A screening tool with five risk factors was developed for fall-risk prediction in community-dwelling elderly

doi:10.1016/J.JCLINEPI.2010.12.014

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A screening tool with five risk factors was developed for fall-risk prediction in community-dwelling elderly

Journal Article•DOI•

A screening tool with five risk factors was developed for fall-risk prediction in community-dwelling elderly

Bienvenu Bongue, Caroline Dupré, Olivier Beauchet¹, Arnaud Rossat, Bruno Fantino¹, Alain Colvez - Show less +2 more•Institutions (1)

University of Angers¹

01 Oct 2011-Journal of Clinical Epidemiology (J Clin Epidemiol)-Vol. 64, Iss: 10, pp 1152-1160

TL;DR: A screening tool with five risk factors and the OLB test could predict falls in healthy community-dwelling older adults.

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About: This article is published in Journal of Clinical Epidemiology.The article was published on 2011-10-01. It has received 105 citations till now. The article focuses on the topics: Framingham Risk Score & Cohort study.

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Journal Article•DOI•

Determining Risk of Falls in Community Dwelling Older Adults: A Systematic Review and Meta-analysis Using Posttest Probability.

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Michelle M. Lusardi¹, Stacy L. Fritz², Addie Middleton, Leslie K Allison³, Mariana Wingood⁴, Emma Phillips⁵, Michelle Criss⁶, Sangita Verma, Jackie Osborne, Kevin K. Chui⁷ - Show less +6 more•Institutions (7)

Sacred Heart University¹, University of South Carolina², Winston-Salem State University³, University of Vermont⁴, University of North Carolina at Chapel Hill⁵, Chatham University⁶, Pacific University⁷

01 Jan 2017-Journal of Geriatric Physical Therapy

TL;DR: Evaluating the predictive ability of history questions, self-report measures, and performance-based measures for assessing fall risk of community-dwelling older adults by calculating and comparing posttest probability (PoTP) values for individual test/measures found no single test/measure demonstrated strong PoTP values.

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Abstract: BACKGROUND: Falls and their consequences are significant concerns for older adults, caregivers, and health care providers. Identification of fall risk is crucial for appropriate referral to preventive interventions. Falls are multifactorial; no single measure is an accurate diagnostic tool. There is limited information on which history question, self-report measure, or performance-based measure, or combination of measures, best predicts future falls. Purpose: First, to evaluate the predictive ability of history questions, self-report measures, and performance-based measures for assessing fall risk of community-dwelling older adults by calculating and comparing posttest probability (PoTP) values for individual test/measures. Second, to evaluate usefulness of cumulative PoTP for measures in combination. Data Sources: To be included, a study must have used fall status as an outcome or classification variable, have a sample size of at least 30 ambulatory community-living older adults (>=65 years), and track falls occurrence for a minimum of 6 months. Studies in acute or long-term care settings, as well as those including participants with significant cognitive or neuromuscular conditions related to increased fall risk, were excluded. Searches of Medline/PubMED and Cumulative Index of Nursing and Allied Health (CINAHL) from January 1990 through September 2013 identified 2294 abstracts concerned with fall risk assessment in community-dwelling older adults. Study Selection: Because the number of prospective studies of fall risk assessment was limited, retrospective studies that classified participants (faller/nonfallers) were also included. Ninety-five full-text articles met inclusion criteria; 59 contained necessary data for calculation of PoTP. The Quality Assessment Tool for Diagnostic Accuracy Studies (QUADAS) was used to assess each study's methodological quality. Data Extraction: Study design and QUADAS score determined the level of evidence. Data for calculation of sensitivity (Sn), specificity (Sp), likelihood ratios (LR), and PoTP values were available for 21 of 46 measures used as search terms. An additional 73 history questions, self-report measures, and performance-based measures were used in included articles; PoTP values could be calculated for 35. Data Synthesis: Evidence tables including PoTP values were constructed for 15 history questions, 15 self-report measures, and 26 performance-based measures. Recommendations for clinical practice were based on consensus. Limitations: Variations in study quality, procedures, and statistical analyses challenged data extraction, interpretation, and synthesis. There was insufficient data for calculation of PoTP values for 63 of 119 tests. Conclusions: No single test/measure demonstrated strong PoTP values. Five history questions, 2 self-report measures, and 5 performance-based measures may have clinical usefulness in assessing risk of falling on the basis of cumulative PoTP. Berg Balance Scale score (=12 seconds), and 5 times sit-to-stand times (>=12) seconds are currently the most evidence-supported functional measures to determine individual risk of future falls. Shortfalls identified during review will direct researchers to address knowledge gaps. Copyright (C) 2016 the Section on Geriatrics of the American Physical Therapy Association Language: en

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320 citations

Journal Article•DOI•

Fall-Risk-Increasing Drugs: A Systematic Review and Meta-analysis: III. Others.

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Lotta J. Seppala¹, Lotta J. Seppala², Esther M.M. van de Glind¹, Esther M.M. van de Glind², Joost G. Daams, Kimberley J. Ploegmakers², Kimberley J. Ploegmakers¹, Max de Vries², Max de Vries¹, Anne M.A.T. Wermelink², Anne M.A.T. Wermelink¹, Nathalie van der Velde², Nathalie van der Velde¹, Hubert Blain, Jean Bousquet, Gösta Bucht, Maria Angeles Caballero-Mora, Tischa J. M. van der Cammen, Patrik Eklund, Marielle H. Emmelot-Vonk, Yngve Gustafson, Sirpa Hartikainen, Rose Anne Kenny, Lucie Laflamme, Francesco Landi, Tahir Masud, Irene O'Byrne-Maguire, Mirko Petrovic, Leocadio Rodriguez, Lotta Seppälä¹, Olle Svensson, Katarzyna Szczerbińska, Heinrich W. Thaler - Show less +29 more•Institutions (2)

Public Health Research Institute¹, University of Amsterdam²

01 Apr 2018-Journal of the American Medical Directors Association

TL;DR: Opioid and antiepileptic use and polypharmacy were significantly associated with increased risk of falling in the meta-analyses, and the causal role of some medication classes as fall-risk-increasing drugs remains unclear.

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178 citations

Journal Article•DOI•

Fall risk-increasing drugs and falls: a cross-sectional study among elderly patients in primary care

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Veronica Milos¹, Åsa Åb Bondesson¹, Martina Magnusson², Ulf Jakobsson¹, Tommy Westerlund², Patrik Midlöv¹ - Show less +2 more•Institutions (2)

Lund University¹, University of Gothenburg²

27 Mar 2014-BMC Geriatrics

TL;DR: Interventions to reduce falls in the elderly by focusing on reducing the total number of drugs and withdrawal of psychotropic medications might improve the quality and safety of drug treatment in primary care.

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Abstract: Background: Falls are the most common cause of injuries and hospital admissions in the elderly. The Swedish National Board of Health and Welfare has created a list of drugs considered to increase the fall risk (FRIDs) and drugs that might cause/worsen orthostatism (ODs). This cross-sectional study was aimed to assess FRIDs and their correlation with falls in a sample of 369 community-dwelling and nursing home patients aged ≥75 years and who were using a multi-dose drug dispensing system. Methods: Data were collected from the patients’ electronic medication lists. Retrospective data on reported falls during the previous three months and severe falls during the previous 12 months were collected. Primary outcome measures were incidence of falls as well as numbers of FRIDs and ODs in fallers and non-fallers. Results: The studied sample had a high incidence of both reported falls (29%) and severe falls (17%). Patients were dispensed a mean of 2.2 (SD 1.5) FRIDs and 2.0 (SD 1.6) ODs. Fallers used on average more FRIDs. Severe falls were more common in nursing homes patients. More women than men experienced severe falls. There were positive associations between number of FRIDs and the total number of drugs (p < 0.01), severe falls (p < 0.01) and female sex (p = 0.03). There were also associations between number of ODs and both total number of drugs (p < 0.01) and being community dwelling (p = 0.02). No association was found between number of ODs and severe falls. Antidepressants and anxiolytics were the most frequently dispensed FRIDs. Conclusions: Fallers had a higher number of FRIDs. Numbers of FRIDs and ODs were correlated with the total number of drugs dispensed. Interventions to reduce falls in the elderly by focusing on reducing the total number of drugs and withdrawal of psychotropic medications might improve the quality and safety of drug treatment in primary care.

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133 citations

Journal Article•DOI•

Ageing vision and falls: a review.

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Liana Nafisa Saftari¹, Oh-Sang Kwon¹•Institutions (1)

Ulsan National Institute of Science and Technology¹

23 Apr 2018-Journal of Physiological Anthropology

TL;DR: A group of phenomena such as vection and sensory reweighting are presented that provide information on how visual motion signals are used to maintain balance, taking into account the relationship between visual motion perception and balance control.

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Abstract: Falls are the leading cause of accidental injury and death among older adults. One of three adults over the age of 65 years falls annually. As the size of elderly population increases, falls become a major concern for public health and there is a pressing need to understand the causes of falls thoroughly. While it is well documented that visual functions such as visual acuity, contrast sensitivity, and stereo acuity are correlated with fall risks, little attention has been paid to the relationship between falls and the ability of the visual system to perceive motion in the environment. The omission of visual motion perception in the literature is a critical gap because it is an essential function in maintaining balance. In the present article, we first review existing studies regarding visual risk factors for falls and the effect of ageing vision on falls. We then present a group of phenomena such as vection and sensory reweighting that provide information on how visual motion signals are used to maintain balance. We suggest that the current list of visual risk factors for falls should be elaborated by taking into account the relationship between visual motion perception and balance control.

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100 citations

Cites background or methods from "A screening tool with five risk fac..."

...[47] Distance visual acuity in fallers and non-fallers did not show significant relation (OR 0....
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...port a significant relationship between visual acuity and fall risk, the Parinaud chart [47], Monoyer chart [47], LogMAR chart [21, 49], and the Early Treatment of Diabetic Retinopathy Study (ETDRS) scale [48] were used....
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Journal Article•DOI•

Predicting Geriatric Falls Following an Episode of Emergency Department Care: A Systematic Review

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Chris Carpenter, Michael S. Avidan, Tanya M. Wildes, Susan Stark, Susan Fowler¹, Alexander X. Lo - Show less +2 more•Institutions (1)

Washington University in St. Louis¹

01 Oct 2014-Academic Emergency Medicine

TL;DR: The paucity of evidence in the literature regarding ED-based screening for risk of future falls among older adults is demonstrated, and screening tools and individual characteristics identified in this study provide an evidentiary basis on which to develop screening protocols for geriatrics adults in the ED to reduce fall risk.

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Abstract: BACKGROUND: Falls are the leading cause of traumatic mortality in geriatric adults. Despite recent multispecialty guideline recommendations that advocate for proactive fall prevention protocols in the emergency department (ED), the ability of risk factors or risk stratification instruments to identify subsets of geriatric patients at increased risk for short-term falls is largely unexplored. OBJECTIVES: This was a systematic review and meta-analysis of ED-based history, physical examination, and fall risk stratification instruments with the primary objective of providing a quantitative estimate for each risk factor's accuracy to predict future falls. A secondary objective was to quantify ED fall risk assessment test and treatment thresholds using derived estimates of sensitivity and specificity. METHODS: A medical librarian and two emergency physicians (EPs) conducted a medical literature search of PUBMED, EMBASE, CINAHL, CENTRAL, DARE, the Cochrane Registry, and Clinical Trials. Unpublished research was located by a hand search of emergency medicine (EM) research abstracts from national meetings. Inclusion criteria for original studies included ED-based assessment of pre-ED or post-ED fall risk in patients 65 years and older with sufficient detail to reproduce contingency tables for meta-analysis. Original study authors were contacted for additional details when necessary. The Quality Assessment Tool for Diagnostic Accuracy Studies (QUADAS-2) was used to assess individual study quality for those studies that met inclusion criteria. When more than one qualitatively similar study assessed the same risk factor for falls at the same interval following an ED evaluation, then meta-analysis was performed using Meta-DiSc software. The primary outcomes were sensitivity, specificity, and likelihood ratios for fall risk factors or risk stratification instruments. Secondary outcomes included estimates of test and treatment thresholds using the Pauker method based on accuracy, screening risk, and the projected benefits or harms of fall prevention interventions in the ED. RESULTS: A total of 608 unique and potentially relevant studies were identified, but only three met our inclusion criteria. Two studies that included 660 patients assessed 29 risk factors and two risk stratification instruments for falls in geriatric patients in the 6 months following an ED evaluation, while one study of 107 patients assessed the risk of falls in the preceding 12 months. A self-report of depression was associated with the highest positive likelihood ratio (LR) of 6.55 (95% confidence interval [CI] = 1.41 to 30.48). Six fall predictors were identified in more than one study (past falls, living alone, use of walking aid, depression, cognitive deficit, and more than six medications) and meta-analysis was performed for these risk factors. One screening instrument was sufficiently accurate to identify a subset of geriatric ED patients at low risk for falls with a negative LR of 0.11 (95% CI = 0.06 to 0.20). The test threshold was 6.6% and the treatment threshold was 27.5%. CONCLUSIONS: This study demonstrates the paucity of evidence in the literature regarding ED-based screening for risk of future falls among older adults. The screening tools and individual characteristics identified in this study provide an evidentiary basis on which to develop screening protocols for geriatrics adults in the ED to reduce fall risk. Language: en

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99 citations

Cites background from "A screening tool with five risk fac..."

...Nonetheless, future investigators should assess the feasibility and prognostic accuracy for future falls of clinical gestalt,(65) as well as existing instruments like the ABCS injurious fall screening tool,(66,67) CAREFALL,(68) FROP-Com,(69,70) HOME FAST,(71) Hendrich II Fall Risk Model,(72,73) STRATIFY,(74) University of Pittsburgh Medical Center screening tool,(67) New York–Presbyterian Fall and Injury Risk Assessment Tool,(73,75) Johns Hopkins Fall Risk Assessment Tool,(76) Maine Medical Center Fall Risk Assessment,(73) Morse Fall Scale,(73,77) Spartanburg Fall Risk Assessment Tool,(78) and risk scores described by Bongue et al.(79) and Stel et al....
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...Geriatric EM researchers ought to agree upon a standard definition of falls and acceptable methods to assess falls prospectively (self-report via telephone or postcards, objective fall devices, caregiver report, etc.).59 Self-reported falls using diaries, calendars, or telephone follow-up probably underestimate the incidence of falls and confounding variables to reporting include cognitive dysfunction, education, and baseline fall risk.60,61 Future researchers need to develop objective assessments to determine the occurrence of falls using smart phones,62 body sensors,63 or other passive monitoring systems.64 Multiple fall risk assessment instruments have been described in outpatient and inpatient settings.25 The ED represents a unique milieu and patient phenotype, so predictive instruments from other settings often fail in the chaotic environment of EM.32 Nonetheless, future investigators should assess the feasibility and prognostic accuracy for future falls of clinical gestalt,65 as well as existing instruments like the ABCS injurious fall screening tool,66,67 CAREFALL,68 FROP-Com,69,70 HOME FAST,71 Hendrich II Fall Risk Model,72,73 STRATIFY,74 University of Pittsburgh Medical Center screening tool,67 New York–Presbyterian Fall and Injury Risk Assessment Tool,73,75 Johns Hopkins Fall Risk Assessment Tool,76 Maine Medical Center Fall Risk Assessment,73 Morse Fall Scale,73,77 Spartanburg Fall Risk Assessment Tool,78 and risk scores described by Bongue et al.79 and Stel et al.80 No study has previously evaluated these instruments in ED settings....
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Book•

Practical statistics for medical research

[...]

Douglas G. Altman

15 Jun 2006

TL;DR: Practical Statistics for Medical Research is a problem-based text for medical researchers, medical students, and others in the medical arena who need to use statistics but have no specialized mathematics background.

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Abstract: Most medical researchers, whether clinical or non-clinical, receive some background in statistics as undergraduates. However, it is most often brief, a long time ago, and largely forgotten by the time it is needed. Furthermore, many introductory texts fall short of adequately explaining the underlying concepts of statistics, and often are divorced from the reality of conducting and assessing medical research. Practical Statistics for Medical Research is a problem-based text for medical researchers, medical students, and others in the medical arena who need to use statistics but have no specialized mathematics background. The author draws on twenty years of experience as a consulting medical statistician to provide clear explanations to key statistical concepts, with a firm emphasis on practical aspects of designing and analyzing medical research. The text gives special attention to the presentation and interpretation of results and the many real problems that arise in medical research

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17,322 citations

"A screening tool with five risk fac..." refers background in this paper

...Altman [38] suggests that the ‘‘best’’ cutoff must be chosen according to the relative costs (not necessarily financial) of the screening test, which is related to the false positives and false negatives and to the prevention strategy that will follow after a positive test....
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Journal Article•DOI•

The Timed “Up & Go”: A Test of Basic Functional Mobility for Frail Elderly Persons

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Diane Podsiadlo¹, Sandra Richardson•Institutions (1)

McGill University¹

01 Feb 1991-Journal of the American Geriatrics Society

TL;DR: This study evaluated a modified, timed version of the “Get‐Up and Go” Test (Mathias et al, 1986) in 60 patients referred to a Geriatric Day Hospital and suggested that the timed “Up & Go’ test is a reliable and valid test for quantifying functional mobility that may also be useful in following clinical change over time.

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Abstract: This study evaluated a modified, timed version of the "Get-Up and Go" Test (Mathias et al, 1986) in 60 patients referred to a Geriatric Day Hospital (mean age 79.5 years). The patient is observed and timed while he rises from an arm chair, walks 3 meters, turns, walks back, and sits down again. The results indicate that the time score is (1) reliable (inter-rater and intra-rater); (2) correlates well with log-transformed scores on the Berg Balance Scale (r = -0.81), gait speed (r = -0.61) and Barthel Index of ADL (r = -0.78); and (3) appears to predict the patient's ability to go outside alone safely. These data suggest that the timed "Up & Go" test is a reliable and valid test for quantifying functional mobility that may also be useful in following clinical change over time. The test is quick, requires no special equipment or training, and is easily included as part of the routine medical examination.

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12,004 citations

"A screening tool with five risk fac..." refers methods in this paper

...Basic mobility was assessed with the Timed Up and Go (TUG) test [18]....
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Journal Article•DOI•

Practical Statistics for Medical Research.

[...]

S. D. Walter, Douglas G. Altman

01 Jun 1992-Biometrics

11,536 citations

Journal Article•DOI•

Progress in Development of the Index of ADL

[...]

Sidney Katz, Thomas D. Downs, Helen R. Cash, Robert C. Grotz

20 Mar 1970-Gerontologist

3,715 citations

"A screening tool with five risk fac..." refers methods in this paper

...This screening tool used three items from the FROP-Com assessment tool [39] most strongly predictive of falls: number of falls in the past 12 months, observation of the person’s balance, and the question regarding the need for assistance to perform domestic ADL....
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...However, the difference in the accuracy between the screening tool of Russell et al. and ours could be explained by the age difference (mean age, 75.9 years vs. 70.7 years), study population (older fallers from the emergency departments of hospitals vs. healthy older adults living in the community-dwelling areas), and frailty (the need for assistance to perform domestic ADL in the study of Russell et al)....
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...According to the Katz index of independence in ADL, 99.2% of participants were independent....
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...[16] Katz S, Downs TD, Cash HR, Grotz RC. Progress in development of the index of ADL....
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...Participant’s ability to perform activities of daily living (ADL) was assessed by the Katz index of dependence (ADL) [16], and depressive symptoms were assessed by the four-item Geriatric Depression Scale [17]....
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Journal Article•DOI•

Predicting the probability for falls in community-dwelling older adults using the Timed Up & Go Test.

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Anne Shumway-Cook¹, Sandy Brauer², Marjorie H. Woollacott²•Institutions (2)

University of Washington¹, University of Oregon²

01 Sep 2000-Physical Therapy

TL;DR: The TUG is a sensitive and specific measure for identifying community-dwelling adults who are at risk for falls and the ability to predict falls is not enhanced by adding a secondary task when performing the TUG.

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Abstract: Background and Purpose. This study examined the sensitivity and specificity of the Timed Up & Go Test (TUG) under single-task versus dual-task conditions for identifying elderly individuals who are prone to falling. Subjects. Fifteen older adults with no history of falls (mean age578 years, SD56, range565‐ 85) and 15 older adults with a history of 2 or more falls in the previous 6 months (mean age586.2 years, SD56, range576 ‐95) participated. Methods. Time taken to complete the TUG under 3 conditions (TUG, TUG with a subtraction task [TUG cognitive], and TUG while carrying a full cup of water [TUG manual]) was measured. A multivariate analysis of variance and discriminant function and logistic regression analyses were performed. Results. The TUG was found to be a sensitive (sensitivity587%) and specific (specificity587%) measure for identifying elderly individuals who are prone to falls. For both groups of older adults, simultaneous performance of an additional task increased the time taken to complete the TUG, with the greatest effect in the older adults with a history of falls. The TUG scores with or without an additional task (cognitive or manual) were equivalent with respect to identifying fallers and nonfallers. Conclusions and Discussion. The results suggest that the TUG is a sensitive and specific measure for identifying communitydwelling adults who are at risk for falls. The ability to predict falls is not enhanced by adding a secondary task when performing the TUG. [Shumway-Cook A, Brauer S, Woollacott M. Predicting the probability for falls in community-dwelling older adults using the Timed Up & Go Test. Phys Ther. 2000;80:896 ‐903.]

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3,023 citations