Influences on modern multifactorial falls prevention interventions and fear of falling in non-frail older adults: a literature review

Cost-Effectiveness of Multifactorial Interventions in Preventing Falls among Elderly Population: A Systematic Review

Objective:

To review the cost-effectiveness of multifactorial interventions to prevent falls in elderly people.

Methods:

In this systematic review, the databases including PubMed via MEDLINE, Web of Science, Embase, Scopus, Cochrane Library and Google Scholar (from 1st January 2000 to 30^th February) were used. All pre-reviewed articles related to cost-effectiveness analysis of multifactorial interventions to prevent falls in elderly were included in this paper and congresses abstracts were excluded. Descriptive statistics were used for quantitative data and content-analysis method to analyze qualitative data.

Results:

Out of the 456 articles, 19 were finally included in the study. Eighteen articles were conducted in High-Income Countries (HICs) and 16 were at the community level. Medical visits consultation and education were the most common interventions. Most studies were cost-effectiveness and using the Randomized Control Trial (RCT) methods. A fall of prevention costs ranged from $ 272 to $ 987. Incremental Cost-Effectiveness Ratio (ICER) interventions also ranged from the US $ 120,667 to the US $ 4280.9.

Conclusion:

The results show that despite the high effectiveness of multifactorial interventions to prevent elderly falls, the cost of the interventions are high and they are not very cost-effective. It would be better to design and implement multifactorial interventions with low cost and high effectiveness that are appropriate for each country.

Cross-Cultural Adaptation of Indonesian Version of Activities-Specific Balance Confidence Scale for Elderly in Surabaya

Falling is a major health problem and is also a major cause of morbidity and mortality in the elderly. The more serious consequences of falling on the elderly are the increased risk of injury and fear of falling. Activities-Specific Balance Confidence (ABC) scale is one of the assessment instruments for fear of falling. This instrument is used to assess balance confidence in various ambulation activities. The purpose of this study was to carry out the process of adaptation of the cross cultural ABC English questionnaire to ABC Indonesian. This study was a cross sectional study with participants of five elderly members of the Posyandu Lansia who were in accordance with the inclusion and exclusion criteria. The output is the correlation between the score of ABC English with ABC Indonesian and the score of ABC Indonesian with ABC English Back Translation which are tested at different times. All the question score in the ABC English questionnaire correlated with ABC Indonesian, as well as the Indonesian Language ABC correlated with ABC English back translation, have a significant correlation (r> 0.3). The conclusion of this study is that the ABC English has a close meaning with the ABC Indonesian and the ABC Indonesian has a close meaning with the ABC English back translation. The validity and reliability of the Indonesian version of ABC questionnaire is needed to obtain a valid and reliable questionnaire.

Cost-effectiveness analysis of a multifactorial fall prevention intervention in older home care clients at risk for falling

Background

Falls among older adults can cause serious morbidity and pose economic burdens on society. Older age is a known risk factor for falls and age has been shown to influence the effectiveness of fall prevention programs. To our knowledge, no studies have explicitly investigated whether cost-effectiveness of a multifactorial fall prevention intervention (the intervention) is influenced by age. This economic evaluation explores: 1) the cost-effectiveness of a multifactorial fall prevention intervention compared to usual care for community-dwelling adults ≥ 75 years at risk of falling in Canada; and 2) the influence of age on the cost-effectiveness of the intervention.

Methods

Net benefit regression was used to examine the cost-effectiveness of the intervention with willingness-to-pay values ranging from $0–$50,000. Effects were measured as change in the number of falls, from baseline to 6-month follow-up. Costs were measured using a societal perspective. The cost-effectiveness analysis was conducted for both the total sample and by age subgroups (75–84 and 85+ years).

Results

For the total sample, the intervention was not economically attractive. However, the intervention was cost-effective at higher willingness-to-pay (WTP) (≥ $25,000) for adults 75–84 years and at lower WTP (< $5,000) for adults 85+ years.

Conclusions

The cost-effectiveness of the intervention depends on age and decision makers' WTP to prevent falls. Understanding the influence of age on the cost-effectiveness of an intervention may help to target resources to those who benefit most.

Trial registration

Retrospectively registered. Clinicaltrials.gov identifier: NCT00463658 (18 April 2007).

Preoperative Falls and Their Association with Functional Dependence and Quality of Life

BACKGROUND

No study has rigorously explored the characteristics of surgical patients with recent preoperative falls. Our objective was to describe the essential features of preoperative falls and determine whether they are associated with preoperative functional dependence and poor quality of life.

METHODS

This was an observational study involving 15,060 surveys from adult patients undergoing elective surgery. The surveys were collected between January 2014 and August 2015, with a response rate of 92%.

RESULTS

In the 6 months before surgery, 26% (99% CI, 25 to 27%) of patients fell at least once, and 12% (99% CI, 11 to 13%) fell at least twice. The proportion of patients who fell was highest among patients presenting for neurosurgery (41%; 99% CI, 36 to 45%). At least one fall-related injury occurred in 58% (99% CI, 56 to 60%) of those who fell. Falls were common in all age groups, but surprisingly, they did not increase monotonically with age. Middle-aged patients (45 to 64 yr) had the highest proportion of fallers (28%), recurrent fallers (13%), and severe fall-related injuries (27%) compared to younger (18 to 44 yr) and older (65+ yr) patients (P < 0.001 for each). A fall within 6 months was independently associated with preoperative functional dependence (odds ratio, 1.94; 99% CI, 1.68 to 2.24) and poor physical quality of life (odds ratio, 2.18; 99% CI, 1.88 to 2.52).

CONCLUSIONS

Preoperative falls might be common and are possibly often injurious in the presurgical population, across all ages. A history of falls could enhance the assessment of preoperative functional dependence and quality of life.

Cross-Cultural Adaptation, Validity and Reliability of the Arabic Version of the Falls Efficacy Scale-International (FES-I)

OBJECTIVE

The aim of this study was to evaluate the validity and reliability of an Arabic language version (Ar) of the Falls Efficacy Scale-International (FES-I) with respect to its use with Arabic-speaking elderly subjects.

SUBJECTS AND METHODS

For cross-cultural adaptation, the translation of the original English version of the scale was conducted based on the protocol of the Prevention of Falls Network Europe (ProFaNE). The FES-I (Ar) was administered via face-to-face interviews to 108 community-dwelling elderly Palestinians (61 women and 47 men, aged 60-84 years). Statistical analyses were used to determine group differences with respect to age, gender and fall history. To assess validity, Spearman's rank correlation coefficient was used to examine the correlation between the total scores of FES-I (Ar) and the Timed Up and Go (TUG) test, gait speed and balance. Test-retest reliability between the two test occasions was assessed in accordance with Svensson's method.

RESULTS

The FES-I (Ar) total scores were positively correlated with TUG (r(s) = 0.641, p < 0.001) and negatively correlated with gait speed (r(s) = -0.670, p < 0.001) and balance (r(s) = -0.592, p < 0.001). All items of the FES-I (Ar) indicated a high percentage agreement (from 88 to 93%), and the relative position ranged from 0.01 to 0.06.

CONCLUSION

In this study, the FES-I (Ar) was shown to be a comprehensible, valid and reliable measure of the concern about falling among community-dwelling elderly subjects. In clinical practice and future research, the FES-I (Ar) instrument could be used to effectively assess concern about falling in Arabic-speaking elderly persons.