Development and Evaluation of an Online Fall-Risk Questionnaire for Nonfrail Community-Dwelling Elderly Persons: A Pilot Study

Predictive ability of a self-rated fall risk assessment tool in community-dwelling older women

BACKGROUND

Falls are a substantial health problem among older adults. An accessible and reliable tool for assessing individual fall risk is needed.

AIMS

The predictive ability of a one-page self-rated fall risk assessment form (KaatumisSeula® [KS]) was evaluated among older women in its current form.

METHODS

A subsample (n = 384) of community-living older women (aged 72-84 years) participating in the Kuopio Fall Prevention Study (KFPS) completed the KS form. Participants' falls were prospectively registered for 12 months with SMS messages. Their group status and form-based fall risk category were compared to the verified fall events during the KFPS intervention. Negative binomial regression and multinomial regression analyses were used. Physical performance measurements (single leg stance, leg extension strength and grip strength) were used as covariates.

RESULTS

During the follow-up, 43.8% of women fell at least once. Among the fallers, 76.8% had at least one self-determined injurious fall, and 26.2% had falls requiring medical attention. According to KS, 7.6% of the women had low fall risk, 75.0% moderate, 15.4% substantial, and only 2.1% high fall risk. Women in the "moderate fall risk" group had 1.47-fold (95% CI 0.74-2.91; nonsignificant), in "substantial fall risk" 4.00-fold (1.93-8.3; p < 0.001) and in "high fall risk" 3.00-fold (0.97-9.22; nonsignificant) higher risk of falls compared to the "low fall risk" group. Performance in physical tests did not account for future falls.

CONCLUSIONS

The KS form proved to be a feasible tool for self-administered fall risk assessment with moderate predictive ability.

TRIAL REGISTRATION

ClinicalTrials.gov identifier: NCT02665169, date of first registration 27/01/2016.

Cultural and Linguistic Adaptation of the Fall Risk Questionnaire-Portuguese Version

Falls are a major problem among older adults worldwide. Early detection of risk factors is important to decrease the burden of falls. The “Fall Risk Questionnaire” (FRQ) is a screening tool used to assess personal fall risk awareness in older populations, and it is also used as a behavior change tool. The aim of the present study was to undertake a cultural and linguistic adaptation of the FRQ to allow its use in the Portuguese population. To achieve this, we used the sequential method proposed by Beaton and colleagues. Statistical analysis was conducted by computing the intraclass correlation coefficient and Cronbach’s alpha score for intra-observer reliability. The panel revision demonstrated high concordance for all assessed items. The pretesting results indicated that, in general, the FRQ—Portuguese Version (FRQ-VP) was well accepted, and all items were adequate and easy to comprehend. The ICC and Cronbach’s alpha scores indicated high consistency between assessments (p < 0.01; alfa = 0.992). The FRQ-VP seemed to have good reliability and internal consistency. Because the definition of a fall experience may not be clear to the older population, a careful explanation of this item can lead to a better score computation.

Predictive validity of the Stopping Elderly Accidents, Deaths & Injuries (STEADI) program fall risk screening algorithms among community-dwelling Thai elderly

BACKGROUND

Fall risk screening using multiple methods was strongly advised as the initial step for preventing fall. Currently, there is only one such tool which was proposed by the U.S. Centers for Disease Control and Prevention (CDC) for use in its Stopping Elderly Accidents, Death & Injuries (STEADI) program. Its predictive validity outside the US context, however, has never been investigated. The purpose of this study was to determine the predictive validity (area under the receiver operating characteristic curve: AUC), sensitivity, and specificity of the two-step sequential fall-risk screening algorithm of the STEADI program for Thai elderly in the community.

METHODS

A 1-year prospective cohort study was conducted during October 2018-December 2019. Study population consisted of 480 individuals aged 65 years or older living in Nakhon Ratchasima Province, Thailand. The fall risk screening algorithm composed of two serial steps. Step 1 is a screening by the clinician's 3 key questions or the Thai Stay Independent brochure (Thai-SIB) 12 questions. Step 2 is a screening by 3 physical fitness testing tools including Time Up and Go test (TUG), 30-s Chair Stand, and 4-stage balance test. Participants were then followed for their fall incidents. Statistical analyses were conducted by using Cox proportional hazard model. The AUC, sensitivity, specificity, and other relevant predictive validity indices were then estimated.

RESULTS

The average age of the participants was 73.3 ± 6.51 years (range 65-95 years), and 52.5% of them were female. The screening based on the clinician's 3 key questions in Step 1 had a high AUC (0.845), with the sensitivity and specificity of 93.9% (95% CI 88.8, 92.7) and 75.0% (95% CI 70.0, 79.6), respectively. Appropriate risk categorization however differed slightly from the original STEADI program.

CONCLUSIONS

With some modification, the fall risk screening algorithm based on the STEADI program was applicable in Thai context.

Development of a Parkinson's disease specific falls questionnaire

BACKGROUND

Falls are a major health burden for older adults with Parkinson's disease (PD), but there is currently no reliable questionnaire to capture the circumstances and consequences of falls in older adults with PD. This study aimed to develop a PD-specific falls questionnaire and to evaluate its test-retest reliability in older adults with PD.

METHODS

A novel PD-specific falls questionnaire (PDF-Q) was developed in two modes (online and paper-based version) and used to assess falls and near-falls events over the past 12-months. Questions were agreed upon by an expert group, with the domains based on previous falls-related questionnaires. The questions included the number and circumstances (activities, location and direction) of falls and near-falls, and consequences (injuries and medical treatment) of falls. The PDF-Q was distributed to 46 older adults with PD (online n = 30, paper n = 16), who completed the questionnaire twice, 4 weeks apart. Kappa (κ) statistics were used to establish test-retest reliability of the questionnaire items.

RESULTS

Pooled results from both questionnaires for all participants were used to assess the overall test-retest reliability of the questionnaire. Questions assessing the number of falls (κ = 0.41) and the number of near-falls (κ = 0.51) in the previous 12-months demonstrated weak agreement, while questions on the location of falls (κ = 0.89) and near-falls (κ = 1.0) demonstrated strong to almost perfect agreement. Questions on the number of indoor (κ = 0.86) and outdoor (κ = 0.75) falls demonstrated moderate to strong agreement, though questions related to the number of indoor (κ = 0.47) and outdoor (κ = 0.56) near-falls demonstrated weak agreement. Moderate to strong agreement scores were observed for the most recent fall and near-fall in terms of the direction (indoor fall κ = 0.80; outdoor fall κ = 0.81; near-fall κ = 0.54), activity (indoor fall κ = 0.70; outdoor fall κ = 0.82; near-fall κ = 0.65) and cause (indoor fall κ = 0.75; outdoor fall κ = 0.62; near-fall κ = 0.56).

CONCLUSIONS

The new PDF-Q developed in this study was found to be reliable for capturing the circumstances and consequences of recent falls and near-falls in older adults with PD.

Fall-related events in people who are lower limb prosthesis users: the lived experience

PURPOSE

To explore lived experiences, and identify common themes as well as vocabulary associated with fall-related events in lower limb prosthesis (LLP) users.

MATERIALS AND METHODS

Five focus groups of LLP users from across the United States were conducted remotely via video or tele-conferencing. Focus group transcripts were coded and analyzed using methods adapted from a grounded theory approach to identify themes.

RESULTS

Focus group participants (n = 25) described experiences associated with fall-related events that resulted in the identification of six themes: (1) memories of fall-related events are shaped by time and context, (2) location and ground conditions influence whether falls occur, (3) some activities come with more risk, (4) fall-related situations are multi-faceted, and often involve the prosthesis, (5) how LLP users land, but not the way they go down, tends to vary, and (6) not all falls affect LLP users, but some near-falls do.

CONCLUSION

Consideration for where LLP users fall, what they are doing when they fall, how they fall, what occurs as a result of a fall, and how well memory of a fall persists may enhance recording and reporting of falls, contribute to development of improved fall risk assessment tools, and inspire the design and function of prosthetic componentry for patient safety.Implications for rehabilitationFalls are a common problem in lower limb prosthesis (LLP) users that can lead to adverse health outcomes.Concerns over near falls, not just falls, may merit greater attention from rehabilitation professionals.Elements of the lived experience that appear unique to LLP users include the role of prosthetic fit, function, and comfort in losing and/or recovering balance; as well as the tendency of LLP users to modify rather than stop or avoid activities associated with falls.

The Stay Independent Brochure as a Screening Evaluation for Fall Risk in an Elderly Thai Population

Introduction

The Stay Independent Brochure (SIB) is a widely used fall-risk self-assessment tool, which is part of the Stopping Elderly Accident, Deaths & Injuries (STEADI) program in the US. However, the validity and reliability of the SIB have not been established in an elderly Thai population.

Objective

To construct a fall risk screening tool based on the SIB in a Thai elderly population and investigate its psychometric effect in a community context.

Methods

A total of 480 elderly participants volunteered to take part in this study from the Nakhon Ratchasima province. In the first part of the study, the original version of the SIB was translated into Thai (total 12 questions) and adapted into a modified version (total 18 questions). The translated SIBs were cross-culturally adapted and tested for content validity, test-retest reliability, inter-rater reliability, construct validity and internal consistency. In the second part of the study, the psychometric properties of the translated SIBs were assessed using test-retest and inter-rater reliability and content and construct validity.

Results

The SIBs had good content validity (IOC: 0.80 to 1.00), and the interclass correlation coefficient (ICC) of test-retest and inter-rater reliability was excellent for both SIB versions (ICC 0.89-0.95). The construct validity of 18 questions was tested by principal component factor analysis with varimax rotation and using factor loading greater than 0.4, and yielded 6 factors that explained 59.1% of the variance in fall risk (more than 12 questions). The coefficient alpha was higher than the usually recommended value of 0.70 for the total score of both SIB versions. The convergent validity between the TUG and BBS tests was statistically significant (p<0.001).

Conclusion

Based on psychometric properties, it is recommended that the two Thai versions of the SIB are an appropriate initial screening tool for the multi-steps fall risk assessment algorithm in predicting falls in an elderly Thai community.

Questionnaire development and validation for designing a health telemonitoring system for frail elderly people

BACKGROUND

Advancements in information technology have been instrumental in successful recent developments in telemonitoring systems. In this regard, there is a lack of development of valid and reliable tools to determine the requirements and applications of telemonitoring systems used to provide health care for frail elderly people living at home, specifically in a national setting.

METHOD

A cross-sectional study was carried out in 2018. The statistical population was 15 geriatric and gerontology professionals and 15 health information management experts. Then, content validity ratio (CVR), Cronbach's alpha, and correlation coefficient were calculated for measuring content validity, internal consistency and external reliability (through the test-retest method) respectively. SPSS software was used to analyze the collected data.

RESULTS

Based on the identified items, a draft questionnaire was developed. Using the validity analysis in two stages, 37 items were removed, and 60 items were approved as the essential system requirements. The final questionnaire was organized into five sections with content validity index 99% and internal reliability (Cronbach's alpha coefficient 0.9). Furthermore, the external reliability results of the questionnaire showed that this instrument has a desirable correlation coefficient (r = 0.85, p-value<0.05).

CONCLUSION

Considering the desirable validity and reliability of the questionnaire developed, it is recommended to telemonitoring system designers to determine the usages and requirements of health monitoring systems for frail elderly people living at home. The verified instrument is suitable for use in countries with the same living conditions and level of development as Iran.