Fall Risk Assessments for Individuals with Visual Impairment: A Scoping Review of Questionnaire-Based Tools.

BackgroundFall incidents are a major problem for patients and healthcare. The “Aachen Fall Prevention App” (AFPA) represents the first mobile Health (mHealth) application (app) empowering older patients (persons 50+ years) to self-assess and monitor their individual fall risk. Self-assessment is based on the “Aachen Fall Prevention Scale,” which consists of three steps. First, patients answer ten standardized yes–no questions (positive criterion ≥ 5 “Yes” responses). Second, a ten-second test of free standing without compensatory movement is performed (positive criterion: compensatory movement). Finally, during the third step, patients rate their subjective fall risk on a 10-point Likert scale, based on the results of steps one and two. The purpose of this app is (1) to offer a low-threshold service through which individuals can independently monitor their individual fall risk and (2) to collect data about how a patient-centered mHealth app for fall risk assessment is used in the field.ResultsThe results represent the first year of an ongoing field study. From December 2015 to December 2016, 197 persons downloaded the AFPA (iOS™ and Android™; free of charge). N = 111 of these persons voluntarily shared their data and thereby participated in the field study. Data from a final number of n = 79 persons were analyzed due to exclusion criteria (age, missing objective fall risk, missing self-assessment). The objective fall risk and the self-assessed subjective risk measured by the AFPA showed a significant positive relationship.ConclusionsThe “Aachen Fall Prevention App” (AFPA) is an mHealth app released for iOS and Android. This field study revealed the AFPA as a promising tool to raise older adults’ awareness of their individual fall risk by means of a low-threshold patient-driven fall risk assessment tool.

Purpose: 1) To study the level of fatigue, level of mobility & fall risk in Individuals with chronic kidney disease. 2) to assess the relationship of fatigue with mobility and fall risk in chronic kidney disease individuals. Relevance: Information regarding the relationship of fatigue with mobility & fall risk can help provide targeted intervention in the chronic kidney disease population to improve the overall QoL of the Individuals which in turn can help to improve relevant patient-reported outcomes Participants: 84 OPD & IPD participants diagnosed with chronic kidney disease of more than 40 years with medication or on haemodialysis were included in the study. Methods: This analytical cross-sectional study includes 84 chronic kidney disease individuals using G* Power 3.1.9.7 of age 40-79 by convenient sampling from Muljibhai Patel Urological Hospital Nadiad in the duration of 10 October 2023 to 10 November 2023. Analysis: Descriptive analysis was used to depict the demographic characteristics of participants. Correlation analysis was done by Pearson’s correlation test. Results: The correlation of fatigue with mobility and fall risk in CKD shows a statistically significant positive association between fatigue and both impaired mobility and increased fall risk in kidney patients. Conclusion: The research analysis suggests a significant correlation between fatigue and mobility in chronic kidney disease patients. Additionally, there appears to be a notable association between fatigue and an increased risk of falls in individuals with CKD. Implications: The results can be applied for structured treatment plan.

Unintentional falls is an increasing public health problem as incidence of falls rises and the population ages. The Centers for Disease Control and Prevention reports that 1 in 3 adults aged 65 years and older will experience a fall this year; 20% to 30% of those who fall will sustain a moderate to severe injury. Physical therapists caring for older adults are usually engaged with these patients after the first injury fall and may have little opportunity to abate fall risk before the injuries occur. This article describes the content selection and development of a simple-to-administer, multifactorial, Fall Risk Assessment & Screening Tool (FRAST), designed specifically for use in primary care settings to identify those older adults with high fall risk. Fall Risk Assessment & Screening Tool incorporates previously validated measures within a new multifactorial tool and includes targeted recommendations for intervention. Development of the multifactorial FRAST used a 5-part process: identification of significant fall risk factors, review of best evidence, selection of items, creation of the scoring grid, and development of a recommended action plan. Fall Risk Assessment & Screening Tool has been developed to assess fall risk in the target population of older adults (older than 65 years) living and ambulating independently in the community. Many fall risk factors have been considered and 15 items selected for inclusion. Fall Risk Assessment & Screening Tool includes 4 previously validated measures to assess balance, depression, falls efficacy, and home safety. Reliability and validity studies of FRAST are under way. Fall risk for community-dwelling older adults is an urgent, multifactorial, public health problem. Providing primary care practitioners (PCPs) with a very simple screening tool is imperative. Fall Risk Assessment & Screening Tool was created to allow for safe, quick, and low-cost administration by minimally trained office staff with interpretation and follow-up provided by the PCP.

Falls are a significant health problem for older adults. With the projected increase in persons aged 65 yr and older by the year 2050, this continues to be a growing concern. Risk of falling (RoF) assessment is a multifactorial approach. Audiologists routinely evaluate older patients in the clinic and therefore might be in an ideal position to identify falling risk factors. The purpose of this study was to gain a better understanding of audiologists' views on RoF assessment related to training and education, screening and assessment, prevention and intervention, the effectiveness of RoF assessment, and challenges associated with RoF assessment in the audiology clinic. The survey was e-mailed to 2000 randomly selected audiologists across the United States. The survey was designed with the primary objective of understanding personal views regarding RoF assessment. Demographic information was included to better understand the type of clinic setting, the primary age of patients, year of graduation, and highest degree earned. Additionally, open-ended questions were offered to provide a forum for further testimonials on current RoF experiences and needs. Questions pertaining to resources used to assess RoF and counsel patients on RoF were asked to determine the audiologists' understanding of a multifactorial approach to assessing patients for RoF. Lastly, a series of Likert scale questions were developed to indicate the strength of agreement or disagreement pertaining to general statements about RoF assessment and the challenges associated with an RoF assessment program. Descriptive statistics (means, standard deviations, frequencies, and percentages) were used for quantitative survey responses. Validation of qualitative data was completed by using triangulation sources. A total of 275 of 2000 audiologists returned the survey; of those who responded, 238 audiologists were analyzed. Two themes emerged from the survey responses: resources used to assess RoF and audiologists' personal views on RoF. Although a majority (83.0% [n = 197/238]) of audiologists surveyed indicated working with geriatric patients (≥61 yr of age), more than half (62.1% [n = 147/238]) of audiologists surveyed indicated no experience with RoF assessment. Overall, 75% (n = 175/233) of the surveyed audiologists consider RoF assessment a role in the audiologist's scope of practice; however, only 16.3% (n = 38/233) believe audiologists are knowledgeable, 11.8% (n = 27/228) believe audiologists are sufficiently trained to provide RoF assessment, and 14% (n = 33/238) are currently implementing RoF as part of vestibular and balance assessment. Although audiologists support RoF assessment, further education is warranted for audiologists to efficiently assess RoF. Many audiologists do not have the resources or time to administer RoF assessment in their clinics; however, if audiologists can ask just a few questions regarding fall history and better understand the risk factors, they can be in a position to refer their patients to other professionals for further investigation.

BACKGROUNDThe 21-item Fall Risk Index questionnaire (FRI-21) was developed to screen for fall risk in older adults. It showed great potential in assessing the fall risk in stroke population. However, no previous study investigated its reliability and validity in people with stroke in Hong Kong.AIMThis study aimed to translate FRI-21 to Chinese and investigate: 1) the FRI-21 scores between people with stroke and healthy older adults; 2) the test-retest reliability of the FRI-21 in people with stroke; 3) the convergent validity by correlated of the FRI-21 with Berg Balance Scale (BBS); 4) the predictive ability of FRI-21 on the fall occurrence in the 2 years follow-up; 5) the optimal FRI-21 cut-off score that distinguishes faller and non-faller among people with stroke in the 2 years follow-up; and 6) the ceiling and floor effects of the Chinese version of the FRI-21.DESIGNCross-sectional study.SETTINGUniversity-based rehabilitation laboratory.POPULATIONIn total, 57 people with stroke and 31 healthy older adults.METHODSThe FRI-21 test was assessed in people with stroke on Day1 and Day 2 (7 days after Day 1), and assessed in healthy older adults on Day 1 only. The BBS was also assessed in Day 1.RESULTSThe mean FRI-21 scores in subjects with stroke was 7.37. The FRI-21 demonstrated good inter-rater reliability (intraclass correlation [ICC] 0.74) and good test–retest reliability (ICC=0.798) in people with stroke. The FRI-21 scores demonstrated significant negative correlations with the BBS (r=-0.308). The FRI-21 score was found to be a significant predictor (OR 1.40 [95% CI 1.06-1.85], P=0.018) of fall in the 2 years of follow-up. The receiver operating characteristic curve analysis identified an optimal FRI-21 cutoff score of 7.5, showing an acceptable diagnostic power in distinguishing faller and non-faller among people with stroke (area under curve = 0.723, P=0.002), with moderate sensitivity (80.0%) and specificity (60.5%). Ceiling and floor effects are negligible.CONCLUSIONSThis study reflects the reliability and validity of the FRI-21 as self-administered tool for assessing fall risk in individuals aged 50 and over with stroke, and without cognitive impairments. A cut-off score of 7.5 was identified to distinguish faller and non-faller in people with stroke. The FRI-21 score was a significant predictor of fall in people with stroke. It effectively differentiates fall risk between people with stroke and healthy older adults. Future research should increase the sample size to enhance the generalizability of the findings.CLINICAL REHABILITATION IMPACTClinicians can use this tool to efficiently identify high-risk individuals among stroke survivors and implement targeted early interventions. This early fall risk screening tool allows healthcare providers to initiate preventive measures and intensive rehabilitation protocols for those at greatest risk, potentially reducing secondary complications, improving functional outcomes, and decreasing hospital readmission rates.

Scoping Review of Fall Risk Assessment Tools for Women Who Receive Maternity Care

Fall risk in stroke survivors: Effects of stroke plus dementia and reduced motor functional capacity

Background: Lower limb amputation (LLA) significantly affects mobility and increases fall risk, particularly in individuals with higher-level amputations and lower functional capacity. Effective tools to assess fall risk are essential in rehabilitation.Objective: This study was conducted at the Department of Physical Medicine and Rehabilitation, Coimbra University Hospital (HUC), Coimbra, Portugal. This study aimed to evaluate the performance of the Timed Up and Go (TUG) test in individuals with unilateral LLA, compare TUG times by amputation level (transfemoral vs. transtibial) and functional level (K2 vs. K3), and determine the predictive value of TUG for fall risk.Methods: A retrospective observational study was conducted with 99 unilateral LLA patients using prostheses. Participants were assessed using the TUG test, and data on demographics, functional classification, and fall history were collected. Statistical comparisons and ROC curve analysis were performed to identify significant differences and the optimal TUG cutoff for fall risk prediction.Results: Transfemoral amputees had significantly slower TUG times than transtibial amputees (17 vs. 12 seconds; p < 0.001). Similarly, K2 amputees in both groups had significantly longer TUG times compared to their K3 counterparts (TF: 30 seconds vs. 14 seconds; TT: 27 seconds vs. 12 seconds; p < 0.001). Individuals with a history of falls also had significantly higher TUG times (26 vs. 10 seconds; p < 0.001). A TUG threshold of 18 seconds demonstrated a sensitivity of 100% and specificity of 69% (AUC = 0.81) for fall prediction.Conclusion: The TUG test is a reliable and practical tool for assessing functional mobility and fall risk in individuals with unilateral LLA. Performance varies significantly with amputation level and functional classification, and a cutoff of 18 seconds effectively identifies individuals at increased risk of falling.

BackgroundFall injuries in the US result in over 19 000 deaths and 2.2 million emergency department visits, and cost over $28 billion. Research shows that, in a clinical setting, effective...

Fall risk assessment and fall detection are crucial for the prevention of adverse and long-term health outcomes. Wearable sensor systems have been used to assess fall risk and detect falls while providing additional meaningful information regarding gait characteristics. Commonly used wearable systems for this purpose are inertial measurement units (IMUs), which acquire data from accelerometers and gyroscopes. IMUs can be placed at various locations on the body to acquire motion data that can be further analyzed and interpreted. Insole-based devices are wearable systems that were also developed for fall risk assessment and fall detection. Insole-based systems are placed beneath the sole of the foot and typically obtain plantar pressure distribution data. Fall-related parameters have been investigated using inertial sensor-based and insole-based devices include, but are not limited to, center of pressure trajectory, postural stability, plantar pressure distribution and gait characteristics such as cadence, step length, single/double support ratio and stance/swing phase duration. The acquired data from inertial and insole-based systems can undergo various analysis techniques to provide meaningful information regarding an individual's fall risk or fall status. By assessing the merits and limitations of existing systems, future wearable sensors can be improved to allow for more accurate and convenient fall risk assessment. This article reviews inertial sensor-based and insole-based wearable devices that were developed for applications related to falls. This review identifies key points including spatiotemporal parameters, biomechanical gait parameters, physical activities and data analysis methods pertaining to recently developed systems, current challenges, and future perspectives.

Inpatients need to recognize their fall risk accurately and objectively. Nurses need to assess how patients perceive their fall risk and identify the factors that influence patients' fall risk perception. This study aims to explore the congruency between nurses' fall risk assessment and patients' perception of fall risk and identify factors related to the non-congruency of fall risk. A descriptive and cross-sectional design was used. The study enrolled 386 patients who were admitted to an acute care hospital. Six nurses assessed the participants' fall risk. Congruency was classified using the Morse Fall Scale for nurses and the Fall Risk Perception Questionnaire for patients. The nurses' fall risk assessments and patients' fall risk perceptions were congruent in 57% of the participants. Underestimation of the patient's risk of falling was associated with gender (women), long hospitalization period, department (orthopedics), low fall efficacy, and history of falls before hospitalization. Overestimation of fall risk was associated with age group, gender (men), department, and a high health literacy score. In the multiple logistic regression, the factors related to the underestimation of fall risk were hospitalization period and department, and the factors related to the overestimation of fall risk were health literacy and department. Nurses should consider the patient's perception of fall risk and incorporate it into fall prevention interventions. Nurses need to evaluate whether patients perceive the risk of falling consistently. For patients who underestimate or overestimate their fall risk, it may be helpful to consider clinical and fall-related characteristics together when evaluating their perception of fall risk.

Decades of research have been conducted on the risk, prevention, and management of falls. Extensive research addresses the identified intrinsic and extrinsic fall risks and the importance of screening for these risks. The emphasis for patient safety interventions surrounding falls and injury prevention must be on patient-centered, multifactorial, individualized care plans that are population-based. Yet the link between risk assessment and the effectiveness of population-based interventions remains weak. Early efforts focused on risk factors for prevention of falls in the elderly, largely ignoring interventions and also considering all fallers as one single group. Research then moved into fall screening and risk assessment, but these two processes were often intermingled, leading to confusion about linking risk to specific interventions. Still the focus was on fall prevention and the elderly, lumping all fallers into one single group. Next, research focused on interventions, but the focus was on fall prevention and the elderly, again lumping all fallers together. A new agenda begins to question this focus on fall prevention and addresses fall protection and injury prevention, emphasizing therapeutic risk associated with activity and community participation. This new agenda also recognizes the need to segment high-risk patient populations to identify unique risks and tailor interventions (e.g., peripheral neuropathy, wheelchair fallers) using new three-dimensional techniques to assess gait and balance as well as other key risk factors. The new agenda also goes beyond fall screening and fall risk assessment, emphasizing the need to screen individuals, follow up with in-depth risk assessment protocols, and link interventions to specific modifiable risk factors. As more evidence is available to clinicians, for translational research efforts are needed to develop clinical tools to make it easier for clinicians to provide evidence-based practice and to explore more effective and efficient strategies for implementing evidence-based programs across clinical settings and facilities. To advocate for evidence-based practice in fall prevention and fall protection, the Veterans Integrated Service Network (VISN) 8 Patient Safety Center of Inquiry held its second international call across professions and experts to articulate the state of the science, elucidate research priorities, and facilitate the translation of research into practice. In April 2007, fall experts from the United States and Canada participated in a three-day national conference, Transforming Fall Prevention Practices. After presenting state-of-the-art knowledge and practices in fall prevention, risk assessment, and interventions, they joined with invited research methodologists and expert clinicians over another half day for the research agenda-setting session. Participants reached consensus on the research needed to advance both science and clinical practice. Priorities were grouped into three research domains: * Clinical interventions. * Biomechanics. * Implementation/translation. The criteria used for selecting research priorities were the-- * Need for consensus among all members. * Feasibility of the research being conducted within 5 years. * Presence of an existing program of research on which to build. * Fit with the mission and vision of the Veterans Health Administration (VHA) in primary health promotion, patient safety, function, and independence. This editorial focuses solely on clinical intervention. We examined the current state of the science relevant to clinical intervention research and developed a research agenda for studies that can be conducted as 5-year research programs likely to result in new discoveries, improved clinical practice, reduced variations in practice, and improved patient outcomes. Clinical intervention research is needed to test the effects of specific interventions related to special populations, medication prescribing, clinical units and staffing, and interdisciplinary approaches to fall prevention [1]. …

Accidental falls are a major problem in later life, reducing the overall well-being, independence, mobility and quality of life of the elderly and those who care for them. The social and economic burden of falls is becoming unsustainable, considering the huge direct and indirect costs associated with each fall and the progressive ageing of the population in industrialised countries. Falls are related to complex and dynamic interactions between intrinsic, subject-specific, and extrinsic, circumstance-related, risk factors. Therefore, the prevention and management of falls in later life still represents a critical challenge for active and healthy ageing. Many healthcare technologies have been proposed to address this in recent years, ranging from fall risk screening and assessment to fall detection and, in more recent studies, fall prediction. However, several critical issues remain, mainly regarding the effectiveness of the proposed solutions, their usability in real environments, sustainability, performance, assessment and technological limitations. The lack of specificity in fall risk assessment, a limited effectiveness in fall prediction and the inability to reliably monitor spontaneous falls in real life conditions with un-obstructive technological solutions remain key unsolved problems. This special issue collects a selection of works across these healthcare technologies giving a snapshot of the latest research in this area. The first paper is an invited literature review on automatic methods for the assessment of fall risk based on statistical machine learning approaches applied to features extracted from wearable accelerometers and/or gyroscopes. This study identified five major recurrent limits identified among the 30 studies included in this review, which the reader of this special issue may consider while designing future studies: publication bias, limited/inadequate sample size, poor model validation, inappropriate model complexity with respect to the available data and poor outcome definition. The second paper in this issue reports a collaborative research effort between Italy, UK and Croatia, investigating the associations between depressed heart rate variability (HRV) and the risk of falling in patients suffering from hypertension. This cross section study enrolled 170 patients over two years, concluding that there is a significant association between depressed HRV and risk of falling, suggesting that it is possible to automatically detect autonomous nervous system states that may lead to falls. The third paper investigates the impact of various parameters on the accuracy vs. energy efficiency of a wearable activity recognition system, based on accelerometers. This study proved that sampling frequency, transmission rate, and method of nodal processing can impact significantly in satisfying the requirement of an activity recognition system. The final paper proposes a framework for fall detection based on wearable accelerometric sensors and machine learning techniques. The paper offers an interesting perspective and reports promising results, although preliminarily tested on a small sample of simulated falls. We hope that you will enjoy reading this special issue, in which some of the challenges of healthcare technologies for fall prediction, detection and risk assessment are examined through a range of different applications.

To assess the fall of risk among the elderly in selected urban area of Thrissur. Objectives a) To assess the fall risk among the elderly people in selected urban area of Kachery, Thrissur. b) To associate fall risk score with selected demographic variables. c) To correlate fall risk assessment questionnaire score and modified fall prevention checklist for personal risk factors score among elderly individuals. d) To teach the elderly people about fall prevention exercise. Methodology: Non-experimental descriptive research design is adopted in this study. We selected 60 samples through random sampling technique. Standardized fall risk assessment questionnaire built by national aging research institute and modified fall prevention checklist for personal risk factors built by Hamilton county was used to collect the data. Tool was administered by interview method for assessing fall risk. Fall preventive intervention module developed, validated and administered following data collection. The data collected were analyzed by using descriptive and inferential statistics. Result: The demographic profile of elderly people shows that 46.66% belongs to age group between 60-70 years and most of them 58.33% were females. The majority 73.33% of elderly person are at low risk for fall and 26.66% are at high risk for fall in questionnaire and 81.67% of elderly are low risk for fall, 18.33% are risk and there is no elderly person high risk for fall in checklist. The overall fall risk is high among elderly individual alone in home and low in elderly in nuclear families. The risk for fall among elderly based on previous history of fall shows that elderly with visual impairment those who don’t have previous knowledge about fall prevention and elderly age between 91-100 is high risk for fall. The risk for fall based on ability to perform ADL in elderly shows those who living alone in the home high risk for fall. There is significant association between score with selected variables like age, previous knowledge about fall prevention, elderly residing in their home alone. We found that there is perfect positive correlation r=1 between fall risk assessment, questionnaires and checklist score. Discussion: At the end of the study the investigator found that the risk for fall based on the assessment of fall history among elderly people shows that, there is significant association between age (p=0.0273) that is, age group between 91-100 years are high risk for fall. Previous knowledge about fall prevention shows that, elderly without previous knowledge about fall prevention is at high risk for fall (p= 0.03074). In sensory impairment that is, elderly having visual impairment (p=0.998) having risk for fall. The risk for fall among elderly people based on their ability to perform activities of daily living shows that, elderly residing in their home alone shows more risk for fall.

Protective effects of elastic band training-detraining on Fall risk, power, body composition, and cognition in older adults with mild cognitive impairment: A 40-week trial