Fall awareness behaviour and its associated factors among community dwelling older adults

Evaluating the Prognostic and Clinical Validity of the Fall Risk Score Derived From an AI-Based mHealth App for Fall Prevention: Retrospective Real-World Data Analysis

Background

Falls pose a significant public health concern, with increasing occurrence due to the aging population, and they are associated with high mortality rates and risks such as multimorbidity and frailty. Falls not only lead to physical injuries but also have detrimental psychological and social consequences, negatively impacting quality of life. Identifying individuals at high risk for falls is crucial, particularly for those aged ≥60 years and living in residential care settings; current professional guidelines favor personalized, multifactorial fall risk assessment approaches for effective fall prevention.

Objective

This study aimed to explore the prognostic validity of the Fall Risk Score (FRS), a multifactorial-based metric to assess fall risk (using longitudinal real-world data), and establish the clinical relevance of the FRS by identifying threshold values and the minimum clinically important differences.

Methods

This retrospective cohort study involved 617 older adults (857 observations: 615 of women, 242 of men; mean age 83.3, SD 8.7 years; mean gait speed 0.49, SD 0.19 m/s; 622 using walking aids) residing in German residential care facilities and used the LINDERA mobile health app for fall risk assessment. The study focused on the association between FRS at the initial assessment (T1) and the normalized number of falls at follow-up (T2). A quadratic regression model and Spearman correlation analysis were utilized to analyze the data, supported by descriptive statistics and subgroup analyses.

Results

The quadratic model exhibited the lowest root mean square error (0.015), and Spearman correlation analysis revealed that a higher FRS at T1 was linked to an increased number of falls at T2 (ρ=0.960, P<.001). Subgroups revealed significant strong correlations between FRS at T1 and falls at T2, particularly for older adults with slower gait speeds (ρ=0.954, P<.001) and those using walking aids (ρ=0.955, P<.001). Threshold values revealed that an FRS of 45%, 32%, and 24% corresponded to the expectation of a fall within 6, 12, and 24 months, respectively. Distribution-based minimum clinically important difference values were established, providing ranges for small, medium, and large effect sizes for FRS changes.

Conclusions

The FRS exhibits good prognostic validity for predicting future falls, particularly in specific subgroups. The findings support a stratified fall risk assessment approach and emphasize the significance of early and personalized intervention. This study contributes to the knowledge base on fall risk, despite limitations such as demographic focus and potential assessment interval variability.

A scoping review of safe mobility behaviour in fall prevention: implications for people with Parkinson's disease

PURPOSE

Falls are a major concern for people with Parkinson's disease (PwPD) due to associated motor and non-motor impairments. Promoting safe mobility behaviour may be an effective fall prevention intervention, however this concept is poorly articulated in the literature. The aim of this scoping review was to map out the definition and concepts of safe mobility behaviour to draw implications for PwPD.

MATERIALS AND METHODS

The Joanna Briggs Institute methodology for scoping reviews was followed. Studies involving older adults (aged ≥ 65 years) and/or PwPD that sought to define, describe, and/or explain this concept were included.

RESULTS

Of the 21,936 records retrieved, 124 publications were included. No studies defined safe mobility behaviour. However, its performance was described as a combination of observable actions and cognitive processes. Mobility behaviour was influenced by an interaction between the person, environment, and task performance.

CONCLUSION

We propose a definition for safer mobility behaviour as any protective action and associated functional cognitive process used to reduce the likelihood of a fall during mobility-related activities. It is unique to each person and occurs across a continuum of safer to riskier behaviour. Future research developing and testing interventions targeting safer mobility behaviour for PwPD is warranted.

Mental health, fall prevention behaviors, and home environments related to fall experiences among older adults from ethnic groups in rural Northern Thailand

Accidental falls pose significant threats to older adults' health and safety. This study investigates the associations between mental health, fall prevention behaviors, home environments, and yearly falls among older adults of various ethnicities. Conducted in rural ethnic areas of two provinces in northern Thailand, this cross-sectional study utilized multi-stage sampling to survey 462 older adults aged 60 and above, including Mien, Hmong, Karens, and indigenous people. Participants self-reported their history of accidental falls and provided mental health (GHQ-28) data. Univariate logistic regression highlighted associations between falls and mental health problems (OR = 14.87, 95%CI = 7.51-29.43) and the score of fall prevention behaviors (OR = 0.37, 95%CI = 0.31-0.45). Home environment factors, including floor type, floor risk factors, and stair safety features, were significantly related to falls (p < .05). Multivariable analysis identified gender, financial status, underlying disease, vision impairment, mental health problems, and fall prevention behaviors as independent predictors of past-year falls among ethnic older adults (p < .05), explaining 84.7 % of the variation in log odds of falling. This study underscores the heightened fall risks among ethnic minority older adults with mental health issues while emphasizing the protective role of fall prevention behaviors.

Association between frailty status and falling in older adults with hip fracture: a cross-sectional study

OBJECTIVES

There is limited research on the relationship between frailty status and falls in hip fractures in older participants. This study aimed to investigate the relationship between frailty and falls in older adults who had experienced a hip fracture.

METHODS

From June 2023 to January 2024, the study population comprised 253 hip fracture patients aged 60 years and over. They were admitted to the orthopedic department of a tertiary care hospital. We excluded participants with incomplete information. The 5-item FRAIL scale (Fatigue, Resistance, Ambulation, Illnesses, and Loss of Weight) was used to assess frailty status and the patient's self-reported falls. We analyzed the relationship between frailty and falls in older hip fracture patients using logistic regression models, subgroup analyses, and stratified analyses.

RESULTS

Finally, 174 older participants with hip fractures were identified in this study, where 155 (89.1%) had falls. Among 155 falls, 39 (78.0%) were in the robust group, 65 (91.5%) were in the pre-frail group, and 51 (96.2%) were in the frail group. An analysis revealed that among more than 60 years old hip fracture patients, each additional point in frailty score was significantly linked to a higher likelihood of experiencing a fall (OR: 1.97, 95% CI: 1.10-3.52, p < 0.05). While frailty appeared as a categorical variable, this association was stronger with an OR of 2.68 (95% CI: 0.71-10.21) in the pre-frailty group and 7.95 (95% CI: 1.11-57.08), compared to the robust group (p for trend < 0.005). In subgroup analyses, an interaction was observed between frailty and falling according to sex. In stratified analyses, the relationship between frailty status and fall significantly differed between the male and female groups (male OR: 1.49, 95% CI: 0.71 -3.13; female OR: 7.54, 95% CI: 1.13 - 50.32, p for interaction = 0.035).

CONCLUSIONS

The study revealed a notable correlation between frailty and falls, with gender and frailty showing an interaction impact on the increased occurrence of falls. Therefore, further research across diverse disease populations is needed to explore the link between frailty status and falls. Large-scale prospective studies are necessary to clarify the causality of this relationship.

CLINICAL TRIAL REGISTRATION

Chinese Clinical Trial Registry (ChiCTR2300073031).

A novel score for predicting falls in community-dwelling older people: a derivation and validation study

BACKGROUND

Early detection of patients at risk of falling is crucial. This study was designed to develop and internally validate a novel risk score to classify patients at risk of falls.

METHODS

A total of 334 older people from a fall clinic in a medical center were selected. Least absolute shrinkage and selection operator (LASSO) regression was used to minimize the potential concatenation of variables measured from the same patient and the overfitting of variables. A logistic regression model for 1-year fall prediction was developed for the entire dataset using newly identified relevant variables. Model performance was evaluated using the bootstrap method, which included measures of overall predictive performance, discrimination, and calibration. To streamline the assessment process, a scoring system for predicting 1-year fall risk was created.

RESULTS

We developed a new model for predicting 1-year falls, which included the FRQ-Q1, FRQ-Q3, and single-leg standing time (left foot). After internal validation, the model showed good discrimination (C statistic, 0.803 [95% CI 0.749-0.857]) and overall accuracy (Brier score, 0.146). Compared to another model that used the total FRQ score instead, the new model showed better continuous net reclassification improvement (NRI) [0.468 (0.314-0.622), P < 0.01], categorical NRI [0.507 (0.291-0.724), P < 0.01; cutoff: 0.200-0.800], and integrated discrimination [0.205 (0.147-0.262), P < 0.01]. The variables in the new model were subsequently incorporated into a risk score. The discriminatory ability of the scoring system was similar (C statistic, 0.809; 95% CI, 0.756-0.861; optimism-corrected C statistic, 0.808) to that of the logistic regression model at internal bootstrap validation.

CONCLUSIONS

This study resulted in the development and internal verification of a scoring system to classify 334 patients at risk for falls. The newly developed score demonstrated greater accuracy in predicting falls in elderly people than did the Timed Up and Go test and the 30-Second Chair Sit-Stand test. Additionally, the scale demonstrated superior clinical validity for identifying fall risk.

Psychometric properties of the Brazilian-Portuguese version of the Falls Behavioral Scale in people with Parkinson's disease

PURPOSE

To verify the psychometric properties of the Brazilian-Portuguese version of the Falls Behavioral (FaB-Brazil) Scale in Parkinson's disease (PD).

MATERIAL AND METHODS

Participants (n = 96) were assessed by disease-specific, self-report and functional mobility measures. Internal consistency of the FaB-Brazil scale was evaluated using Cronbach's alpha and inter-rater and test-retest reliability using intraclass correlation coefficients (ICC). The standard error of measurement (SEM), minimal detectable change (MDC), ceiling and floor effects, and convergent and discriminative validity were evaluated.

RESULTS

Internal consistency was moderate (α = 0.77). Excellent inter-rater (ICC = 0.90; p < 0.001) and test-retest (ICC = 0.91; p < 0.001) reliability were found. The SEM was 0.20 and MDC was 0.38. Ceiling and floor effects were not found. Convergent validity was established by the positive correlations between the FaB-Brazil scale and age, modified Hoehn and Yahr, PD duration, Movement Disorders Society-Unified Parkinson's Disease Rating Scale, Motor Aspects of Experiences of Daily Living, Timed Up & Go and 8-item Parkinson's Disease Questionnaire, and negative correlations between the FaB-Brazil scale and community mobility, Schwab & England, and Activities-specific Balance Confidence scale. Females showed greater protective behaviors than males; recurrent fallers showed greater protective behaviors than non-recurrent fallers (p < 0.05).

CONCLUSIONS

The FaB-Brazil scale is reliable and valid for assessing people with PD.

Psychometric evaluation of the Protection Motivation Theory scale in assessing fall protection motivation among older adults to reduce fall risk

BACKGROUND

Protection Motivation Theory could be another potential and good framework that addresses essential elements in a behavioural change leading to positive fall protective behaviours. The positive behavioural change could reduce the risk of falls and improve the quality of life of the older community. The study aims to evaluate the reliability and validity of the culturally adapted Protection Motivation Theory scale for older adults' fall protection motivation or protective behaviours to reduce fall risk.

METHODS

A cross-sectional study was conducted to establish a psychometric instrument validation. A total of 389 participants aged 55 years and above were included. The study was conducted in Sarawak, Malaysia, from November 2021 to January 2022 in two phases, translation of the PMT Scale, cross-cultural adaptation, face validation and pre-testing of the PMT Scale. The participants were selected using multistage random sampling in a primary healthcare clinic. Data entry and statistical analysis were performed using IBM SPSS version 26 for exploratory factor analysis and SmartPLS version 3.3.7 for confirmatory factor analysis using partial least square structural equation modelling.

RESULTS

The Kaiser-Meyer-Olkin value was 0.760, Bartlett's sphericity test was significant and the total variance explained was 61%. It identified 31 items within eight dimensions of the Protection Motivation Theory scale. The Higher Order Constructs' measurement model indicates that the convergent and discriminant validity were established (Cronbach's alpha and composite reliability: ≥ 0.740; average variance extracted: 0.619 to 0.935 and Henseler's Heterotrait-Monotrait criterion for all constructs' discriminant validity: < 0.9). Test-retest for the intraclass correlation coefficient was 0.745. The model's coefficient of determination demonstrated R2 = 0.375.

CONCLUSION

Overall, the Protection Motivation Theory Scale has established its reliability and validity for assisting older adults in the community. The Protection Motivation Theory Scale could be used in fall prevention interventions by promoting fall protective behaviours to reduce fall risk among community-dwelling older adults. The scale could assist healthcare providers in assessing the intention of older adults to use fall protective behaviours to reduce fall risk and serve as an alternative reference in developing fall prevention education in a fall prevention strategy.

Malaysian older persons' perceptions about falls and their desired educational website characteristics: A qualitative study

Falls is a common and debilitating condition among the older population, intensifying the need to educate older persons about falls. Technology advancement enables effective and efficient delivery of falls education to the older population. However, there is paucity of information on the perception of Malaysian older population on falls and their preferred website characteristics such as font size, design, layout, colour, navigation, and use of graphics or videos. Physiological changes in vision, cognition and psychomotor skills can affect how the older persons use the website. As Malaysia is a multicultural country, the needs of the website characteristics and falls perception of older persons may differ greatly. The aim of this study was to explore the perceptions of the older persons about falls and their desired website characteristics. Twenty-five community-living older persons (n = 25) of age 60 years and above were involved in the focus group discussions. NvivoTM software was used for data management and thematic analysis was undertaken. Emerging themes included ’Perceptions of falls in older persons’, ’Actions taken when falls occurred’, ’Perceived prevention strategies for falls’ and ’End user requirements for falls educational website’. Falls were perceived as both an avoidable and a non-avoidable incident. Although the participants mentioned physical activity and home hazard modifications as strategies to prevent falls, they mainly discussed self-initiated precautionary approaches in falls prevention. Regarding desired website characteristics, the participants emphasized on easily readable text, appealing design, clear information, use of images/videos, and simple website navigation. Special requirements for colour selection and multi-language options were also raised. The delivery of falls education through website can be made possible by understanding the perception of older persons about falls and their requirements for the website. This is especially important as ethnic and cultural influences may play a role on their perceptions about falls and desired website characteristics.

The Value of Cognitive and Physical Function Tests in Predicting Falls in Older Adults: A Prospective Study

Introduction

Previous studies suggested that physical and cognitive function can be indicators to assess the risk of falls in the elderly. Various tests are widely used in geriatric clinical studies as assessment tools of physical and cognitive function. However, large sample studies comparing the fall predictive value of these tests are still sparse. This study was conducted to investigate the value of cognitive and physical function tests in predicting the risk of subsequent falls in the elderly, with the overarching goal of providing more evidence on fall-risk assessment.

Methods

The current study was based on the data of respondents aged 60 and above from the China Health and Retirement Longitudinal Study (CHARLS). Data from the 2015 CHARLS national survey were used as the baseline data, and the fall data in 2018 were used as the follow-up data. Physical function tests included balance, walking speed, the five times sit-to-stand test (FTSST), and grip strength. The value of cognitive and physical function tests in predicting falls was evaluated by logistic regression analysis and receiver operating characteristic (ROC) curves.

Results

The incidence of falls among the 4,857 subjects included in this study was 20.86%. Results showed that cognition (OR = 0.83, 95% CI: 0.70–0.98), the FTSST (OR = 3.51, 95% CI: 1.66–7.46), and grip strength (OR = 1.02, 95% CI: 1.01–1.03) were independent predictors of falls in the full sample after adjusting for various confounders. Notably, the above tests showed better predictive value for falls for the oldest-old (≥ 80 years) subjects.

Conclusion

Overall, results showed that grip strength, the FTSST, and cognition tests are simple and practicable tools for identifying individuals at higher risk of falls in the community. Moreover, the fall predictive performance of physical and cognitive function tests was age-dependent, with a higher predictive value in older adults aged 80 and above.

Falls and Preventive Practices among Institutionalized Older People

The present study about falls among the older adult population essentially explores bio-physiological factors. In light of the complexity of the factors that cause these accidents, it is important to identify the safety and self-care practices of institutionalized older adults and their relationship with falls in order to introduce prevention measures and personalized cognitive–behavioral strategies. The objective of this study was to: (a) determine the frequency of falls and their recurrence among institutionalized older adults, and (b) to associate the occurrence of falls among institutionalized adults with or without cognitive impairment to communication and safety practices. This was a quantitative, correlational, and longitudinal study with 204 institutionalized older adults living in two long-term care facilities in Portugal. The Scale of Practices and Behaviors for Institutionalized Elderly to Prevent Falls was administered to the sample. The prevalence of falls at a 12-month follow-up was 41.6%, of which 38.3% were recurring episodes. Older adults with cognitive decline showed lower mean scores for safety practices. Further research with larger samples should explore the relationships between communication and safety practices and falls, their recurrence, and fear of new falls.

Risk Factors Associated with Fall Awareness, Falls, and Quality of Life Among Ethnic Minority Older Adults in Upper Northern Thailand

Background

Falls are a major public health issue and one of the leading causes of morbidity and mortality among the older adults in many countries. Falls and their consequences have an impact on people’s quality of life, particularly the older adults. However, there have been very few studies on falls among ethnic minority groups living in rural areas. The aim of this study was to examine factors related to fall awareness, falls, and quality of life among ethnic minority older adults living in northern Thailand.

Methods

A cross-sectional study was conducted among 462 older adults from ethnic minority groups living in rural communities in Phayao and Lamphun provinces of northern Thailand using a multi-stage sampling technique. The data were collected through face-to-face interviews, with structured questionnaires covering health information, fall awareness, and quality of life (WHOQOL-OLD). The factors were determined using simple linear regression and binary logistic regression.

Results

The mean age of the participants was 68.2, Karen (35.5%), Mien (24.2%), indigenous (20.8%), and Hmong (19.5%). In the previous 12 months, 20.6% of elders had experienced a fall, and 4.5% of them had experienced multiple falls. More than half of the elders had moderate fall awareness and quality of life (71.6% and 68.6%, respectively). Univariate analysis revealed that minority group, sociodemographic characteristics, sleep duration, and fear of falling were all found to be associated with fall awareness, falls, and quality of life score (p<0.001). There was a significant relationship among fall awareness, falls, and quality of life score (p<0.001). Compared to those who had not fallen in the previous year, the quality of life of the older adults who had fallen was about 11 points lower.

Conclusion

Several independent variables were discovered to be fall risk factors and quality of life indicators. It is critical to recognize the risk factors to promote fall prevention programs that are appropriate for the older adults among ethnic minorities. Therefore, public health agencies and local government should be aware of the problem and initiate an implementation program and policy to prevent falls and improve the quality of life among ethnic minority older adults.