Assessing Subjective Fall Concerns in Residential Living Seniors: Development of the Activities-Specific Fall Caution Scale

Abstract

Pearce NJ, Myers AM, Blanchard RA. Assessing subjective fall concerns in residential living seniors: development of the Activities-specific Fall Caution Scale. Objectives To examine subjective fall concerns of seniors in residential care and to develop a tool applicable to both nursing home and assisted living settings. Design Used focus groups with residents and staff for construct examination and item generation; surveyed staff and interviewed residents for item verification; and conducted psychometric testing using Rasch analysis for scale refinement. Setting Seventeen residential care facilities in Ontario, Canada. Participants Convenience samples totaling 57 staff and 234 residents. Interventions Not applicable. Main Outcome Measure The Activities-specific Fall Caution (AFC) Scale, developed inductively with residents and staff, with items pertaining to residential living (eg, moving around a room full of people, furniture, or walkers). Results Resident terms (being cautious or careful) and qualifications (whether alone and proximity of gait aids) guided tool development. Rasch analysis showed that the final 13-item AFC Scale was hierarchic and unidimensional, with good person (.86) and item (.95) reliability. Conclusions The AFC scale is a promising new tool for assessing subjective fall concerns in residential care residents. This tool can be administered via interview in about 10 minutes to most residents with Mini-Mental State Examination scores of 12 or greater, using practice questions to determine understanding and a 4-point color response card similar to a traffic light to facilitate responding.