Abstract
Objectives
The First-time Injurious Fall (FIF) screening tool was created to identify fall risk
in community-living older adults who may benefit from primary preventive interventions.
The aim of this study was to evaluate the predictive performance of the FIF tool in
2 cohorts of older adults.
Design
Longitudinal cohort study.
Setting and Participants
The Swedish National Study on Aging and Care in Skåne (SNAC-S) and Blekinge (SNAC-B),
Sweden. Community-living people aged ≥60 years (n = 2766).
Methods
Nurses and physicians collected data in the 2 cohorts through interviews and testing.
Data on injurious falls were collected from register data and were defined as receipt
of care after a fall. The FIF tool, consisting of 3 questions and 1 balance test,
was examined in relation to injurious falls for up to 5 years of follow-up using Cox
proportional hazards models. The predictive performance of the FIF tool was further
explored using Harrell C statistic and Youden cut-off for sensitivity and specificity.
Results
The hazard ratios (HRs) of an injurious fall in the high-risk group for women and
men were 3.80 (95% confidence interval [CI] 2.53, 5.73) and 5.10 (95% CI 2.57, 10.12)
in SNAC-S and 4.45 (95% CI 1.86, 10.61) and 32.58 (95% CI 4.30, 247.05) in SNAC-B
compared with those in the low risk group. The sensitivity and specificity of the
Youden cut-off point (3 or higher for high-risk) were 0.64 and 0.69 for women and
0.68 and 0.69 for men in SNAC-S, and 0.64 and 0.74 for women and 0.94 and 0.68 for
men in SNAC-B. The predictive values (Harrell C statistic) for the scores for women
and men were 0.73 and 0.74 in SNAC-S and 0.72 and 0.89 in SNAC-B.
Conclusions and Implications
Our results suggest that the FIF tool is a valid tool to use for prediction of first-time
injurious falls in community-living older adults.
Keywords
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References
- Prevention of falls and consequent injuries in elderly people.Lancet. 2005; 366: 1885-1893
- WHO Global Report on Falls Prevention in Older Age.WHO Press, Geneva2019
- Will my patient fall?.JAMA. 2007; 297: 77-86
- Systematic review of accuracy of screening instruments for predicting fall risk among independently living older adults.J Rehabil Res Dev. 2008; 45: 1105-1116
- Tools for assessing fall risk in the elderly: A systematic review and meta-analysis.Aging Clin Exp Res. 2018; 30: 1-16
- Risk factors for falls in community-dwelling older people: a systematic review and meta-analysis.Epidemiology. 2010; 21: 658-668
- Functional performance as a predictor of injurious falls in older adults.J Am Geriatr Soc. 2015; 63: 315-320
- One-leg balance is an important predictor of injurious falls in older persons.J Am Geriatr Soc. 1997; 45: 735-738
- Development and preliminary examination of the predictive validity of the Falls Risk Assessment Tool (FRAT) for use in primary care.J Public Health. 2004; 26: 138-143
- A risk profile for identifying community-dwelling elderly with a high risk of recurrent falling: results of a 3-year prospective study.Oseoporos Int. 2006; 17: 417-425
- Development of the Falls Risk for Older People in the Community (FROP-Com) screening tool.Age Ageing. 2009; 38: 40-46
- Fall-risk screening test: A prospective study on predictors for falls in community-dwelling elderly.J Clin Epidemiol. 2001; 54: 837-844
- Risk profiles for injurious falls in people over 60: A population-based cohort study.J Gerontol A Biol Sci Med Sci. 2018; 73: 233-239
- Summary of the Updated American Geriatrics Society/British Geriatrics Society clinical practice guideline for prevention of falls in older persons.J Am Geriatr Soc. 2011; 59: 148-157
- Cognitive and physical function in relation to the risk of injurious falls in older adults: A population-based study.J Gerontol A Biol Sci Med Sci. 2017; 72: 669-675
- Predicting first-time injurious falls in older men and women living in the community: Development of the First Injurious Fall Screening Tool.J Am Med Dir Assoc. 2019; 20: 1163-1168.e3
- Risk factors for incident falls in older men and women: The English Longitudinal Study of Ageing.BMC Geriatr. 2018; 18: 117
- Sex differences in the association between pain and injurious falls in older adults: A population-based longitudinal study.Am J Epidemiol. 2017; 186: 1049-1056
- Predictive performance of a Fall Risk Assessment Tool for Community-Dwelling Older People (FRAT-up) in 4 European cohorts.J Am Med Dir Assoc. 2016; 17: 1106-1113
- Thai Falls Risk Assessment Test (Thai-FRAT) developed for community-dwelling Thai elderly.J Med Assoc Thai. 2008; 91: 1823-1831
- The development and validation of a brief performance-based fall risk assessment tool for use in primary care.J Gerontol A Biol Sci Med Sci. 2010; 65: 896-903
- Validity of the Falls Risk for Older People in the Community (FROP-Com) tool to predict falls and fall injuries for older people presenting to the emergency department after falling.Eur J Ageing. 2019; 16: 377-386
- A longitudinal study integrating population, care and social services data. The Swedish National study on Aging and Care (SNAC).Aging Clin Exp Res. 2004; 16: 158-168
- Falls in the general elderly population: A 3- and 6- year prospective study of risk factors using data from the longitudinal population study “Good ageing in Skane”.BMC Geriatr. 2013; 13: 81
- Pain and fractures are independently related to lower walking speed and grip strength: Results from the population study "Good Ageing in Skane".Acta Orthop. 2006; 77: 902-911
- Index for rating diagnostic tests.Cancer. 1950; 3: 32-35
- Extent and consequences of misclassified injury diagnoses in a national hospital discharge registry.Inj Prev. 2011; 17: 108-113
- Applied logistic regression.in: Lemeshow S. Studivant R.X. Wiley Series in Probability and Statistics. 3rd ed. Wiley, Hoboken, NJ2013
- Critical appraisal and data extraction for systematic reviews of prediction modelling studies: The CHARMS checklist.PLoS Med. 2014; 11: e1001744
- A review of goodness of fit statistics for use in the development of logistic regression models.Am J Epidemiol. 1982; 115: 92-106
- Test of calibration and goodness-of-fit in the survival setting.Stat Med. 2015; 34: 1659-1680
- Evaluating the yield of medical tests.JAMA. 1982; 247: 2543-2546
- Multivariable prognostic models: Issues in developing models, evaluating assumptions and adequacy, and measuring and reducing errors.Stat Med. 1996; 15: 361-387
- A risk model for the prediction of recurrent falls in community-dwelling elderly: A prospective cohort study.J Clin Epidemiol. 2002; 55: 1088-1094
- Validation of the LASA fall risk profile for recurrent falling in older recent fallers.J Clin Epidemiol. 2010; 63: 1242-1248
- Mortality, disability, and falls in older persons: The role of underlying disease and disability.Am J Public Health. 1992; 82: 395-400
- Validating an evidence-based, self-rated fall risk questionnaire (FRQ) for older adults.J Safety Res. 2011; 42: 493-499
Article info
Publication history
Published online: June 18, 2020
Footnotes
The Swedish National Study on Aging and Care is supported by the Swedish Ministry of Health and Social Affairs and the participating county councils and municipalities. This study was further supported by the Swedish Research Council (grant number 521-2014-21-96), Therese och Johan Anderssons minne, The Strategic Research Area Health Care Science at Karolinska Institutet and Umeå University, and the Doctoral School in Health Care Sciences at Karolinska Institutet.
The authors declare no conflict of interest.
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© 2020 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
