Falls and fracture risk screening in primary care: update and validation of a postal screening tool for community dwelling older adults recruited to UK Prevention of Falls Injury Trial (PreFIT)

BACKGROUND

Postal screening has not previously been validated as a method for identifying fall and fracture risk in community-dwelling populations. We examined prognostic performance of a postal risk screener used in the UK Prevention of Falls Injury Trial (PreFIT; ISRCTN71002650), to predict any fall, recurrent falls, and fractures over 12 months. We tested whether adding variables would improve screener performance.

METHODS

Nine thousand eight hundred and eight community-dwelling participants, aged 70 years and older, and 63 general practices in the UK National Health Service (NHS) were included in a large, pragmatic cluster randomised trial comparing screen and treat fall prevention interventions. The short postal screener was sent to all participants in the trial intervention arms as an A4 sheet to be completed and returned to the GP (n = 6,580). The postal screener items were embedded in the baseline pre-randomisation postal questionnaire for all arms of the trial (n = 9,808). We assessed discrimination and calibration using area under the curve (AUC). We identified additional predictors using data from the control arm and applied these coefficients to internal validation models in the intervention arm participants. We used logistic regression to identify additional predictor variables.

FINDINGS

A total of 10,743 falls and 307 fractures were reported over 12 months. Over one third of participants 3,349/8,136 (41%) fell at least once over 12 month follow up. Response to the postal screener was high (5,779/6,580; 88%). Prediction models showed similar discriminatory ability in both control and intervention arms, with discrimination values for any fall AUC 0.67 (95% CI 0.65 to 0.68), and recurrent falls (AUC 0.71; 95% CI 0.69, 0.72) but poorer discrimination for fractures (AUC 0.60; 95% CI 0.56, 0.64). Additional predictor variables improved prediction of falls but had modest effect on fracture, where AUC rose to 0.71 (95% CI 0.67 to 0.74). Calibration slopes were very close to 1.

CONCLUSION

A short fall risk postal screener was acceptable for use in primary care but fall prediction was limited, although consistent with other tools. Fracture and fall prediction were only partially reliant on fall risk although were improved with the additional variables.

The Fall Risk Screening Scale Is Suitable for Evaluating Adult Patient Fall

(1) Background: This study aimed to test the feasibility of utilizing the screening tool for fall risk assessment in adult inpatient and verify its accuracy in a medical center in Taiwan. (2) Methods: This study retrospectively collected all adult fall cases among inpatients occurring in the general wards of a medical center between 1 January 2013 and 31 December 2015. This inpatient fall risk screening scale was measured by the sensitivity, specificity, and accuracy. (3) Results: There were 1331 (0.4%) falls among a total of 357,395 inpatients during this period. Factors predictive of falling risk included: age, consciousness, body shift assistance, use of fall risk medications, fall history, dizziness or weakness, toileting, and impaired mobility. Using the eight-factor assessment, two was the best cutoff point for identifying the fall risk group, with area under Receiver Operating Characteristic (ROC) curve (AUC) = 0.817, sensitivity = 80.93%, specificity = 73.0%, accuracy = 73.03%, and likelihood ratio = 11.48. (4) Conclusions: The accuracy of the eight-item fall risk assessment tool created for this study was validated. These results can serve as a reference for institutions to develop more effective fall risk assessment scale for inpatients, enabling clinical nurses to identify and more comprehensively assess the groups at highest risk for falling during their hospital stay.

Psychometric Properties of the European Portuguese Version of the Memorial Emergency Department Fall Risk Assessment Tool

Falls are a public health problem that cause serious damage to people’s health and health systems. This study aims to estimate the validity and reliability of the Memorial Emergency Department Fall Risk Assessment Tool for the European Portuguese population. The sample included 186 adults from an emergency department of a District Hospital in Portugal. Reliability and precision (inter-rater reliability) are assessed by two independent raters. The relationship between MEDFRAT and the Morse Fall Risk Scale is evaluated. All items presented a high Kappa index. The MEDFRAT showed a high and significant correlation with the Morse Fall Risk Scale. The influence of sociodemographic and clinical data was also checked. The MEDFRAT is adequate, valid and reliable for the European Portuguese population to assess the risk of falling of emergency department patients.

Examination of tools associated with the evaluation of knowledge uptake and utilization: A scoping review

Knowledge transfer and exchange (KTE) has become an integral part of organizational practice. Evaluation of KTE, as well as knowledge products generated through this process, is important for understanding the effectiveness of KTE strategies. This scoping review aimed to identify tools and frameworks used to evaluate knowledge uptake and utilization (KUU). The search strategy included review of PubMed and Scopus databases, hand searching of relevant journals, and citation tracing. Over 6500 abstracts were screened; 292 full-text articles were shortlisted by two reviewers. Seventy-two articles described tools for evaluating KUU. A total of 23 tools could be generally applied to knowledge products/processes used in different sectors; 36 evaluation tools were designed for specific knowledge products (i.e., websites); 9 tools were discipline-specific (i.e., medical field), and four articles described evaluations of knowledge products/processes using alternative methods such as Google Analytics or qualitative methods. The majority of tools (n = 40, 56 %) focused on usability of a knowledge product or process. This scoping review identified various tools being used to assess the effectiveness and impact of KTE processes/products, however, the measures were as varied as the projects, and were often not designed to evaluate KTE in particular.

Fall prediction using decision tree analysis in acute care units

[Purpose] To present an accurate and straight-forward system of fall prediction by performing decision tree analysis using both the fall assessment sheet and Berg balance scale (BBS). [Participants and Methods] The participants in this retrospective study were inpatients from acute care units. We extracted the risk factors for falls from the fall assessment and performed a decision tree analysis using the extracted fall risk factors and BBS score. [Results] "History of more than one fall in the last 1 year", "Muscle weakness", "Use of a walking aid or wheelchair", "Requires assistance for transfer", "Use of Narcotics", "Dangerous behavior", and "High degree of self-reliance" were fall risk factors. The decision tree analysis extracted five fall risk factors, with an area under the curve of 0.7919. Patients with no history of falls and who did not require assistance for transfer or those with a BBS score ≥51 did not fall. [Conclusion] Decision tree-based fall prediction was useful and straightforward and revealed that patients with no history of falling and those who did not require assistance for transfer or had a BBS score ≥51 had a low risk of falling.

Factors included in adult fall risk assessment tools (FRATs): a systematic review

Falls often have severe financial and environmental consequences, not only for those who fall, but also for their families and society at large. Identifying fall risk in older adults can be of great use in preventing or reducing falls and fall risk, and preventative measures that are then introduced can help reduce the incidence and severity of falls in older adults. The overall aim of our systematic review was to provide an analysis of existing mechanisms and measures for evaluating fall risk in older adults. The 43 included FRATs produced a total of 493 FRAT items which, when linked to the ICF, resulted in a total of 952 ICF codes. The ICF domain with the most used codes was body function, with 381 of the 952 codes used (40%), followed by activities and participation with 273 codes (28%), body structure with 238 codes (25%) and, lastly, environmental and personal factors with only 60 codes (7%). This review highlights the fact that current FRATs focus on the body, neglecting environmental and personal factors and, to a lesser extent, activities and participation. This over-reliance on the body as the point of failure in fall risk assessment clearly highlights the need for gathering qualitative data, such as from focus group discussions with older adults, to capture the perspectives and views of the older adults themselves about the factors that increase their risk of falling and comparing these perspectives to the data gathered from published FRATs as described in this review.

The role of lower urinary tract symptoms in fall risk assessment tools in hospitals: a review

A large number of falls in hospitals occur on the way to the toilet. Accordingly, a literature search was conducted in Web of Science, PubMed, Embase, and the Cochrane Library to identify fall risk screening and assessment metrics published between 1980 and 2019 and to study the inclusion of lower urinary tract symptoms (LUTS) and their related parameters in these screening tools. In addition, the literature was searched to explore the relationship between toilet-related falls and LUTS. In total, 23 fall risk scales were selected, from which 11 were applicable for in-hospital patients. In nine of the 11 scales for in-hospital patients, a LUTS or LUTS-related parameter was included. In the 12 risk assessment tools for community-dwelling older people, there were no LUTS included. Frequency, urinary incontinence, and nocturia were mostly reported in the literature as a potential fall risk parameter. It is recommended to create greater awareness of nocturia and other LUTS among caregivers of hospitalized patients to prevent falls.

Evaluating a Fall Risk Assessment Tool in an Emergency Department

INTRODUCTION

A hospital's emergency department (ED) used the Johns Hopkins fall risk assessment tool (JHFRAT), which was not developed to assess the ED patients. The ED committee recommended the memorial ED fall risk assessment tool (MEDFRAT) plus a "nursing judgment" category. However, the modified MEDFRAT needed to be evaluated before implementation. This research evaluated the modified MEDFRAT in ED patients and nurses' perception of the tool.

METHODS

A two-stage quantitative design was used. Stage 1 was a chart review using both tools for patients who fell (n = 57) in the past 4 years and the control patients (n = 57). Two tools were compared using t-tests, Bland-Altman, predictive abilities, and mismatch rates. Stage 2 was the assessment of all ED patients (n = 435) seen by the ED triage nurses for 1 week using both tools. The chi-squared test and mismatch rates were used to compare the tools. Time to complete both tools and nurses' perceptions to the modified MEDFRAT were analyzed.

RESULTS

Two tools were significantly different. The modified MEDFRAT had higher predictive ability and lower mismatch rates than the JHFRAT. It needed shorter time to complete and was preferred by most nurses.

CONCLUSIONS

The modified MEDFRAT is adequate to use in the ED.

Actions of the fall prevention protocol: mapping with the classification of nursing interventions

Objective:

to analyze the correspondence between the actions contained in the fall prevention protocol of the Ministry of Health and the Nursing Interventions Classification (NIC) by a cross-mapping.

Method:

this is a descriptive study carried out in four stages: protocol survey, identification of NIC interventions related to nursing diagnosis, the risk of falls, cross-mapping, and validation of the mapping from the Delphi technique.

Results:

there were 51 actions identified in the protocol and 42 interventions in the NIC. Two rounds of mapping evaluation were carried out by the experts. There were 47 protocol actions corresponding to 25 NIC interventions. The NIC interventions that presented the highest correspondence with protocol actions were: fall prevention, environmental-safety control, and risk identification. Regarding the classification of similarity and comprehensiveness of the 47 actions of the protocol mapped, 44.7% were considered more detailed and specific than the NIC, 29.8% less specific than the NIC and 25.5% were classified as similar in significance to the NIC.

Conclusion:

most of the actions contained in the protocol are more specific and detailed, however, the NIC contemplates a greater diversity of interventions and may base a review of the protocol to increase actions related to falls prevention..