Comprehensive Fall Risk Research Articles

Cross-cultural adaptation, content validity, and reliability of the Amharic version of the modified John-Hopkins fall risk assessment scale among older adults who attend home health care services

BackgroundThe modified John-Hopkins fall risk assessment tool (mJH-FRAT) is a comprehensive and multi-factor fall risk assessment tool used to screen and grade older adult’s fall risk levels in home health care services. This can help to identify risky individuals early, establish prevention protocols, and reduce the occurrence of injury. Nevertheless, there is a dearth of contextually valid and reliable fall risk assessment tools among this population in the study area. The aim of this study is therefore to cross-culturally adapt and assess the content validity and reliability of the modified John-Hopkins fall risk assessment tool among older adults following home health care in Ethiopia.MethodThe English version of the mJH-FRAT underwent cross-cultural adaptation into Amharic. The final Amharic version was subjected to face validity and then content validity was computed. This community-based study was conducted from November 2023 to May 2024 with a total of 150 participants selected through convenience sampling. Data collection occurred through face-to-face interviews. Epi-Info 7 and Statistical Package for the Social Sciences software version 25 facilitated data entry and analysis, respectively. Reliability was assessed by employing intra-rater and inter-rater reliability using Cohen’s kappa.ResultThe CVI based on the item level of all the items was between 0.8 and 1. The S-CVI based on average for domains such as general condition and clinical condition was 0.925 and 1, respectively, and the S-CVI (average) of the scale was 0.96. The S-CVI based on the universal agreement value for the overall 8 items was 0.75. The kappa statistic coefficient value was between 0.79 and 1. The intra-rater reliability and inter-rater reliability were 0.94 and 0.93, respectively.ConclusionThe rigorous adaptation process, face and content validity, and reliability analyses demonstrated that the Amharic mJH-FRAT is a content valid and reliable tool for assessing the fall risk level in this population. Clinicians and researchers can utilize this tool for the advancement of both clinical practice and research work on this group of people in Ethiopia.

Using Video Technology and AI within Parkinson's Disease Free-Living Fall Risk Assessment.

Falls are a major concern for people with Parkinson's disease (PwPD), but accurately assessing real-world fall risk beyond the clinic is challenging. Contemporary technologies could enable the capture of objective and high-resolution data to better inform fall risk through measurement of everyday factors (e.g., obstacles) that contribute to falls. Wearable inertial measurement units (IMUs) capture objective high-resolution walking/gait data in all environments but are limited by not providing absolute clarity on contextual information (i.e., obstacles) that could greatly influence how gait is interpreted. Video-based data could compliment IMU-based data for a comprehensive free-living fall risk assessment. The objective of this study was twofold. First, pilot work was conducted to propose a novel artificial intelligence (AI) algorithm for use with wearable video-based eye-tracking glasses to compliment IMU gait data in order to better inform free-living fall risk in PwPD. The suggested approach (based on a fine-tuned You Only Look Once version 8 (YOLOv8) object detection algorithm) can accurately detect and contextualize objects (mAP50 = 0.81) in the environment while also providing insights into where the PwPD is looking, which could better inform fall risk. Second, we investigated the perceptions of PwPD via a focus group discussion regarding the adoption of video technologies and AI during their everyday lives to better inform their own fall risk. This second aspect of the study is important as, traditionally, there may be clinical and patient apprehension due to ethical and privacy concerns on the use of wearable cameras to capture real-world video. Thematic content analysis was used to analyse transcripts and develop core themes and categories. Here, PwPD agreed on ergonomically designed wearable video-based glasses as an optimal mode of video data capture, ensuring discreteness and negating any public stigma on the use of research-style equipment. PwPD also emphasized the need for control in AI-assisted data processing to uphold privacy, which could overcome concerns with the adoption of video to better inform IMU-based gait and free-living fall risk. Contemporary technologies (wearable video glasses and AI) can provide a holistic approach to fall risk that PwPD recognise as helpful and safe to use.

Using tele-paramedicine to conduct in-home fall risk reduction after emergency department discharge: Preliminary data.

Older adults discharged from our emergency department (ED) do not receive comprehensive fall risk evaluations. We conducted a quality improvement project using an existing Community Tele-Paramedicine (CTP) program to perform in-home fall risk assessment and mitigation after ED discharge. High falls-risk patients, as defined by STEADI score >4, were referred for a CTP home visit by community paramedics supervised virtually by emergency physicians. Home hazards assessment, Timed Up and Go test (TUG), medication reconciliation, and psychosocial evaluation were used to develop fall risk mitigation plans. Outcomes assessed at 30 days post ED-discharge included: completed CTP visits, falls, ED revisits, hospital admissions, and referrals. Between November 2022 and June 2023, 104 (65%) patients were discharged and referred to CTP. The mean age of enrolled patients was 80 years, 66% were female, 63% White, 79% on Medicare or Medicaid, most lived with a family member (50%) or alone (38%). Sixty-one (59%) patients received an initial CTP visit, 48 (79%) a follow-up visit, and 12 (11%) declined a visit. Abnormal TUG tests (74%), home hazards (67%), high-risk medications (36%), or need for outpatient follow-up (49%) or additional home services (41%) were frequently identified. At 30 days, only one of the CTP patients reported a fall, one patient had a fall-related ED visit, and one patient was admitted secondary to a fall. A quality improvement initiative using CTP to perform fall risk reduction after ED discharge identified areas of risk mitigation in the home where most falls take place. Further controlled studies are needed to assess the impact of CTP on clinical outcomes important to patients and health systems.

Undiagnosed vertebral fragility fractures in patients with distal radius fragility fractures: an opportunity for prevention of morbimortality in osteoporotic patients in developing countries.

This study's main goal was to look into the frequency, location, kind, and severity of asymptomatic vertebral fragility fractures (VFF) in people who had fractures of the fragility of the distal radius. Although VFF is frequently misdiagnosed, it is linked to higher mortality, morbidity, and hip fracture risk. The study also attempted to investigate the relationship between VFF and certain demographic and lifestyle factors, as well as FRAX data, in this patient population. Between January, 2021, and January, 2022, individuals with low-energy distal radial fractures who presented to the emergency room of tertiary care hospital of Karachi, Pakistan, were the subject of a cross-sectional study and were 45years of age or older except those who fitted the exclusion criteria (n = 208). The thoracic and/or lumbar spine was imaged using radiology, and information on demographics, way of life, and FRAX (Fracture Risk Assessment Tool) was gathered. Using the Genant semiquantitative approach, an impartial and blinded orthopaedist identified VF in the images and determined their severity. SPSS version 20 was used to analyse the data. Two hundred eleven (41.21%) of them were found to have radiographic VFF and only 12 (2.34%) of the 512 patients who were tested were getting osteoporotic therapy. The thoracic spine (32.7%), followed by the lumbar spine (43.12%), was the area most frequently afflicted. In 24.17% of the patients, multiple fractures of the thoracolumbar spine were found. The wedge form (54.5%), followed by biconcave (30.81%) and crush (14.7%), was the most prevalent VFF type. The majority of detected VFF were rated as having a 25-40% height loss (64.9%) then severe (> 40%) fractures (35.1%), according to the Genant grading method. Notably, there were no variations in smoking, drinking, BMI, or FRAX score between patients with and without VFF that were statistically significant. Based on our study's findings, it is clear that osteoporotic vertebral fragility fractures occur in almost half of individuals with distal radius fractures. The lumbar spine is notably the most affected region, predominantly with wedge fractures. Given the high prevalence of asymptomatic vertebral fragility fractures (VFF), proactive measures are necessary to mitigate associated risks. Prioritising comprehensive fall risk assessments for these patients and interventions to enhance bone mineral density and strength are crucial. Early identification of asymptomatic VFF enables timely intervention, optimising patient care and minimising the risk of complications in this vulnerable population.

Reducing falls among residents of retirement homes: A DNP project.

Falls among older adults (OAs) living in retirement homes (RHs) in Canada are a major public health concern due to high morbidity and mortality as well as significant healthcare expenditures. This quality improvement (QI) initiative, conducted for the author's Doctor of Nursing Practice (DNP) project, aimed to decrease fall rates and ED transfers related to falls among OAs in six RHs across the Greater Toronto Area in Ontario, Canada through a multipart intervention with two primary goals. First, the project aimed to facilitate RH NPs' implementation of a comprehensive fall risk assessment and fall prevention strategy in their practice by incorporating the Stopping Elderly Accidents, Deaths & Injuries (STEADI) toolkit into their armamentarium. Second, it sought to enhance the knowledge of the RHs' registered practical nurses (RPNs), personal support workers (PSWs), and unregulated care providers (UCPs) in assessing fall risk and incorporating fall prevention strategies in their daily practice. By improving NP, RPN, PSW, and UCP knowledge and increasing (by 20%) RPN, PSW, and UCP use of fall prevention strategies, this QI initiative successfully reduced fall rates in the RHs by 40.4%, with no falls requiring transfer to the ED, in the postintervention period. The results of this project highlight the need for an interdisciplinary approach to fall risk reduction in RHs that includes implementation of multifactorial intervention strategies as well as effective organizational policies and procedures for maximum impact.

The impact of falls on activities of daily living in older adults: A retrospective cohort analysis.

Falls contribute to impairments in activities of daily living (ADLs), resulting in significant declines in the quality of life, safety, and functioning of older adults. Understanding the magnitude and duration of the effect of falls on ADLs, as well as identifying the characteristics of older adults more likely to have post-fall ADL impairment is critical to inform fall prevention and post-fall intervention. The purpose of this study is to 1) Quantify the association between falls and post-fall ADL impairment and 2) Model trajectories of ADL impairment pre- and post-fall to estimate the long-term impact of falls and identify characteristics of older adults most likely to have impairment. Study participants were from the Ginkgo Evaluation of Memory Study, a randomized controlled trial in older adults (age 75+) in the United States. Self-reported incident falls and ADL scores were ascertained every 6 months over a 7-year study period. We used Cox proportional hazards analyses (n = 2091) to quantify the association between falls and ADL impairment and latent class trajectory modeling (n = 748) to visualize trajectories of ADL impairment pre-and post-fall. Falls reported in the previous 6 months were associated with impairment in ADLs (HR: 1.42; 95% CI 1.32, 1.52) in fully adjusted models. Based on trajectory modeling (n = 748), 19% (n = 139) of participants had increased, persistent ADL impairment after falling. Participants who were female, lived in a neighborhood with higher deprivation, or experienced polypharmacy were more likely to have ADL impairment post-fall. Falls are associated with increased ADL impairment, and this impairment can persist over time. It is crucial that all older adults, and particularly those at higher risk of post-fall ADL impairment have access to comprehensive fall risk assessment and evidence-based fall prevention interventions, to help mitigate the negative impacts on ADL function.

Development of a statistical analysis software for determining effectiveness of a comprehensive fall risk management protocol

IntroductionAs the leading cause of fatal injuries in geriatric populations, falls are a serious health concern with a predicted rate of seven fall-related deaths per hour by 2030. The Timed...

THE VALUE OF BALANCE CONFIDENCE IN OLDER ADULT FALL RISK ASSESSMENT

Abstract Fall risk assessment traditionally focuses on objective physical performance. Balance confidence, a subjective measure of physical function, may provide important information to better predict fall risk and guide assessment and intervention strategies. This study examines the associations of balance confidence congruency with physical performance measures and fall occurrence. One-hundred-fifty-five community-dwelling adults aged 60 and over completed a comprehensive fall risk assessment including physical performance tests (timed up and go, 4-stage balance, 30-second chair stand, and 4-M gait speed), activities-specific balance confidence (ABC) scale, and self-reported falls in the past year. Four groups were created based on congruency between balance confidence (low vs. high) and each physical performance measure or overall fall risk category (at fall risk vs. not at fall risk, based on the STEADI tool kit). Poison regression analyses, adjusted for age and gender, tested the association between group membership and number of falls in the past year. Participants with high balance confidence and at fall risk based on 4-stage balance performance (Estimate=0.88, p < 0.001), or high balance confidence and at fall risk following the STEADI screening algorithm (Estimate=0.69, p = 0.003) were at increased risk of more falls compared to participants in the group with high balance confidence and not at fall risk. These results suggest that older adults who overestimate their balance relative to their physical performance may be at increased fall risk, and that participant subjective reporting of physical performance should be paired with objective physical performance measures to better identify older adults at fall risk.

Can the 1-Leg Standing Test Be Replaced by Self-reported Balance in the First-Time Injurious Fall Screening Tool?

The First-time Injurious Fall (FIF) screening tool was created to identify fall risk in community-living older men and women, who may be targets for primary preventive interventions. The FIF tool consists of 3 self-reported questions and 1 physical test (1-leg standing balance). The purpose of this study was to examine the predictive ability of the FIF tool and a modified FIF tool (in which 1-leg standing is replaced by self-reported balance) for first-time injurious falls. A cohort of 1194 community-living people 60 years and older from the Swedish National Study on Aging and Care in Kungsholmen (SNAC-K), Sweden, was followed longitudinally for 5 years. Data on injurious falls were collected from registered data and were defined as receipt of care after a fall. The predictive ability of the FIF tool and the m-FIF tool was explored using Harrell's C statistic, stratified by sex. The injurious fall rate per 1000 person-years was 54.9 (95% CI: 47.22-63.78) for women and 36.3 (95% CI: 28.84-45.78) for men. The predictive ability for women and men according to Harrell's C statistic was 0.70 and 0.71 for the FIF tool and the m-FIF tool. The predictive ability was 0.70 and 0.69 for 1-leg standing, and 0.65 and 0.60 for self-reported balance problems. The m-FIF tool presented similar predictive ability as the FIF tool regarding first-time injurious falls. This finding could extend the usefulness of the tool to other settings, such as to electronic health (eHealth). A quickly and easily administered screening tool can help physical therapists to identify people with a high risk of falling who may need to undergo a more comprehensive fall risk assessment.

Accidental Fall Death in McLean County: Examining Variables in Community-Dwelling Older Adults.

Fall risk assessment is a complex phenomenon involving several risk factors, including an individual's balance and mobility status, chronic health conditions, visual impairment, hearing deficits, environmental hazards (e.g., loose rugs, clutter), and being homebound or semi-homebound. Comprehensive fall risk assessment is the cornerstone of fall prevention in older adults throughout the community. The current study was based on secondary data and sought to examine variables associated with death due to accidental fall in a rural, midwestern county in Illinois, and to heighten awareness for consistent screening and risk assessment in older adults residing in the community. Results illustrated that among community-dwelling older adults with accidental falls, blunt injury or subdural hematoma had significantly fewer days until death than a fracture. [Journal of Gerontological Nursing, 48(6), 26-32.].

Impact of a personalised care plan for the elderly calling emergency medical services after a fall at home: The RISING-DOM multi-centre randomised controlled trial protocol

BackgroundA growing number of emergency calls are made each year for elderly people who fall. Many of them are not taken to hospital or are rapidly discharged from the Emergency Department (ED). Evidence shows that, with no further support, this vulnerable population is particularly at risk of injuries, dependency and death. This study aims to determine the effectiveness of a comprehensive geriatric assessment and a tailored intervention in the elderly calling on an Emergency Medical Service (EMS) for a fall at home, but not conveyed to the ED or rapidly discharged from it (less than 24 h from hospitalisation), to the time to institutionalisation or death.MethodsRising-Dom is a two-arm randomised (ratio 1:1), interventional, multi-centre and open study. Community-dwelling elderly people (≥ 70 years) who call an EMS for a fall at home are recruited. The intervention group receives home visits by a nurse with a comprehensive fall risk assessment and a personalised intervention care plan with a planned follow-up (six nurse home visits and five nurse phone calls). Subjects enrolled in the usual care-control group continue to receive their routine care for the prevention or treatment of diseases. Primary (time to institutionalisation or death) and secondary (unscheduled hospitalisations, additional EMS calls relating to falls, functional decline and quality of life) outcome data will be collected for both groups through five phone calls made by Clinical Research Associates (CRA) blind to the participants’ group during the follow-up period (24-months). Twelve hospital centres in the South-West of France are participating in the study as study sites. The inclusion period started in October 2019 and will end in March 2022. By the end of this period, 1,190 subjects are expected to be enrolled.DiscussionStudies on elderly home falls have rarely concerned people who were not taken to hospital. The Rising-Dom intervention scheme should enhance understanding of features related to this vulnerable population and investigate the impact of a nurse care at home on delaying death and institutionalisation.Trial registrationClinicaltrials.gov identifier: NCT04132544. Registration date: 18/10/2019. Sponsor: University Hospital, Toulouse. https://www.clinicaltrials.gov/ct2/show/NCT04132544?term=rising-dom&draw=2&rank=1

A Mobile App (FallSA) to Identify Fall Risk Among Malaysian Community-Dwelling Older Persons: Development and Validation Study.

BackgroundRecent falls prevention guidelines recommend early routine fall risk assessment among older persons.ObjectiveThe purpose of this study was to develop a Falls Screening Mobile App (FallSA), determine its acceptance, concurrent validity, test-retest reliability, discriminative ability, and predictive validity as a self-screening tool to identify fall risk among Malaysian older persons.MethodsFallSA acceptance was tested among 15 participants (mean age 65.93 [SD 7.42] years); its validity and reliability among 91 participants (mean age 67.34 [SD 5.97] years); discriminative ability and predictive validity among 610 participants (mean age 71.78 [SD 4.70] years). Acceptance of FallSA was assessed using a questionnaire, and it was validated against a comprehensive fall risk assessment tool, the Physiological Profile Assessment (PPA). Participants used FallSA to test their fall risk repeatedly twice within an hour. Its discriminative ability and predictive validity were determined by comparing participant fall risk scores between fallers and nonfallers and prospectively through a 6-month follow-up, respectively.ResultsThe findings of our study showed that FallSA had a high acceptance level with 80% (12/15) of older persons agreeing on its suitability as a falls self-screening tool. Concurrent validity test demonstrated a significant moderate correlation (r=.518, P<.001) and agreement (k=.516, P<.001) with acceptable sensitivity (80.4%) and specificity (71.1%). FallSA also had good reliability (intraclass correlation .948; 95% CI .921-.966) and an internal consistency (α=.948, P<.001). FallSA score demonstrated a moderate to strong discriminative ability in classifying fallers and nonfallers. FallSA had a predictive validity of falls with positive likelihood ratio of 2.27, pooled sensitivity of 82% and specificity of 64%, and area under the curve of 0.802.ConclusionsThese results suggest that FallSA is a valid and reliable fall risk self-screening tool. Further studies are required to empower and engage older persons or care givers in the use of FallSA to self-screen for falls and thereafter to seek early prevention intervention.

A Machine Learning-Based Fall Risk Assessment Model for Inpatients.

Falls are one of the most common accidents among inpatients and may result in extended hospitalization and increased medical costs. Constructing a highly accurate fall prediction model could effectively reduce the rate of patient falls, further reducing unnecessary medical costs and patient injury. This study applied data mining techniques on a hospital's electronic medical records database comprising a nursing information system to construct inpatient-fall-prediction models for use during various stages of inpatient care. The inpatient data were collected from 15 inpatient wards. To develop timely and effective fall prediction models for inpatients, we retrieved the data of multiple-time assessment variables at four points during hospitalization. This study used various supervised machine learning algorithms to build classification models. Four supervised learning and two classifier ensemble techniques were selected for model development. The results indicated that Bagging+RF classifiers yielded optimal prediction performance at all four points during hospitalization. This study suggests that nursing personnel should be aware of patients' risk factors based on comprehensive fall risk assessment and provide patients with individualized fall prevention interventions to reduce inpatient fall rates.

Specific Motor and Cognitive Performances Predict Falls during Ward-Based Geriatric Rehabilitation in Patients with Dementia.

The aim of this study was to identify in-hospital fall risk factors specific for multimorbid hospitalized geriatric patients with dementia (PwD) during hospitalization. Geriatric inpatients during ward-based rehabilitation (n = 102; 79.4% females; 82.82 (6.19) years of age; 20.26 (5.53) days of stay) were included in a comprehensive fall risk assessment combining established clinical measures, comprehensive cognitive testing including detailed cognitive sub-performances, and various instrumented motor capacity measures as well as prospective fall registration. A combination of unpaired t-tests, Mann–Whitney-U tests, and Chi-square tests between patients with (“in-hospital fallers”) and without an in-hospital fall (“in-hospital non-fallers”), univariate and multivariate regression analysis were used to explore the best set of independent correlates and to evaluate their predictive power. In-hospital fallers (n = 19; 18.63%) showed significantly lower verbal fluency and higher postural sway (p < 0.01 to 0.05). While established clinical measures failed in discriminative as well as predictive validity, specific cognitive sub-performances (verbal fluency, constructional praxis, p = 0.01 to 0.05) as well as specific instrumented balance parameters (sway area, sway path, and medio-lateral displacement, p < 0.01 to 0.03) significantly discriminated between fallers and non-fallers. Medio-lateral displacement and visuospatial ability were identified in multivariate regression as predictors of in-hospital falls and an index combining both variables yielded an accuracy of 85.1% for fall prediction. Results suggest that specific cognitive sub-performances and instrumented balance parameters show good discriminative validity and were specifically sensitive to predict falls during hospitalization in a multimorbid patient group with dementia and an overall high risk of falling. A sensitive clinical fall risk assessment strategy developed for this specific target group should include an index of selected balance parameters and specific variables of cognitive sub-performances.

The Validity Of A Smartphone-based Seated Postural Control Assessment In Non-ambulatory Adults

Individuals who rely on wheeled mobility have unique fall risk factors (e.g. seated postural control) but recommended fall risk screening tools are predominately designed for ambulatory individuals. Consequently, most non-ambulatory adults do not undergo comprehensive fall risk screening or receive targeted fall prevention strategies. PURPOSE: To examine the validity of smartphone-based postural control assessments in non-ambulatory adults. METHODS: Eleven participants (age: 35.4 ± 17.9) completed three clinical tests: The Trunk Control Test, Function in Sitting Test (FIST), and Tee-Shirt Test, as well as, four instrumented balance tasks in a standardized order: eyes open, eyes closed, functional reach, and functional stability boundary. During the balance tasks, participants held a smartphone and research-grade accelerometer to their chest. These devices measured root mean square (RMS) acceleration in the medial-lateral (ML), anterior-posterior, and vertical axes during all tasks. A median split of FIST scores differentiated participants with better and worse postural control. Spearman rank-order correlations between the two devices’ measurements were conducted, and receiver operating characteristic (ROC) and the area under the curves (AUC) were constructed to distinguish participants with better and worse postural control. RESULTS: Participant scores from the FIST differed between those with better and worse postural control (p = 0.020). There were significant moderate to strong correlations between measures derived from the smartphone and measures derived from the research-grade accelerometer during the balance tasks (ρ = 0.636-1.000; p < 0.01-0.035). The AUC for ROC plots were significant for RMS ML sway during the eyes open task and functional stability boundary (p=0.045 and 0.018, respectively). CONCLUSION: This pilot study illustrated that smartphone technology may be able to provide a valid assessment of seated postural control and have the ability to distinguish between those with better and worse postural control in the ML direction. Leveraging this form of technology could provide easily accessible and objective fall risk assessments for non-ambulatory adults. Funded by: The National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR)

THE DAILY BALANCE PROJECT: AN INQUIRY INTO THE INTRAINDIVIDUAL DYNAMICS OF PERCEIVED AND ACTUAL FALL RISK

An accurate understanding of one’s abilities and limitations allows adaptive response to the challenges that are faced in daily life. However, older adults may over or under estimate their actual abilities. The Daily Balance Project examined the intraindividual dynamics of older adults’ perceived balance with objective measures of balance and physical activity. For 30 consecutive days, following a comprehensive fall risk assessment, 20 older adults rated their balance confidence (Activities Balance Confidence scale) at that moment and then performed five standardized balance assessments measured via smartphone accelerometer held to their chest. Physical activity was measured with an activity monitor. Baseline measurements of fall risk differentiated the extent of intraindividual variation and co-variation of balance and physical activity. For some participants, actual and perceived balance became more closely aligned as the study progressed. The implications of the findings for life-span perspectives on aging and fall prevention are discussed.

Using Health-Related Quality of Life (SF-36v2®) to Predict Falls in Community-Dwelling Older Adults

Background: Falls are the leading cause of hospitalization and death among older adults; therefore, the ability to predict fall risk among older adults is critical. Several performance-based outcome measures exist to assess fall risk. Psychological factors are also associated with fall risk yet can be difficult to assess and are often overlooked. In this study, we investigated whether the Short Form 36 Item Health Survey (SF-36v2®), a measure of health-related quality of life (HRQOL), predicted future falls in a sample of community-dwelling older adults. A secondary purpose was to examine relationships between the SF-36v2® and balance performance. Methods: Forty-three community-dwelling older adults completed the SF-36v2® and 3 well-established measures of balance performance: Berg Balance Scale, Tinetti Mobility Assessment, and Timed Up and Go. Future falls were recorded for 12 months after testing. Results: The SF-36v2® physical component summary (PCS) scores predicted future fall status at 12 months. The PCS was correlated with all three measures of balance performance, in which higher PCS scores were associated with better balance. The mental component summary (MCS) scores were not significantly associated with balance performance. Conclusions: In this study, HRQOL as measured by the SF-36v2® predicted future falls and was associated with well-established balance performance measure scores. The instrument should be considered for inclusion in a comprehensive fall risk assessment.

Validation and reliability of Falls Risk for Hospitalized Older People (FRHOP): Taiwan version.

A comprehensive fall risk assessment can provide information for effective prevention and intervention measures and reduce falls among hospitalized elderly people. The purpose of this study was to develop a Chinese version of an inpatient fall risk assessment tool and evaluate its validity and reliability.This study employed the Falls Risk for Hospitalised Older People (FRHOP) assessment to construct a FRHOP-Taiwan Version (Tw-FRHOP) through forward, synthesized, and backward translation. A face validation was conducted by 5 clinical nurses and a content validation was conducted by 5 specialists using the content validity index (CVI) to validate the proposed model. Thirty hospitalized older adults in an internal care unit were selected for an interrater reliability assessment, conducted separately by specialists in 4 disciplines (i.e., nurses, physicians, occupational therapists, and physiotherapists) by using Cohen kappa statistic and intraclass correlation coefficients (ICCs). Specifically, the assessment rating developed in the Tw-FRHOP was compared with the Morse Fall Scale (MFS), St. Thomas Risk Assessment Tool in Falling Elderly Inpatients (STRATIFY), and the Hendrich II Fall Risk Model (HIIFRM) for criterion validation.According to the analysis results, the CVI was 0.94, and the indexes of criterion-related validity for the FRHOP-Taiwan Version, MFS, STRATIFY, and HIIFRM were 0.49, 0.63, and 0.54 (all P < .001), respectively. In addition, after interrater reliability testing was conducted, the results indicated that the index of response consistency in each discipline was 86.7% to 100%, and the values of Cohen kappa were 0.651 to 1.000. The ICCs of the discipline-related subscale were 0.97 to 1.00.The Tw-FRHOP is a multidisciplinary comprehensive fall risk assessment that can serve as a satisfactorily valid and reliable reference tool for medical personnel with full professional training, as well as inpatient fall prevention interventions for multidisciplinary teams in hospitals.

Risk of Falls in Dizzy Patients

Dizziness is the most common symptom in elderly patients and has been identified as a risk factor for falls. They can affect objectively the ability to achieve a stable gaze, posture, and gait. Research on the relationship between vestibular hypofunction and falls in elderly people has been rarely performed and the evidence is controversial. Because falls result from various combinations of many factors, validated tools should be used for assessment of falling. Many of the tests and numerous parameters associated with the risk of falling have already been introduced, however guidance on which test is most appropriate for use in a specific setting still lack in the medical community. Therefore, developement of comprehensive fall risk management guideline and assessment tool including physical, psychosocial, environmental factors are necessary to prevent falls in the elderly. Establishment of validity and reliability for relationship among several vestibular function test are more important to evaluate efficiently risk of falls in the dizzy patients. Also we can expect that decreasing risk of fall when conduct the developement of additional customized intervention method using verified assessment tools. Keywords: Falls; Risk; Prevention; Dizziness 중심 단어: 낙상, 위험, 예방, 어지럼

Variability of spatial temporal gait parameters and center of pressure displacements during gait in elderly fallers and nonfallers: A 6-month prospective study.

Considering that most of the falls in elderly population arise during walking, tests derived from walking performance would be desirable for comprehensive fall risk assessment. The analysis of spatial temporal parameters and the center of pressure displacement, which represents the interaction between the human body and the ground, would be beneficial. The aim of this study was to compare spatial temporal gait parameters and their variability and the variability of the center of pressure displacement between elderly fallers and nonfallers during gait at self-selected, defined and fast speeds. A prospective study design was used. At the baseline, measurements of ground reaction force during gait at self-selected, defined and fast walking speeds by two force plates were performed. In addition, the Tinetti balance assessment tool, the Falls Efficacy Scale-International and the Activities-Specific Balance Confidence Scale were used. Mean and coefficient of variation of spatial temporal gait parameters and standard deviations of center of pressure displacement during loading response, midstance, terminal stance and preswing phases were calculated. Comparison of the fallers and nonfallers exhibited no significant difference in clinical tool, scales or spatial temporal parameters. Compared to nonfallers’ increased variability of walking speed at self-selected and defined speed, step width at fast walking speed and center of pressure displacement during preswing phase in medial-lateral directions at defined walking speed was found in fallers. However, application of the Holm-Bonferroni procedure for multiple comparisons exhibited no significant effect of group in any of the gait parameters. In general, our study did not observe an effect of group (fallers vs. nonfallers) on variability of spatial temporal parameters and center of pressure movement during gait. However, walking speed, step width as well as standard deviation of COP displacement in the medial-lateral direction during preswing exhibited a certain potential for distinguishing between elderly fallers and nonfallers.