Abstract
BackgroundFall risk assessment in older people is of major importance for providing adequate preventive measures. Current predictive models are mainly focused on intrinsic risk factors and do not adjust for contextual exposure. The validity and utility of continuous risk scores have already been demonstrated in clinical practice in several diseases. In this study, we aimed to develop and validate an intrinsic-exposure continuous fall risk score (cFRs) for community-dwelling older people through standardized residuals.MethodsSelf-reported falls in the last year were recorded from 504 older persons (391 women: age 73.1 ± 6.5 years; 113 men: age 74.0 ± 6.1 years). Participants were categorized as occasional fallers (falls ≤1) or recurrent fallers (≥ 2 falls). The cFRs was derived for each participant by summing the standardized residuals (Z-scores) of the intrinsic fall risk factors and exposure factors. Receiver operating characteristic (ROC) analysis was used to determine the accuracy of the cFRs for identifying recurrent fallers.ResultsThe cFRs varied according to the number of reported falls; it was lowest in the group with no falls (− 1.66 ± 2.59), higher in the group with one fall (0.05 ± 3.13, p < 0.001), and highest in the group with recurrent fallers (2.82 ± 3.94, p < 0.001). The cFRs cutoff level yielding the maximal sensitivity and specificity for identifying recurrent fallers was 1.14, with an area under the ROC curve of 0.790 (95% confidence interval: 0.746–0.833; p < 0.001).ConclusionsThe cFRs was shown to be a valid dynamic multifactorial fall risk assessment tool for epidemiological analyses and clinical practice. Moreover, the potential for the cFRs to become a widely used approach regarding fall prevention in community-dwelling older people was demonstrated, since it involves a holistic intrinsic-exposure approach to the phenomena. Further investigation is required to validate the cFRs with other samples since it is a sample-specific tool.
Highlights
Fall risk assessment in older people is of major importance for providing adequate preventive measures
Further investigation is required to validate the continuous fall risk score (cFRs) with other samples since it is a sample-specific tool
This study primarily aimed to develop and examine the construct validity of a dynamic fall risk model based on an intrinsic-exposure multifactorial sex-specific continuous fall risk score for Portuguese community-dwelling older people
Summary
Fall risk assessment in older people is of major importance for providing adequate preventive measures. We aimed to develop and validate an intrinsic-exposure continuous fall risk score (cFRs) for community-dwelling older people through standardized residuals. Medical associations and national health authorities are unanimous in recommending the use of fall risk assessment tools [7]. Fall risk assessment instruments commonly include risk factors such as previous fall occurrence, impaired balance and gait, and medical conditions such as chronic diseases, physical impairments, and medication use [10]. Current assessment instruments are considered inadequate or limited in terms of predicting falls in community-dwelling older people; researchers recommend that fall risk assessment tools should not be used in isolation to identify older people at high risk of falls [9, 11]
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