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Development and Evaluation of an Online Fall-Risk Questionnaire for Nonfrail Community-Dwelling Elderly Persons: A Pilot Study. Curr Gerontol Geriatr Res 2016; 2016:1520932. [PMID: 27247571 PMCID: PMC4877464 DOI: 10.1155/2016/1520932] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 03/22/2016] [Accepted: 04/13/2016] [Indexed: 12/02/2022] Open
Abstract
Introduction. Falls are frequent in older adults and may have serious consequences but awareness of fall-risk is often low. A questionnaire might raise awareness of fall-risk; therefore we set out to construct and test such a questionnaire. Methods. Fall-risk factors and their odds ratios were extracted from meta-analyses and a questionnaire was devised to cover these risk factors. A formula to estimate the probability of future falls was set up using the extracted odds ratios. The understandability of the questionnaire and discrimination and calibration of the prediction formula were tested in a cohort study with a six-month follow-up. Community-dwelling persons over 60 years were recruited by an e-mail snowball-sampling method. Results and Discussion. We included 134 persons. Response rates for the monthly fall-related follow-up varied between the months and ranged from low 38% to high 90%. The proportion of present risk factors was low. Twenty-five participants reported falls. Discrimination was moderate (AUC: 0.67, 95% CI 0.54 to 0.81). The understandability, with the exception of five questions, was good. The wording of the questions needs to be improved and measures to increase the monthly response rates are needed before test-retest reliability and final predictive value can be assessed.
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Boulton E, Hawley-Hague H, Vereijken B, Clifford A, Guldemond N, Pfeiffer K, Hall A, Chesani F, Mellone S, Bourke A, Todd C. Developing the FARSEEING Taxonomy of Technologies: Classification and description of technology use (including ICT) in falls prevention studies. J Biomed Inform 2016; 61:132-40. [PMID: 27018213 DOI: 10.1016/j.jbi.2016.03.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 01/31/2016] [Accepted: 03/22/2016] [Indexed: 12/01/2022]
Abstract
BACKGROUND Recent Cochrane reviews on falls and fall prevention have shown that it is possible to prevent falls in older adults living in the community and in care facilities. Technologies aimed at fall detection, assessment, prediction and prevention are emerging, yet there has been no consistency in describing or reporting on interventions using technologies. With the growth of eHealth and data driven interventions, a common language and classification is required. OBJECTIVE The FARSEEING Taxonomy of Technologies was developed as a tool for those in the field of biomedical informatics to classify and characterise components of studies and interventions. METHODS The Taxonomy Development Group (TDG) comprised experts from across Europe. Through face-to-face meetings and contributions via email, five domains were developed, modified and agreed: Approach; Base; Components of outcome measures; Descriptors of technologies; and Evaluation. Each domain included sub-domains and categories with accompanying definitions. The classification system was tested against published papers and further amendments undertaken, including development of an online tool. Six papers were classified by the TDG with levels of consensus recorded. RESULTS Testing the taxonomy with papers highlighted difficulties in definitions across international healthcare systems, together with differences of TDG members' backgrounds. Definitions were clarified and amended accordingly, but some difficulties remained. The taxonomy and manual were large documents leading to a lengthy classification process. The development of the online application enabled a much simpler classification process, as categories and definitions appeared only when relevant. Overall consensus for the classified papers was 70.66%. Consensus scores increased as modifications were made to the taxonomy. CONCLUSION The FARSEEING Taxonomy of Technologies presents a common language, which should now be adopted in the field of biomedical informatics. In developing the taxonomy as an online tool, it has become possible to continue to develop and modify the classification system to incorporate new technologies and interventions.
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Affiliation(s)
- Elisabeth Boulton
- School of Nursing, Midwifery and Social Work, Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK; Manchester Academic Health Sciences Centre, Manchester, UK.
| | - Helen Hawley-Hague
- School of Nursing, Midwifery and Social Work, Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK; Manchester Academic Health Sciences Centre, Manchester, UK.
| | - Beatrix Vereijken
- Department of Neuroscience, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Amanda Clifford
- Department of Clinical Therapies, University of Limerick, Limerick, Ireland.
| | - Nick Guldemond
- University Medical Centre Utrecht, Utrecht, The Netherlands.
| | - Klaus Pfeiffer
- Klinik für Geriatrische Rehabilitation, Robert-Bosch-Krankenhaus, Stuttgart, Germany.
| | - Alex Hall
- School of Nursing, Midwifery and Social Work, Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK; Manchester Academic Health Sciences Centre, Manchester, UK.
| | - Federico Chesani
- Department of Computer Science and Engineering - DISI, University of Bologna, Bologna, Italy.
| | - Sabato Mellone
- Biomedical Engineering Unit, Department of Electrical, Electronic, and Information Engineering, University of Bologna, Bologna, Italy.
| | - Alan Bourke
- Department of Neuroscience, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Chris Todd
- School of Nursing, Midwifery and Social Work, Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK; Manchester Academic Health Sciences Centre, Manchester, UK.
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Schoberer D, Breimaier HE, Mandl M, Halfens RJG, Lohrmann C. Involving the consumers: An exploration of users' and caregivers' needs and expectations on a fall prevention brochure: A qualitative study. Geriatr Nurs 2016; 37:207-14. [PMID: 26975837 DOI: 10.1016/j.gerinurse.2016.02.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 02/04/2016] [Accepted: 02/08/2016] [Indexed: 11/17/2022]
Abstract
This study aims to explore and compare nursing home residents', family members', and nursing staff's needs and expectations regarding a fall prevention brochure. Focus groups were carried out with 25 residents, 12 family members and 14 nursing staff separately, from three randomly selected nursing homes. Qualitative content analysis was used to analyze the data using a concept-driven coding frame. Results showed that residents want to be informed about dealing with extrinsic fall risks and coping strategies after a fall event. In addition, family members wanted to have detailed information on intrinsic fall risks as well as specific fall prevention strategies, such as body exercises. Of special importance for nursing staff was that not all falls are preventable even when preventive measures were taken. As the need and expectations of users differ substantially, one brochure could not comprise all postulated criteria and different brochures are necessary for residents and for family members.
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Affiliation(s)
- Daniela Schoberer
- Institute of Nursing Science, Medical University of Graz, Billrothgasse 6, 8010 Graz, Austria.
| | - Helga E Breimaier
- Institute of Nursing Science, Medical University of Graz, Billrothgasse 6, 8010 Graz, Austria
| | - Manuela Mandl
- Institute of Nursing Science, Medical University of Graz, Billrothgasse 6, 8010 Graz, Austria
| | - Ruud J G Halfens
- Department of Health Services Research, School CAPHRI, Maastricht University, 6229 GT Maastricht, The Netherlands
| | - Christa Lohrmann
- Institute of Nursing Science, Medical University of Graz, Billrothgasse 6, 8010 Graz, Austria
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Fall Risk Assessment Tools for Elderly Living in the Community: Can We Do Better? PLoS One 2015; 10:e0146247. [PMID: 26716861 PMCID: PMC4696849 DOI: 10.1371/journal.pone.0146247] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 12/15/2015] [Indexed: 11/20/2022] Open
Abstract
Background Falls are a common, serious threat to the health and self-confidence of the elderly. Assessment of fall risk is an important aspect of effective fall prevention programs. Objectives and methods In order to test whether it is possible to outperform current prognostic tools for falls, we analyzed 1010 variables pertaining to mobility collected from 976 elderly subjects (InCHIANTI study). We trained and validated a data-driven model that issues probabilistic predictions about future falls. We benchmarked the model against other fall risk indicators: history of falls, gait speed, Short Physical Performance Battery (Guralnik et al. 1994), and the literature-based fall risk assessment tool FRAT-up (Cattelani et al. 2015). Parsimony in the number of variables included in a tool is often considered a proxy for ease of administration. We studied how constraints on the number of variables affect predictive accuracy. Results The proposed model and FRAT-up both attained the same discriminative ability; the area under the Receiver Operating Characteristic (ROC) curve (AUC) for multiple falls was 0.71. They outperformed the other risk scores, which reported AUCs for multiple falls between 0.64 and 0.65. Thus, it appears that both data-driven and literature-based approaches are better at estimating fall risk than commonly used fall risk indicators. The accuracy–parsimony analysis revealed that tools with a small number of predictors (~1–5) were suboptimal. Increasing the number of variables improved the predictive accuracy, reaching a plateau at ~20–30, which we can consider as the best trade-off between accuracy and parsimony. Obtaining the values of these ~20–30 variables does not compromise usability, since they are usually available in comprehensive geriatric assessments.
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Lacroix A, Kressig RW, Muehlbauer T, Gschwind YJ, Pfenninger B, Bruegger O, Granacher U. Effects of a Supervised versus an Unsupervised Combined Balance and Strength Training Program on Balance and Muscle Power in Healthy Older Adults: A Randomized Controlled Trial. Gerontology 2015; 62:275-88. [PMID: 26645282 DOI: 10.1159/000442087] [Citation(s) in RCA: 98] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Accepted: 11/02/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Losses in lower extremity muscle strength/power, muscle mass and deficits in static and particularly dynamic balance due to aging are associated with impaired functional performance and an increased fall risk. It has been shown that the combination of balance and strength training (BST) mitigates these age-related deficits. However, it is unresolved whether supervised versus unsupervised BST is equally effective in improving muscle power and balance in older adults. OBJECTIVE This study examined the impact of a 12-week BST program followed by 12 weeks of detraining on measures of balance and muscle power in healthy older adults enrolled in supervised (SUP) or unsupervised (UNSUP) training. METHODS Sixty-six older adults (men: 25, women: 41; age 73 ± 4 years) were randomly assigned to a SUP group (2/week supervised training, 1/week unsupervised training; n = 22), an UNSUP group (3/week unsupervised training; n = 22) or a passive control group (CON; n = 22). Static (i.e., Romberg Test) and dynamic (i.e., 10-meter walk test) steady-state, proactive (i.e., Timed Up and Go Test, Functional Reach Test), and reactive balance (e.g., Push and Release Test), as well as lower extremity muscle power (i.e., Chair Stand Test; Stair Ascent and Descent Test) were tested before and after the active training phase as well as after detraining. RESULTS Adherence rates to training were 92% for SUP and 97% for UNSUP. BST resulted in significant group × time interactions. Post hoc analyses showed, among others, significant training-related improvements for the Romberg Test, stride velocity, Timed Up and Go Test, and Chair Stand Test in favor of the SUP group. Following detraining, significantly enhanced performances (compared to baseline) were still present in 13 variables for the SUP group and in 10 variables for the UNSUP group. CONCLUSION Twelve weeks of BST proved to be safe (no training-related injuries) and feasible (high attendance rates of >90%). Deficits of balance and lower extremity muscle power can be mitigated by BST in healthy older adults. Additionally, supervised as compared to unsupervised BST was more effective. Thus, it is recommended to counteract intrinsic fall risk factors by applying supervised BST programs for older adults.
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Affiliation(s)
- André Lacroix
- Division of Training and Movement Sciences, University of Potsdam, Potsdam, Germany
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Rodríguez-Molinero A, Narvaiza L, Gálvez-Barrón C, de la Cruz JJ, Ruíz J, Gonzalo N, Valldosera E, Yuste A. [Falls in the Spanish elderly population: Incidence, consequences and risk factors]. Rev Esp Geriatr Gerontol 2015; 50:274-80. [PMID: 26168776 DOI: 10.1016/j.regg.2015.05.005] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Revised: 03/19/2015] [Accepted: 05/04/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Falls in the elderly constitute a public health concern. The objective of the present study was to collect updated data on the frequency of falls in the Spanish elderly population, as well as to analyse their consequences and associated risk factors. MATERIAL AND METHODS This prospective study was conducted on a probabilistic sample of 772 Spanish, community dwelling, older adults. During the baseline visit, data were collected on functional capacity, history of falls, disease background, number of medications used, balance impairment, use of walking aids, cognitive capacity and depression symptoms. Participants were followed up for one year by means of quarterly phone calls, where they were asked about the number of falls occurred in that period, as well as their consequences and associated use of healthcare resources. RESULTS During the one-year follow up period, 28.4% (95%CI 24.9-32.1) of participants suffered one or more falls, while 9.9% (95%CI 7.4-11.4) suffered multiple falls. One-third of the falls were due to accidental extrinsic causes. Among participants who had suffered falls, 9.3% suffered a fracture (3.1% hip fracture), and 55.4% required healthcare services (29% were managed in the hospital emergency room, and 7.3% were admitted to hospital). Risk factors identified through multivariate analysis were: advanced age (>79 years), not having a companion, using more than 2 drugs, dependency in BADLs, impaired strength or balance, and use of walking aids. CONCLUSIONS Falls continue to be a major public health concern in Spain. Given that some of the associated risk factors may be modified, introducing programs aimed at tackling this problem should be regarded as a priority.
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Affiliation(s)
- Alejandro Rodríguez-Molinero
- Servicio de Geriatría, Consorci Sanitari del Garraf, Vilanova i la Geltrú, Barcelona, España; Unidad de Investigación Clínica, Fundación Privada Sant Antoni Abat, Vilanova i la Geltrú, Barcelona, España; School of Engineering and Informatics, National University of Ireland at Galway, Galway, Ireland.
| | - Leire Narvaiza
- Servicio de Geriatría, Consorci Sanitari del Garraf, Vilanova i la Geltrú, Barcelona, España; Unidad de Investigación Clínica, Fundación Privada Sant Antoni Abat, Vilanova i la Geltrú, Barcelona, España
| | - César Gálvez-Barrón
- Servicio de Geriatría, Consorci Sanitari del Garraf, Vilanova i la Geltrú, Barcelona, España; Unidad de Investigación Clínica, Fundación Privada Sant Antoni Abat, Vilanova i la Geltrú, Barcelona, España
| | - Juan José de la Cruz
- Departamento de Medicina Preventiva y Salud Pública, Universidad Autónoma de Madrid, Madrid, España
| | - Jorge Ruíz
- Unidad de Investigación Clínica, Fundación Privada Sant Antoni Abat, Vilanova i la Geltrú, Barcelona, España
| | - Natalia Gonzalo
- Unidad de Investigación Clínica, Fundación Privada Sant Antoni Abat, Vilanova i la Geltrú, Barcelona, España
| | - Esther Valldosera
- Unidad de Investigación Clínica, Fundación Privada Sant Antoni Abat, Vilanova i la Geltrú, Barcelona, España
| | - Antonio Yuste
- Servicio de Geriatría, Consorci Sanitari del Garraf, Vilanova i la Geltrú, Barcelona, España; Unidad de Investigación Clínica, Fundación Privada Sant Antoni Abat, Vilanova i la Geltrú, Barcelona, España
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Klenk J, Kerse N, Rapp K, Nikolaus T, Becker C, Rothenbacher D, Peter R, Denkinger MD. Physical Activity and Different Concepts of Fall Risk Estimation in Older People--Results of the ActiFE-Ulm Study. PLoS One 2015; 10:e0129098. [PMID: 26058056 PMCID: PMC4461251 DOI: 10.1371/journal.pone.0129098] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 05/05/2015] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES To investigate the relationship between physical activity and two measures of fall incidence in an elderly population using person-years as well as hours walked as denominators and to compare these two approaches. DESIGN Prospective cohort study with one-year follow-up of falls using fall calendars. Physical activity was defined as walking duration and recorded at baseline over one week using a thigh-worn uni-axial accelerometer (activPAL; PAL Technologies, Glasgow, Scotland). Average daily physical activity was extracted from these data and categorized in low (0-59 min), medium (60-119 min) and high (120 min and more) activity. SETTING The ActiFE Ulm study located in Ulm and adjacent regions in Southern Germany. PARTICIPANTS 1,214 community-dwelling older people (≥65 years, 56.4% men). MEASUREMENTS Negative-binomial regression models were used to calculate fall rates and incidence rate ratios for each activity category each with using (1) person-years and (2) hours walked as denominators stratified by gender, age group, fall history, and walking speed. All analyses were adjusted either for gender, age, or both. RESULTS No statistically significant association was seen between falls per person-year and average daily physical activity. However, when looking at falls per 100 hours walked, those who were low active sustained more falls per hours walked. The highest incidence rates of falls were seen in low-active persons with slow walking speed (0.57 (95% confidence interval (95% CI): 0.33 to 0.98) falls per 100 hours walked) or history of falls (0.60 (95% CI: 0.36 to 0.99) falls per 100 hours walked). CONCLUSION Falls per hours walked is a relevant and sensitive outcome measure. It complements the concept of incidence per person years, and gives an additional perspective on falls in community-dwelling older people.
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Affiliation(s)
- Jochen Klenk
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
- Department of Clinical Gerontology and Rehabilitation, Robert-Bosch-Hospital, Stuttgart, Germany
- * E-mail:
| | - Ngaire Kerse
- Department of General Practice and Primary Health Care, School of Population Health, University of Auckland, Auckland, New Zealand
| | - Kilian Rapp
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
- Department of Clinical Gerontology and Rehabilitation, Robert-Bosch-Hospital, Stuttgart, Germany
| | | | - Clemens Becker
- Department of Clinical Gerontology and Rehabilitation, Robert-Bosch-Hospital, Stuttgart, Germany
| | | | - Richard Peter
- Institute of the History, Philosophy and Ethics of Medicine, Ulm University, Ulm, Germany
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