Development and Evaluation of an Online Fall-Risk Questionnaire for Nonfrail Community-Dwelling Elderly Persons: A Pilot Study

Introduction. Falls are frequent in older adults and may have serious consequences but awareness of fall-risk is often low. A questionnaire might raise awareness of fall-risk; therefore we set out to construct and test such a questionnaire. Methods. Fall-risk factors and their odds ratios were extracted from meta-analyses and a questionnaire was devised to cover these risk factors. A formula to estimate the probability of future falls was set up using the extracted odds ratios. The understandability of the questionnaire and discrimination and calibration of the prediction formula were tested in a cohort study with a six-month follow-up. Community-dwelling persons over 60 years were recruited by an e-mail snowball-sampling method. Results and Discussion. We included 134 persons. Response rates for the monthly fall-related follow-up varied between the months and ranged from low 38% to high 90%. The proportion of present risk factors was low. Twenty-five participants reported falls. Discrimination was moderate (AUC: 0.67, 95% CI 0.54 to 0.81). The understandability, with the exception of five questions, was good. The wording of the questions needs to be improved and measures to increase the monthly response rates are needed before test-retest reliability and final predictive value can be assessed.

[1]  S. Muir,et al.  The role of cognitive impairment in fall risk among older adults: a systematic review and meta-analysis. , 2012, Age and ageing.

[2]  L. Bouter,et al.  A risk profile for identifying community-dwelling elderly with a high risk of recurrent falling: results of a 3-year prospective study , 2006, Osteoporosis International.

[3]  M. Tinetti,et al.  Summary of the Updated American Geriatrics Society/british Geriatrics Society Clinical Practice Guideline for Prevention of Falls in Older Persons , 2022 .

[4]  Karim M Khan,et al.  Meta-analysis of the impact of 9 medication classes on falls in elderly persons. , 2009, Archives of internal medicine.

[5]  Examination of validity of fall risk assessment items for screening high fall risk elderly among the healthy community-dwelling Japanese population. , 2011, Archives of gerontology and geriatrics.

[6]  M. Barr,et al.  Prevalence, circumstances and consequences of falls among community-dwelling older people: results of the 2009 NSW Falls Prevention Baseline Survey. , 2011, New South Wales public health bulletin.

[7]  A. Chin,et al.  Ten‐year mortality in older patients attending the emergency department after a fall , 2016, Geriatrics & gerontology international.

[8]  Lesley M Day,et al.  Development of the Falls Risk for Older People in the Community (FROP-Com) screening tool. , 2008, Age and ageing.

[9]  H. Menz,et al.  A physiological profile approach to falls risk assessment and prevention. , 2003, Physical therapy.

[10]  Comparison of simple vs. performance-based fall prediction models: data from the National Health and Aging Trends Study. , 2015, Gerontology & geriatric medicine.

[11]  M. Renfro,et al.  Multifactorial Screening for Fall Risk in Community-Dwelling Older Adults in the Primary Care Office: Development of the Fall Risk Assessment & Screening Tool , 2011, Journal of geriatric physical therapy.

[12]  A. Biderman,et al.  Validation of a fall-risk screening test, the Elderly Fall Screening Test (EFST), for community-dwelling elderly. , 1998, Disability and rehabilitation.

[13]  C. Goldsmith,et al.  Muscle Weakness and Falls in Older Adults: A Systematic Review and Meta‐Analysis , 2004, Journal of the American Geriatrics Society.

[14]  M. Tinetti,et al.  Risk factors for falls among elderly persons living in the community. , 1988, The New England journal of medicine.

[15]  Federico Chesani,et al.  FRAT-up, a Web-based Fall-Risk Assessment Tool for Elderly People Living in the Community , 2015, Journal of medical Internet research.

[16]  Olivier Beauchet,et al.  A screening tool with five risk factors was developed for fall-risk prediction in community-dwelling elderly. , 2011, Journal of clinical epidemiology.

[17]  Y. Robitaille,et al.  Changes in fall-related mortality in older adults in Quebec, 1981-2009. , 2013, Chronic diseases and injuries in Canada.

[18]  M. Tinetti,et al.  Drugs and Falls in Older People: A Systematic Review and Meta‐analysis: I. Psychotropic Drugs , 1999, Journal of the American Geriatrics Society.

[19]  Anne-Sophie Rigaud,et al.  Psychotropic Drugs and Falls in the Elderly People: Updated Literature Review and Meta-Analysis , 2011, Journal of aging and health.

[20]  Son Chae Kim,et al.  Validity and reliability of the modified John Hopkins Fall Risk Assessment Tool for elderly patients in home health care. , 2013, Geriatric nursing.

[21]  Seanne Wilkins,et al.  The physical environment as a fall risk factor in older adults: Systematic review and meta-analysis of cross-sectional and cohort studies. , 2010, Australian occupational therapy journal.

[22]  Orthopaedic Surgeons Panel On Falls Prevention Guideline for the Prevention of Falls in Older Persons , 2001 .

[23]  Mark Speechley,et al.  Using a single question to assess physical activity in older adults: a reliability and validity study , 2012, BMC Medical Research Methodology.

[24]  A Modified Fall Risk Assessment Tool That Is Specific to Physical Function Predicts Falls in Community-Dwelling Elderly People , 2014, Journal of geriatric physical therapy.

[25]  M. Tinetti,et al.  Drugs and Falls in Older People: A Systematic Review and Meta‐analysis: II. Cardiac and Analgesic Drugs , 1999, Journal of the American Geriatrics Society.

[26]  Lesley M Day,et al.  The reliability and predictive accuracy of the falls risk for older people in the community assessment (FROP-Com) tool. , 2008, Age and ageing.

[27]  Eva Negri,et al.  Risk Factors for Falls in Community-dwelling Older People: A Systematic Review and Meta-analysis , 2010, Epidemiology.

[28]  L. Bouter,et al.  Validation of the LASA fall risk profile for recurrent falling in older recent fallers. , 2010, Journal of clinical epidemiology.

[29]  Klaus Hauer,et al.  Older people's views of falls-prevention interventions in six European countries. , 2006, The Gerontologist.

[30]  Mark Speechley,et al.  Application of a fall screening algorithm stratified fall risk but missed preventive opportunities in community-dwelling older adults: a prospective study. , 2010, Journal of geriatric physical therapy.

[31]  M. Tinetti,et al.  Perceptions of physicians on the barriers and facilitators to integrating fall risk evaluation and management into practice , 2006, Journal of General Internal Medicine.

[32]  B. Bergvall-Kåreborn,et al.  Fall Risk Awareness and Safety Precautions Taken by Older Community-Dwelling Women and Men—A Qualitative Study Using Focus Group Discussions , 2015, PloS one.

[33]  Y. E. Miedany,et al.  Falls risk assessment score (FRAS): Time to rethink , 2011 .

[34]  Catherine Sherrington,et al.  Development of a tool for prediction of falls in rehabilitation settings (Predict_FIRST): a prospective cohort study. , 2010, Journal of rehabilitation medicine.

[35]  E W Steyerberg,et al.  See Blockindiscussions, Blockinstats, Blockinand Blockinauthor Blockinprofiles Blockinfor Blockinthis Blockinpublication Prognostic Blockinmodels Blockinbased Blockinon Blockinliterature Blockinand Individual Blockinpatient Blockindata Blockinin Blockinlogistic Blockinregression Analysis Article Blo , 2022 .

[36]  C. Tournoux-Facon,et al.  Estimation of the risk factors for falls in the elderly: Can meta‐analysis provide a valid answer? , 2013, Geriatrics & gerontology international.

[37]  J. Ponsford,et al.  Self-Awareness of Falls Risk Among Elderly Patients: Characterizing Awareness Deficits and Exploring Associated Factors. , 2015, Archives of physical medicine and rehabilitation.

[38]  C. Ng,et al.  Barriers faced by healthcare professionals when managing falls in older people in Kuala Lumpur, Malaysia: a qualitative study , 2015, BMJ Open.

[39]  L. Rubenstein,et al.  The Yield, Reliability, and Validity of a Postal Survey for Screening Community‐Dwelling Older People , 2003, Journal of the American Geriatrics Society.

[40]  Catherine Sherrington,et al.  The development and validation of a brief performance-based fall risk assessment tool for use in primary care. , 2010, The journals of gerontology. Series A, Biological sciences and medical sciences.

[41]  L. Bouter,et al.  Fall-risk screening test: a prospective study on predictors for falls in community-dwelling elderly. , 2001, Journal of clinical epidemiology.

[42]  C. Becker,et al.  Fall incidence in Germany: results of two population-based studies, and comparison of retrospective and prospective falls data collection methods , 2014, BMC Geriatrics.

[43]  K. Covinsky,et al.  History and mobility exam index to identify community-dwelling elderly persons at risk of falling. , 2001, The journals of gerontology. Series A, Biological sciences and medical sciences.

[44]  Mark Speechley,et al.  Quantifying the magnitude of risk for balance impairment on falls in community-dwelling older adults: a systematic review and meta-analysis. , 2010, Journal of clinical epidemiology.

[45]  S. Lord,et al.  Visual Risk Factors for Falls in Older People , 2001, Age and ageing.

[46]  B. Stubbs,et al.  Pain and the risk for falls in community-dwelling older adults: systematic review and meta-analysis. , 2014, Archives of physical medicine and rehabilitation.

[47]  Judy A Stevens,et al.  Validating an evidence-based, self-rated fall risk questionnaire (FRQ) for older adults. , 2011, Journal of safety research.

[48]  Athanase Benetos,et al.  A Simple Clinical Scale to Stratify Risk of Recurrent Falls in Community-Dwelling Adults Aged 65 Years and Older , 2010, Physical Therapy.

[49]  Kim Delbaere,et al.  Depressive Symptomatology as a Risk Factor for Falls in Older People: Systematic Review and Meta‐Analysis , 2013, Journal of the American Geriatrics Society.

[50]  Tom Fahey,et al.  Is the Timed Up and Go test a useful predictor of risk of falls in community dwelling older adults: a systematic review and meta- analysis , 2014, BMC Geriatrics.

[51]  T. Hoffmann,et al.  'They will tell me if there is a problem': limited discussion between health professionals, older adults and their caregivers on falls prevention during and after hospitalization. , 2013, Health education research.

[52]  J. Knottnerus,et al.  A risk model for the prediction of recurrent falls in community-dwelling elderly: a prospective cohort study. , 2002, Journal of clinical epidemiology.

[53]  J. Ponsford,et al.  Development of a new self-awareness of falls risk measure (SAFRM). , 2014, Archives of gerontology and geriatrics.

[54]  R. Atkinson,et al.  Accessing Hidden and Hard-to-Reach Populations: Snowball Research Strategies , 2022 .

[55]  P. Tang,et al.  Meta‐analysis of type and complexity of a secondary task during walking on the prediction of elderly falls , 2013, Geriatrics & gerontology international.

[56]  Einschätzung der Sturzgefährdung gebrechlicher, noch selbstständig lebender, älterer Menschen , 2006, Zeitschrift für Gerontologie und Geriatrie.

[57]  Luca Palmerini,et al.  Fall Risk Assessment Tools for Elderly Living in the Community: Can We Do Better? , 2015, PloS one.

[58]  Wantana Maneesriwongul,et al.  Thai falls risk assessment test (Thai-FRAT) developed for community-dwelling Thai elderly. , 2008, Journal of the Medical Association of Thailand = Chotmaihet thangphaet.

[59]  C Brèque,et al.  Episodes of falling among elderly people: a systematic review and meta-analysis of social and demographic pre-disposing characteristics , 2010, Clinics.