Fall Risk Screening Research Articles

Physical Therapists as Partners for Community Fall Risk Screenings and Referrals to Community Programs.

Objectives: Physical therapists (PTs) are integral team members in fall prevention in clinical settings; however, few studies have investigated PTs' engagement in pro-bono community-based falls prevention. Therefore, we aimed to describe the characteristics of PTs and physical therapist assistants (PTAs) in the United States who conduct community-based fall screenings, the reach of screenings, their knowledge and utilization of the Centers for Disease Control and Prevention's fall-risk screening toolkit (STEADI, Stopping Elderly Accidents, Deaths, and Injuries), and therapists' knowledge and referrals to evidence-based programs (EBPs) and community resources.Methods: A cross-sectional survey distributed to a convenience sample of PTs/PTAs in the United States through news-blasts, and social media.Results: Four hundred and forty-four therapists who worked with older adults completed the survey. Approximately 40% of the respondents (n = 180) conduct screenings, most frequently annually. People who screen tend to be PTs with >20 years of experience, work in outpatient/wellness or academia, and be involved in the least amount of direct patient care. The majority (n = 344, 77.5%) of survey respondents were somewhat to very familiar with the STEADI, and ~84% (n = 114) of respondents who were very familiar with the STEADI (n = 136) use the toolkit to conduct community-based, pro-bono fall risk screenings. Twenty-six percent (n = 14) out of the 53 PTAs who responded to the survey conduct falls screenings in the community. Of the PTs/PTAs who conduct community-based fall screenings (n = 180), ~ 75% (n = 136) are aware of and refer older adults to EBPs. Over half also refer to Silver Sneakers and/or senior centers.Discussion: PTs and PTAs are key partners in evidence-based multifactorial fall prevention in the community. Data helps inform community organizations that most PTs who engage in community-based fall risk screening utilize the STEADI toolkit and refer to community-based programs. Community organizations seeking PT partners to engage in fall risk screenings and promote referrals to local resources or EBPs will likely have the most success collaborating with local physical therapy education programs or physical therapy clinic managers.

Moving the needle on fall prevention: A Geriatric Emergency Care Applied Research (GEAR) Network scoping review and consensus statement.

Although falls are common, costly, and often preventable, emergency department (ED)-initiated fall screening and prevention efforts are rare. The Geriatric Emergency Medicine Applied Research Falls core (GEAR-Falls) was created to identify existing research gaps and to prioritize future fall research foci. GEAR's 49 transdisciplinary stakeholders included patients, geriatricians, ED physicians, epidemiologists, health services researchers, and nursing scientists. We derived relevant clinical fall ED questions and summarized the applicable research evidence, adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews. The highest-priority research foci were identified at the GEAR Consensus Conference. We identified two clinical questions for our review (1) fall prevention interventions (32 studies) and (2) risk stratification and falls care plan (19 studies). For (1) 21 of 32 (66%) of interventions were a falls risk screening assessment and 15 of 21 (71%) of these were combined with an exercise program or physical therapy. For (2) 11 fall screening tools were identified, but none were feasible and sufficiently accurate for ED patients. For both questions, the most frequently reported study outcome was recurrent falls, but various process and patient/clinician-centered outcomes were used. Outcome ascertainment relied on self-reported falls in 18 of 32 (56%) studies for (1) and nine of 19 (47%) studies for (2). Harmonizing definitions, research methods, and outcomes is needed for direct comparison of studies. The need to identify ED-appropriate fall risk assessment tools and role of emergency medical services (EMS) personnel persists. Multifactorial interventions, especially involving exercise, are more efficacious in reducing recurrent falls, but more studies are needed to compare appropriate bundle combinations. GEAR prioritizes five research priorities: (1) EMS role in improving fall-related outcomes, (2) identifying optimal ED fall assessment tools, (3) clarifying patient-prioritized fall interventions and outcomes, (4) standardizing uniform fall ascertainment and measured outcomes, and (5) exploring ideal intervention components.

On the Move clinic: A fall prevention nurse practitioner-driven model of care

Falls in older adults are common and interventions to reduce associated morbidity and mortality remain difficult to implement. This quality improvement project evaluated On the Move, a new clinic designed to provide tailored recommendations to reduce falls risk, based on an adaptation of CDC's STEADI: a falls risk screening, assessment and intervention guide. 89 participants were referred by primary care and emergency services. A nurse practitioner assessed modifiable physical, behavioral and environmental risk factors and utilized motivational interviewing and education to guide participants in developing an intervention plan. A physical therapist assessed gait/balance, the need for ongoing PT services and provided brief counseling. Participants received a 6-week phone call and 12-week follow up visit. Measurements, including 30-second chair stands, Timed Up and Go, 4-Item Dynamic Gait Index, and Activities-Specific Balance Confidence Scale all showed significant improvement. Participants made behavioral changes to reduce risk, and plans to continue exercise.

Adapted Stopping Elderly Accidents, Deaths, and Injuries Questions for Falls Risk Screening: Predictive Ability in Older Drivers

Fall fatality rates among U.S. older adults increased 30% from 2007 to 2016. In response, the Centers for Disease Control and Prevention developed the Stopping Elderly Accidents, Deaths, and Injuries algorithm for fall risk screening, assessment, and intervention. The current Stopping Elderly Accidents, Deaths, and Injuries algorithm with 2 levels (at risk and not at risk) was adapted to an existing cohort of older adult drivers. A U.S. multisite prospective cohort (N=2,990) of drivers (aged 65-79 years), from 2015 to 2017, was used for these analyses completed in January 2020-October 2020. To measure the adapted Stopping Elderly Accidents, Deaths, and Injuries key questions for fall risk screening performance in predicting future falls, adjusted logistic regression determined the area of the receiver operating characteristic curve. An adjusted mixed logistic regression modeled the association between the adapted Stopping Elderly Accidents, Deaths, and Injuries key questions and future falls. The adapted Stopping Elderly Accidents, Deaths, and Injuries key questions yielded an area under the curve of 0.65 in determining any fall over 2 years. The adjusted mixed logistic regression model suggests that those at risk for falls at baseline were associated with 2.37 times higher odds of any fall (95% CI=2.00, 2.80) and 3.60 times higher odds of multiple falls (95% CI=2.88, 4.51) over 2 years. The adapted Stopping Elderly Accidents, Deaths, and Injuries key questions for fall risk screening yielded fair predictive ability for falls over 2 years and were strongly associated with future falls for older adult drivers. The adapted Stopping Elderly Accidents, Deaths, and Injuries key questions can be applied to existing data in nonclinical settings to strengthen fall screening and prevention at a population level.

Preoperative screening in patients having elective shoulder surgery reveals a high rate of fall risk.

Fall risk is an acknowledged but relatively understudied concern for older patients undergoing shoulder surgery. The cause is multifactorial, and it includes advanced age, impaired upper extremity function, use of shoulder abduction braces, and postoperative use of opioid medications. No previous study has examined preoperative fall risk in patients undergoing elective shoulder surgery. Previous literature looking at fall risk in elective orthopedic procedures has predominantly focused on falls occurring in the hospital setting, although falls have also been shown to occur in the outpatient setting. Gait speed and Timed Up and Go (TUG) are well-researched functional measures in the aging population with established cutoff scores indicating increased fall risk. The purpose of this study was to quantify gait speed and TUG scores in a series of patients who were scheduled to undergo either rotator cuff repair (RCR) or total shoulder arthroplasty (TSA) in order to assess overall risk of fall in these populations. A total of 198 patients scheduled for TSA or RCR surgery were evaluated preoperatively from multiple outpatient physical therapy clinics within Greenville, South Carolina. The TUG score (>14 seconds considered high fall risk) and 10 Meter Walk test (<0.7m/s considered high risk for falls) were recorded for each patient. Patient-reported outcomes were also collected, including Veteran's Rand 12 Physical Component and Mental Component Scores, American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form score, and the Single Assessment Numeric Evaluation. Patients undergoing TSA (n = 80; 65.4 ± 11.4 years) were older than those undergoing RCR (n = 118; 59.0 ± 14.2 years). Fifty-nine percent of all patients were classified as being a high risk for falls based on gait speed <0.7 m/s. Patients in the TSA group were more likely to display preoperative fall risk compared to patients in the RCR group (62% vs. 38%; χ2 = 8.9, P = .03). There were no significant differences in ambulatory status, Veteran's Rand 12 Physical Component and Mental Component Scores, American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form, or Single Assessment Numeric Evaluation scores between groups (P= .11). Both patient groups demonstrated a high rate of fall risk in preoperative evaluation. Patients undergoing TSA more often displayed fall risk compared with patients undergoing RCR. Although patients in the TSA group were older, there was no association between age or ambulatory status and fall risk. Our results suggest that fall risk screening may be important for patients undergoing TSA and RCR surgeries. The higher fall risk in the TSA group may be an important consideration as this procedure shifts toward outpatient status.

The use of a primary care provider survey to implement a fall prevention program in an urban hospital system

BackgroundFalls are the leading cause of traumatic injury in older adults. Multidisciplinary approaches between trauma surgeons and primary care providers can powerfully advocate for fall prevention. This study explores current fall prevention practices and barriers to falls screening and prevention in the primary care setting and proposes pertinent recommendations to address the deficiencies. MethodsA questionnaire was adapted from a previous survey study to explore the beliefs, knowledge, attitudes, and clinical practice regarding falls by primary care providers. The questionnaire was distributed by e-mail to primary care providers at a tertiary urban medical center. ResultsThe survey achieved a response rate of 58%. All respondents agreed that older adult patients should be assessed for fall risks and that evidence-based fall prevention programs can reduce the risk of falls. However, 43% of respondents did not agree that they had the expertise to perform fall risk assessments, and similarly 43% did not agree they have the time to perform fall risk assessments in the office. Furthermore, although 52% of respondents were aware of the Medicare reimbursement for fall risk screening, only 24% had billed for fall risk screening and only 5% agreed that they were adequately reimbursed. ConclusionSeveral barriers to performing fall prevention care in the primary care setting were identified: unfamiliarity with resources, perceived lack of time, and perceived insufficient reimbursement. We implemented a set of interventions which include an educational series and workflow optimization to overcome barriers identified.

Can Fall Risk Screening and Fall Prevention Advice in Hospital Settings Motivate Older Adult Patients to Take Action to Reduce Fall Risk?

Objective:We investigated whether an in-hospital intervention consisting of fall risk screening and tailored advice could prompt patients to take preventive action.Method:Patients (≥70) attending the emergency department and nephrology outpatient clinic in a Dutch hospital were screened. Patients at high risk received tailored advice based on their individual risk factors. Three months after screening, preventive steps taken by patients were surveyed.Results:Two hundred sixteen patients were screened. Of the 83 patients completing a 3-month follow-up, 51.8% took action; among patients who received tailored advice (n = 20), 70% took action. Patients most often adhered to advice on improving muscle strength and undergoing vision checkups (20%). Tailored advice and a reported low quality of life were associated with consulting a health care provider.Discussion:Patients at risk in these settings are inclined to take action after screening. However, they do not always adhere to the tailored prevention advice.

In older adults, adding fall-risk screening with targeted interventions to mailed advice did not reduce fractures.

Lamb SE, Bruce J, Hossain A, et al. Screening and intervention to prevent falls and fractures in older people. N Engl J Med. 2020;383:1848-59. 33211928.

Stakeholder and Data-Driven Fall Screen in a Program of All-Inclusive Care for the Elderly: Quality Improvement Initiative.

The Program of All-Inclusive Care for the Elderly (PACE) delivers community-based long-term care services to low-income, nursing home eligible adults. In the PACE population, one of the most common reasons for hospitalizations is falls. The purpose of this quality improvement study was to create a stakeholder-driven process for developing a fall risk screen and evaluate how well this process discriminated injurious and noninjurious fallers. The quality improvement design was a prospective, longitudinal data collection for 5 PACE programs in Colorado. Physical therapists collected the Short Physical Performance Battery (SPPB) on participants at least annually. The Kotter practice change framework guided the processes for practice and organizational change in developing and implementing a fall screen. An iterative, stakeholder, and data-driven process allowed our team of researchers and a PACE program to establish a fall risk screen to stratify PACE participants. We provided feedback to PACE staff regarding screening rates and results on discrimination of faller status to promote continued uptake of screening and discussion regarding next steps. Rehabilitation therapists screened 66% of the PACE population, and participants were stratified into high risk (1-7 points) or low risk (8-12 points) based on the SPPB. Participants with low SPPB scores had 79% greater risk of a fall (risk ratio [RR] = 1.8; 95% confidence interval [CI], 1.5-2.1) and 86% greater risk of an injurious fall (RR = 1.9; 95% CI, 1.4-2.4), compared with those with high SPPB scores. Our study describes a collaboration to address fall rates in a PACE population. Program of All-Inclusive Care for the Elderly clinicians can use the identified cut-offs to stratify PACE populations at risk for falls and allocate scarce rehabilitation resources efficiently to best serve participants at highest risk, while using less resource-intensive interventions for those at lower risk.

Critically appraised paper: Screening for fall risk and a targeted exercise or multifactorial intervention do not reduce fracture rate in older adults more than advice only [synopsis

Critically appraised paper: Screening for fall risk and a targeted exercise or multifactorial intervention do not reduce fracture rate in older adults more than advice only [synopsis

Critically appraised paper: Screening for fall risk and a targeted exercise or multifactorial intervention do not reduce fracture rate in older adults more than advice only [commentary

Critically appraised paper: Screening for fall risk and a targeted exercise or multifactorial intervention do not reduce fracture rate in older adults more than advice only [commentary

Information Models Offer Value to Standardize Electronic Health Record Flowsheet Data: A Fall Prevention Exemplar.

The rapid implementation of electronic health records (EHRs) resulted in a lack of data standardization and created considerable difficulty for secondary use of EHR documentation data within and between organizations. While EHRs contain documentation data (input), nurses and healthcare organizations rarely have useable documentation data (output). The purpose of this article is to describe a method of standardizing EHR flowsheet documentation data using information models (IMs) to support exchange, quality improvement, and big data research. As an exemplar, EHR flowsheet metadata (input) from multiple organizations was used to validate a fall prevention IM. A consensus-based, qualitative, descriptive approach was used to identify a minimum set of essential fall prevention data concepts documented by staff nurses in acute care. The goal was to increase generalizable and comparable nurse-sensitive data on the prevention of falls across organizations for big data research. The research team conducted a retrospective, observational study using an iterative, consensus-based approach to map, analyze, and evaluate nursing flowsheet metadata contributed by eight health systems. The team used FloMap software to aggregate flowsheet data across organizations for mapping and comparison of data to a reference IM. The FloMap analysis was refined with input from staff nurse subject matter experts, review of published evidence, current documentation standards, Magnet Recognition nursing standards, and informal fall prevention nursing use cases. Flowsheet metadata analyzed from the EHR systems represented 6.6 million patients, 27 million encounters, and 683 million observations. Compared to the original reference IM, five new IM classes were added, concepts were reduced by 14 (from 57 to 43), and 157 value set items were added. The final fall prevention IM incorporated 11 condition or age-specific fall risk screening tools and a fall event details class with 14 concepts. The iterative, consensus-based refinement and validation of the fall prevention IM from actual EHR fall prevention flowsheet documentation contributes to the ability to semantically exchange and compare fall prevention data across multiple health systems and organizations. This method and approach provides a process for standardizing flowsheet data as coded data for information exchange and use in big data research. Opportunities exist to work with EHR vendors and the Office of the National Coordinator for Health Information Technology to implement standardized IMs within EHRs to expand interoperability of nurse-sensitive data.

Inpatient falls prevention: state-wide survey to identify variability in Western Australian hospitals

Objective: A point prevalence survey was conducted across Western Australia to monitor adherence to evidence-based practices to prevent falls in hospitals. Study design and methods: A state-wide point prevalence survey of patients and their medical records was conducted across 20 hospitals, over 17 days during May 2014. The survey determined rates of: provision of verbal information to patients; completion of a falls risk screening tool and age based cognitive testing. Univariate and multivariate logistic regression was utilised to determine key risks and opportunities to improve. Results: Information was collected from 2,720 patients. The provision of verbal information to prevent falls, as recalled by patients was 60% (hospital range 35–88%). This was significantly higher for patients with a stay of six or more days or involved in rehabilitation care. Perinatal women were three times less likely to be provided with verbal falls prevention information. A falls risk screening tool was completed for 82% of patients (range 28–98%). Perinatal women, and both adult and paediatric patients compared to older adults, were significantly less likely to have a complete falls risk screening tool. Thirty seven percent of patients within the recommended age ranges had cognitive testing (range 0–87%). Short-term patients and those not involved in rehabilitation, were significantly less likely to have been tested. Discussion: The survey identified differences in patient care and supporting processes across all hospitals. The results have highlighted areas for improvement. Conclusion: There were wide variations across all the hospitals in the provision of falls information, completion of falls risk screening tools and cognitive testing. At significant risk of missing out on falls prevention strategies were short stay patients and perinatal women. Five hospitals had significantly low rates of cognitive testing, indicating a hospitalwide issue rather than specific patient cohorts. Subsequently, the importance of ensuring that falls prevention strategies are conducted is vital to reduce preventable inpatient falls in all care settings. Implications for research, policy and practice: This was the first state-wide point prevalence study in WA and it has informed the need for further research into the implication of falls risk inpatients. It was found that falls risk assessment was not conducted for each patient who met the screening criteria. A review of the criteria, and practicability to carry out the assessment may need to be further investigated to determine if the practice should be refined. What is already known about the topic? Falls in hospitals are a frequent and largely considered preventable health concern. Falls that occur in hospitals are associated with an increased length of stay and use of health resources. What this paper adds: This paper offers a comprehensive insight into the variation in hospital falls prevention strategies, from a state-wide perspective. It also identifies perinatal women as a high-risk group who are missing out on falls prevention strategies despite having the potential to fall. It also gives an insight to health services that not all at risk patients are being screened and those screened are not screened early in their inpatient stay which can be a risk to both patient and staff.

Utilization of an Integrated Medicare Advantage Model Is Positively Associated With Medication Adherence

An estimated 30% of U.S. healthcare costs are due to waste, inefficiencies, and excessive pricing. Research shows that integrated primary care models (IPC) improve health outcomes and reduce costs. Nearly all IPCs embed ancillary clinicians, including pharmacists, within the clinic. IPCs that embed a primary care clinic within a pharmacy are novel. This study describes the first known IPC for older adults that is based in a pharmacy and examines its impact on medication adherence. In January 2018, Walgreens launched an IPC focused on Medicare Advantage patients at select Kansas City Walgreens locations. Each morning the entire IPC team meets to review needs of patients who will be seen that day. Upon arrival, the patient is first seen by a pharmacist who completes medication and immunization reviews and fall risk screening. If a new medication is prescribed during the physician visit, the pharmacist returns to consult the patient. The IPC team works together to ensure that the Medicare Annual Wellness Exam is completed in entirety. We examined the impact of IPC utilization on adherence to the top seven chronic condition drug groups. IPC patients age 50+ with sub-optimal adherence (<80% proportion of days covered) during the year prior to the clinic opening were included (n=64). A Student’s t-test revealed an 11% improvement in optimal adherence year-over-year between the pre- and post- periods (p<0.001). The pharmacy-based IPC is associated with improved medication adherence. Future research should examine the impact of this model on patient satisfaction and additional health outcomes.

Fall Prevention in Dutch Physician Practices: A Descriptive Study

Falls are an important health threat among frail older people. Physicians are often the first to contact for health issues and can be seen as designated professionals to provide fall prevention. However, it is unknown what they exactly do and why regarding fall prevention. This study aims to describe what physicians in the Netherlands do during daily practice in regards to fall prevention. About 65 physicians (34 practices) located throughout the Netherlands were followed up for 12 months. When a physician entered specific ICPC-codes related to frailty and falls in the Hospital Information System, the physician received a pop-up asking if the patient is frail. If so, the physician subsequently completed a questionnaire. The physicians completed 1396 questionnaires. More than half (n=726) of the patients had experienced a fall in the previous year and/or had a fear of falling (FOF) and 37% of these patients received fall prevention. Physicians did not know of 20% of the patients if they had experienced a fall and of 29% of the patients if they had a FOF. The three most often treated underlying causes were mobility problems, FOF and cardiovascular risk factors. The results show that physicians are not always aware of a patient’s fall history and/or FOF and that only part of these patients receives fall prevention. Hence, it might be important to develop and implement strategies for systematic fall risk screening and fall prevention provision in the primary care setting to reduce falls among frail older people.

A Practical and Validated Fall Risk Screening Instrument: A Systematic Review

Early detection of a high fall risk is important to start fall preventive interventions in time and to reduce fall risk among older people. Several fall risk screening instruments are available, however it is unclear which instrument is validated and most suitable for the primary care setting. This systematic review aims to identify the most suitable fall risk screening instrument(s) for the primary care setting (i.e. requires limited time, no expensive equipment and no additional space) with good prognostic ability to assess high fall risk among independently living older people. An extensive search was conducted in the databases PubMed, EMBASE CINAHL, Cochrane and PsycINFO. Twenty-six out of 2277 articles published between January 2000 and February 2019 were included. Six fall risk screening instruments were identified; TUG test, Gait Speed test, BBS, POMA, FR test, Fall History. Most articles reported AUCs ranging from 0.5-0.7 for all instruments. Sensitivity and specificity varied substantially across studies (e.g. TUG, sens.: 10-83.3%, spec.:37-96.6%). The results showed that none of the included screening instruments had sufficient (AUC>0.7) predictive performance (Šimundić, 2009). As suitability for the primary care setting prevails for now, Fall History appears to be the most suitable screening instrument. Compared to the other instruments, Fall History requires the least amount of time, no expensive equipment, no training, and no space (adjustments). Patient’s fall history together with a health care professional’s clinical judgment, might be a promising screening strategy for the primary care setting to identify high fall risk among older people.

Promoting older adult fall prevention education and awareness in a community setting: A nurse-led intervention

Background and objectivesFalls are costly and one of the most expensive medical conditions to treat. The implementation of fall prevention toolkits (FPTs), such as fall risk screenings and fall prevention education (FPE), have become progressively important in reducing fall incidences. Nurses have a greater role and responsibility to care for the aging population. The purpose of this project was to implement a FPT to adults age 65 and older that attended mobile IPE community clinics. Research design and methodsThis project used quantitative pretest-posttests and an open-ended participant feedback survey. The Missouri Alliance for Home Care 10-question survey and components of the CDC's Stopping Elderly Accidents, Deaths, and Injuries (STEADI) FPE were used to assess and educate participants on fall risks and fall prevention. An initial baseline fall assessment and fall education score was obtained at the mobile IPE clinics. Follow-up assessments occurred one month after the initial assessment and compared to the initial fall assessment and fall education scores with an additional open-ended participant survey. ResultsIn both fall risk assessment tools, lower scores indicated a lower fall risk; both fall risk assessment tool mean scores decreased over the one-month period. Discussion and implicationsFuture FPE implementation projects should consider providing needed resources the participants may need so there is no delay in increasing fall prevention and safety measures. The follow-up time period should also be increased to fortify FPE and keep participants engaged in fall prevention safety.

The Short Physical Performance Battery (SPPB): A Quick and Useful Tool for Fall Risk Stratification Among Older Primary Care Patients

ObjectivesEvaluate fall risk with the Short Physical Performance Battery (SPPB) and examine its application within the Stopping Elderly Accidents, Deaths, and Injuries (STEADI) tool advocated by the Centers for Disease Control and Prevention. DesignProspective longitudinal cohort study. Setting and Participants417 community-dwelling adults aged ≥65 years at risk for mobility decline, recruited from 9 primary care practices. MethodsThe SPPB, a 3-part performance-based test (gait time, chair stand, and balance), was assessed at baseline. Previously established cutpoints were used to categorize participant scores into 3 groups: low, middle, and best performers. Self-reported falls were assessed in-person at baseline and via phone interviews quarterly for 4 years. Multivariable negative binomial regression models were used to evaluate the relationship of the SPPB and each of its 3 components with fall rates over 1 and 4 years of follow-up. Additional analysis were stratified by fall risk screen status (+/−) based on self-reported fall history and balance self-efficacy using an adapted STEADI model. ResultsParticipants had median age 76 years (interquartile range 70-82) and were 67.2% female with mean baseline SPPB 8.7 ± 2.3. Poor performance on the SPPB and on each of its 3 components independently predicted higher fall risk in the first year. After 4 years, the low total baseline SPPB [rate ratio (RR) 1.53, confidence interval (CI) 1.09-2.17] and gait time performances (RR 1.61, CI 1.07-2.41) predicted higher fall risk. After stratifying the sample according to the STEADI model, we observed the highest 1-year fall risk among those with a (+) fall risk screen who also scored lowest on the SPPB. Conclusions and ImplicationsThe SPPB is a performance measure with clinical utility for fall risk stratification over 1 and 4 years of follow-up among older adults. It shows promise as a complement to the STEADI guidelines, but its full benefits should be confirmed within a larger study.

Screening and Intervention to Prevent Falls and Fractures in Older People

BackgroundCommunity screening and therapeutic prevention strategies may reduce the incidence of falls in older people. The effects of these measures on the incidence of fractures, the use of health resources, and health-related quality of life are unknown.MethodsIn a pragmatic, three-group, cluster-randomized, controlled trial, we estimated the effect of advice sent by mail, risk screening for falls, and targeted interventions (multifactorial fall prevention or exercise for people at increased risk for falls) as compared with advice by mail only. The primary outcome was the rate of fractures per 100 person-years over 18 months. Secondary outcomes were falls, health-related quality of life, frailty, and a parallel economic evaluation.ResultsWe randomly selected 9803 persons 70 years of age or older from 63 general practices across England: 3223 were assigned to advice by mail alone, 3279 to falls-risk screening and targeted exercise in addition to advice by mail, and 3301 to falls-risk screening and targeted multifactorial fall prevention in addition to advice by mail. A falls-risk screening questionnaire was sent to persons assigned to the exercise and multifactorial fall-prevention groups. Completed screening questionnaires were returned by 2925 of the 3279 participants (89%) in the exercise group and by 2854 of the 3301 participants (87%) in the multifactorial fall-prevention group. Of the 5779 participants from both these groups who returned questionnaires, 2153 (37%) were considered to be at increased risk for falls and were invited to receive the intervention. Fracture data were available for 9802 of the 9803 participants. Screening and targeted intervention did not result in lower fracture rates; the rate ratio for fracture with exercise as compared with advice by mail was 1.20 (95% confidence interval [CI], 0.91 to 1.59), and the rate ratio with multifactorial fall prevention as compared with advice by mail was 1.30 (95% CI, 0.99 to 1.71). The exercise strategy was associated with small gains in health-related quality of life and the lowest overall costs. There were three adverse events (one episode of angina, one fall during a multifactorial fall-prevention assessment, and one hip fracture) during the trial period.ConclusionsAdvice by mail, screening for fall risk, and a targeted exercise or multifactorial intervention to prevent falls did not result in fewer fractures than advice by mail alone. (Funded by the National Institute of Health Research; ISRCTN number, ISRCTN71002650.)

Falls risk score removal does not impact inpatient falls: A stepped-wedge, cluster-randomised trial.

To investigate the impact of removing a falls risk screening tool from an overall falls risk assessment programme on the rate of falls, injurious falls and completion of falls prevention activities by staff. Falls in older patients are common adverse events in hospital settings. Screening and assessing individual patients for risk of falls are a common, but controversial element of falls prevention strategies in hospitals. A stepped-wedge, cluster-randomised controlled trial using a disinvestment approach. This trial was carried out according to the Consolidated Standards of Reporting Trials (CONSORT). All patients were admitted to 20 health service wards (9 units) over the 10-month study period. The control condition contained a falls risk screening tool element, a full falls risk factor assessment and intervention provision section. In the intervention condition, only the full falls risk factor assessment and intervention provision section was applied, and the falls risk screening tool element was removed. Fall rates were extracted from hospital level data, files were audited for tool completion, and nurses surveyed about tool use. There did not appear to be an impact on the falls rate per month when the risk screening tool component was removed (incidence rate ratio (IRR)=0.84-favours intervention, 95%CI=0.67 to 1.05, p=.14) nor on the falls rate with serious injury (IRR=0.90, 95%CI=0.26 to 3.09, p=.87). There was a thirty-six second reduction of time per patient reported by staff to complete paperwork (p<.001). There was no difference in the proportion of patients for whom the tool was completed, nor the number of falls prevention interventions identified for implementation. Removing the falls risk screening tool section did not negatively impact falls and reduced time spent completing falls prevention paperwork. Falls prevention is an important issue in health services. Removal of a screening risk tool is unlikely to impact falls. This has the potential to reduce nursing administration time that may be otherwise redirected to individual approaches to falls prevention.