Abstract
Objectives
To evaluate and compare the predictive accuracy of fall history, staff clinical judgment,
the Care Home Falls Screen (CaHFRiS), and the Fall Risk Classification Algorithm (FRiCA).
Design
Prospective multicenter cohort study with 6 months' follow-up.
Setting and Participants
A total of 420 residents from 15 nursing homes participated.
Methods
Fall history, clinical judgment of staff (ie, physiotherapists, nurses and nurses'
aides), and the CaHFRiS and FRiCA were assessed at baseline, and falls were documented
in the follow-up period. Predictive accuracy was calculated at 1, 3, and 6 months
by means of sensitivity, specificity, positive and negative predictive value, positive
and negative likelihood ratio, Youden Index, and overall accuracy.
Results
In total, 658 falls occurred and 50.2% of the residents had at least 1 fall with an
average fall rate of 1.57 (SD 2.78, range 0-20) per resident. The overall accuracy
for all screening methods at all measuring points ranged from 54.8% to 66.5%. Fall
history, FRiCA, and a CaHFRiS score of ≥4 had better sensitivity, ranging from 64.4%
to 80.8%, compared with the clinical judgment of all disciplines (sensitivity ranging
from 47.4% to 71.2%). The negative predictive value (ranging from 92.9% at 1 month
to 59.6% at 6 months) had higher scores for fall history, FRiCA, and a CaHFRiS score
of ≥4. Specificity ranged from 50.3% at 1 month to 77.5% at 6 months, with better
specificity for clinical judgment of physiotherapists and worse specificity for FRiCA.
Positive predictive value ranged from 22.2% (clinical judgment of nurses' aides) at
1 month to 67.8% at 6 months (clinical judgment of physiotherapists).
Conclusions and Implications
No strong recommendations can be made for the use of any screening method. More research
on identifying residents with the highest fall risk is crucial, as these residents
benefit the most from multifactorial assessments and subsequent tailored interventions.
Keywords
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Article info
Publication history
Published online: August 17, 2020
Footnotes
This study was funded by the Flemish Ministry of Welfare, Belgium, Public Health and Family, and the Universiteit Derde Leeftijd Leuven vzw, Belgium. The funding agencies had no role in the design, data collection, analysis, study results interpretation, article writing, or article submission for publication.
The authors declare no conflicts of interest.
Identification
Copyright
© 2020 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
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February 2021 Issue: COVID-19 in Nursing Homes / Palliative Care / Driving Safety / Identifying Falls Risk
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