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 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<.001), BBS (r=.84, P<.001), and TUG (r=−.84, P<.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 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 Management of Falls in Community-Dwelling Older Adults: Clinical Guidance Statement From the Academy of Geriatric Physical Therapy of the American Physical Therapy Association

2015 ◽  
Vol 95 (6) ◽  
pp. 815-834 ◽  
Author(s):  
Keith G. Avin ◽  
Timothy A. Hanke ◽  
Neva Kirk-Sanchez ◽  
Christine M. McDonough ◽  
Tiffany E. Shubert ◽  
...  
Keyword(s):  
Older Adults ◽  
Physical Therapy ◽  
Fall Risk ◽  
Gap Analysis ◽  
Physical Therapists ◽  
Community Dwelling ◽  
Health Concern ◽  
Clinical Guidance ◽  
Practice Committee ◽  
Community Dwelling Older Adults

Background Falls in older adults are a major public health concern due to high prevalence, impact on health outcomes and quality of life, and treatment costs. Physical therapists can play a major role in reducing fall risk for older adults; however, existing clinical practice guidelines (CPGs) related to fall prevention and management are not targeted to physical therapists. Objective The purpose of this clinical guidance statement (CGS) is to provide recommendations to physical therapists to help improve outcomes in the identification and management of fall risk in community-dwelling older adults. Design and Methods The Subcommittee on Evidence-Based Documents of the Practice Committee of the Academy of Geriatric Physical Therapy developed this CGS. Existing CPGs were identified by systematic search and critically appraised using the Appraisal of Guidelines, Research, and Evaluation in Europe II (AGREE II) tool. Through this process, 3 CPGs were recommended for inclusion in the CGS and were synthesized and summarized. Results Screening recommendations include asking all older adults in contact with a health care provider whether they have fallen in the previous year or have concerns about balance or walking. Follow-up should include screening for balance and mobility impairments. Older adults who screen positive should have a targeted multifactorial assessment and targeted intervention. The components of this assessment and intervention are reviewed in this CGS, and barriers and issues related to implementation are discussed. Limitations A gap analysis supports the need for the development of a physical therapy–specific CPG to provide more precise recommendations for screening and assessment measures, exercise parameters, and delivery models. Conclusion This CGS provides recommendations to assist physical therapists in the identification and management of fall risk in older community-dwelling adults.

scholarly journals Functional Balance Assessment of Older Community Dwelling Adults: A Systematic Review of the Literature

2007 ◽  
Author(s):  
Felicity Langley ◽  
Shylie Mackintosh
Keyword(s):  
Older Adults ◽  
Concurrent Validity ◽  
Berg Balance Scale ◽  
Community Dwelling ◽  
Balance Assessment ◽  
Timed Up And Go ◽  
Functional Balance ◽  
Balance Scale ◽  
Balance Tests ◽  
Community Dwelling Older Adults

Background: For allied health professionals wishing to assess the functional balance of older adults living in the community, the vast number of functional balance tests available makes it difficult to decide which assessment is most appropriate. Objective: To identify the reliability, concurrent validity and clinical practicality of functional balance tests with community dwelling older adults. Methods: A systematic review of published literature relevant to 17 functional balance tests was undertaken. The 17 functional balance tests were identified by a preliminary literature search and through consultation with an expert in the field of functional balance assessment. Studies published in English before January 2007, assessing the use of these functional balance tests with community dwelling adults aged 65 years or above were included. The CINAHL, MEDLINE, Ageline, Amed, PubMed, Cochrane library, PEDro and Joanna Briggs Institute databases were searched. The methodological quality of studies was assessed using a checklist criteria adapted from the Cochrane Working Group for Screening and Diagnostic Tests. Results: Eight databases were searched and 21 studies were included. The majority of studies demonstrated low to moderate methodological quality scores. Despite limitations reported for clinical application with community dwelling older adults, the Berg Balance Scale and the Timed Up and Go Test have been most rigorously tested. Reliability and concurrent validity of the Balance Screening Tool and the Fullerton Advanced Balance Scale had also been established in this population, however only one study was retrieved for each. Conclusion: The Berg Balance Scale and Timed Up and Go Test have published reliability, validity with community dwelling older adults. Further testing of other functional balance tests is required to establish their reliability and validity in this target population.

The Diagnostic Accuracy of the Berg Balance Scale in Predicting Falls

2016 ◽  
Vol 39 (11) ◽  
pp. 1502-1525 ◽  
Author(s):  
Seong-Hi Park ◽  
Young-Shin Lee
Keyword(s):  
Predictive Validity ◽  
Neuromuscular Disease ◽  
Fall Risk ◽  
Screening Tool ◽  
Berg Balance Scale ◽  
Balance Scale ◽  
Statistical Heterogeneity ◽  
Risk Of Falls ◽  
Fall Risks ◽  
Accuracy Curve

This study aimed to evaluate the predictive validity of the Berg Balance Scale (BBS) as a screening tool for fall risks among those with varied levels of balance. A total of 21 studies reporting predictive validity of the BBS of fall risk were meta-analyzed. With regard to the overall predictive validity of the BBS, the pooled sensitivity and specificity were 0.72 and 0.73, respectively; the accuracy curve area was 0.84. The findings showed statistical heterogeneity among studies. Among the sub-groups, the age group of those younger than 65 years, those with neuromuscular disease, those with 2+ falls, and those with a cutoff point of 45 to 49 showed better sensitivity with statistically less heterogeneity. The empirical evidence indicates that the BBS is a suitable tool to screen for the risk of falls and shows good predictability when used with the appropriate criteria and applied to those with neuromuscular disease.

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.

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.

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