives medications (unadjusted and adjusted odds ratio).The diabetes, and hyper tension showed association for adjusted odds ratio only. In subjects with one fall and more than one fall, TUG, BBS, EFST, GDS-S score, NSAIDS and antidepressants use showed a significant association with fall (unadjusted and adjusted odds ratio). The ICF may be used in routine for fall risk assessment in community dwelling older adults.

Looking for frailty in community-dwelling older persons: The Gerontopole Frailty Screening Tool (GFST)

2013 ◽  
Vol 17 (7) ◽  
pp. 629-631 ◽  
Author(s):  
B. Vellas ◽  
L. Balardy ◽  
S. Gillette-Guyonnet ◽  
G. Abellan Van Kan ◽  
A. Ghisolfi-Marque ◽  
...  
Keyword(s):  
Older Persons ◽  
Screening Tool ◽  
Community Dwelling
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