Advertisement

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

  • Marlon Mascarenhas
  • Keith D. Hill
  • Anna Barker
  • Elissa BurtonEmail author
Original Investigation

Abstract

The aims of this study were to (1) externally validate the accuracy of the Falls Risk for Older People in the Community (FROP-Com) falls risk assessment tool in predicting falls and (2) undertake initial validation of the accuracy of the FROP-Com to predict injurious falls (requiring medical attention) in people aged ≥ 60 years presenting to emergency departments (EDs) after falling. Two hundred and thirteen participants (mean age = 72.4 years; 59.2% women) were recruited (control group of a randomised controlled trial). A FROP-Com assessment was completed at a home visit within 2 weeks of ED discharge. Data on falls and injurious falls requiring medical attention were collected via monthly falls calendars for the next 12 months. Predictive accuracy was evaluated using sensitivity and specificity of a high-risk FROP-Com classification (score ≥ 19) in predicting a fall and injurious falls requiring medical attention. Fifty per cent of participants fell, with 60.4% of falls requiring medical attention. Thirty-two per cent were classified as high, 49% as moderate and 19% low falls risk. Low sensitivity was achieved for the FROP-Com high-risk classification for predicting falls (43.4%) and injurious falls (34.4%), although specificity was high (79.4% and 78.6%, respectively). Despite the FROP-Com’s low predictive accuracy, the high fall rate and high falls risk of the sample suggest that older people who fall, present to ED and are discharged home are at high risk of future falls. In high-falls-risk populations such as in this study, the FROP-Com is not a valid tool for classifying risk of falls or injurious falls. Its potential value may instead be in identifying risk factors for falling to direct tailoring of falls prevention interventions to reduce future falls.

Keywords

Accidental falls Geriatric assessment Older adults Risk factors External validity 

Notes

Acknowledgements

Authors acknowledge RESPOND research staff, particularly Dr Renata Morello for her assistance with the RESPOND data; the participants of the RESPOND research study; Ms Angela Jacques and Dr Robyn Fary.

Funding

This project was funded under the Australian National Health and Medical Research Council’s Partnership Projects funding scheme (Project Number APP1056802) with financial and in-kind contributions from the following partner organisations: Health Strategy and Networks Branch, Strategic Policy and Planning, Department of Health WA; Aged and Continuing Care Directorate, Department of Health WA; Royal Perth Hospital; Curtin University; The University of Western Australia; The Royal Perth Hospital Medical Research Foundation; Sir Charles Gairdner Hospital (SCGH) Rehabilitation and Aged Care Falls Specialist Program; Injury Control Council of Western Australia; The George Institute for Global Health; The Alfred Hospital; Monash University; Integrated Care, Victoria Department of Health.

Compliance with ethical standards

Conflicts of interest

The authors declare that they have no conflict of interest.

References

  1. AIHW (Australian Institute of Health and Welfare): Bradley C (2012) Hospitalisations due to falls by older people, Australia 2007–08. Injury research and statistics series no. 61. Cat. no. INJCAT 137. AIHW, CanberraGoogle Scholar
  2. Altman DG, Vergouwe Y, Royston P, Moons KGM (2009) Prognosis and prognostic research: validating a prognostic model. BMJ 338:B604.  https://doi.org/10.1136/bmj.b605 CrossRefGoogle Scholar
  3. Australian Commission on Safety and Quality in Health Care (2009) Preventing falls and harm from falls in older people: Best practice guidelines for Australian community care. ACSQIH, SydneyGoogle Scholar
  4. Barker AL, Kamar J, Graco M, Lawlor V, Hill K (2011) Adding value to the stratify falls risk assessment in acute hospitals. J Adv Nurs 67:450–457.  https://doi.org/10.1111/j.1365-2648.2010.05503.x CrossRefGoogle Scholar
  5. Barker AL et al (2015) RESPOND—a patient-centred programme to prevent secondary falls in older people presenting to the emergency department with a fall: protocol for a multicentre randomised controlled trial. Inj Prev 21:e1.  https://doi.org/10.1136/injuryprev-2014-041271 CrossRefGoogle Scholar
  6. Bleijlevens MHC, Diederiks JPM, Hendriks MRC, van Haastregt JCM, Crebolder HFJM, van Eijk JThM (2010) Relationship between location and activity in injurious falls: an exploratory study. BMC Geriatr.  https://doi.org/10.1186/1471-2318-10-40 CrossRefGoogle Scholar
  7. Bloch F, Jegou D, Dhainaut J-F, Rigaud A-S, Coste J, Lundy J-E, Claessens Y-E (2009) Do ED staffs have a role to play in the prevention of repeat falls in elderly patients? Am J Emerg Med 27:303–307.  https://doi.org/10.1016/j.ajem.2008.02.026 CrossRefGoogle Scholar
  8. Close J et al (2012) Older people presenting to the emergency department after a fall: a population with substantial recurrent healthcare use. Emerg Med J 29:742–747.  https://doi.org/10.1136/emermed-2011-200380 CrossRefGoogle Scholar
  9. DeGrauw X, Annest JL, Stevens JA, Xu L, Coronado V (2016) Unintentional injuries treated in hospital emergency departments among persons aged 65 years and older, United States, 2006–2011. J Saf Res 56:105–109.  https://doi.org/10.1016/j.jsr.2015.11.002 CrossRefGoogle Scholar
  10. Gillespie LD, Robertson MC, Gillespie WJ, Sherrington C, Gates S, Clemson LM, Lamb SE (2012) Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev 9:CD007146.  https://doi.org/10.1002/14651858.cd007146.pub3 CrossRefGoogle Scholar
  11. Haines TP, Hill K, Walsh W, Osborne R (2007) Design-related bias in hospital fall risk screening tool predictive accuracy evaluations: systematic review and meta-analysis. J Gerontol Ser A Biol Sci Med Sci 62:664–672CrossRefGoogle Scholar
  12. Hannan M et al (2010) Optimizing the tracking of falls in studies of older participants: comparison of quarterly telephone recall with monthly falls calendars in the MOBILIZE Boston Study. Am J Epidemiol 171:1031–1036.  https://doi.org/10.1093/aje/kwq024 CrossRefGoogle Scholar
  13. Heinrich S, Rapp K, Rissmann U, Becker C, König H-H (2010) Cost of falls in old age: a systematic review. Osteoporos Int 21:891–902.  https://doi.org/10.1007/s00198-009-1100-1 CrossRefGoogle Scholar
  14. Hill K et al (2016) Falls risk assessment outcomes and factors associated with falls for older Indigenous Australians. Aust N Z J Public Health 40:553–558.  https://doi.org/10.1111/1753-6405.12569 CrossRefGoogle Scholar
  15. IBM Corp (2016) IBM SPSS Statistics for Windows, Version 24.0. IBM Corp, Armonk, NYGoogle Scholar
  16. Kalula SZ, de Villiers L, Ross K, Ferreira M (2006) Management of older patients presenting after a fall–an accident and emergency department audit. S Afr Med J 96:718–721Google Scholar
  17. Kempen G, Yardley L, van Haastregt J, Zijlstra G, Beyer N, Hauer K, Todd C (2008) The Short FES-I: a shortened version of the falls efficacy scale-international to assess fear of falling. Age Ageing 37:45–50CrossRefGoogle Scholar
  18. Lee J, Geller AI, Strasser DC (2013) Analytical review: focus on fall screening assessments. Phys. Med. Rehabil 5:609–621.  https://doi.org/10.1016/j.pmrj.2013.04.001 CrossRefGoogle Scholar
  19. Lukaszyk C et al (2016) Risk factors, incidence, consequences and prevention strategies for falls and fall-injury within older indigenous populations: a systematic review. Aust N Z J Public Health 40:564–568.  https://doi.org/10.1111/1753-6405.12585 CrossRefGoogle Scholar
  20. Meyer C, Dow B, Bilney B, Moore K, Bingham A, Hill K (2012) Falls in older people receiving in-home informal care across Victoria: influence on care recipients and caregivers. Australas J Ageing 31:6–12.  https://doi.org/10.1111/j.1741-6612.2010.00484.x CrossRefGoogle Scholar
  21. Muir SW, Berg K, Chesworth B, Speechley M (2008) Use of the berg balance scale for predicting multiple falls in community-dwelling elderly people: a prospective study. Phys Ther 88:449–459.  https://doi.org/10.2522/ptj.20070251 CrossRefGoogle Scholar
  22. Myers H (2003) Hospital fall risk assessment tools: a critique of the literature. Int J Nurs Pract 9:223–235CrossRefGoogle Scholar
  23. National Ageing Research Institute (NARI) Falls Risk for Older People-Community setting (FROP-Com): Guidelines. National Ageing Research Institute, Melbourne. https://www.nari.net.au/files/files/documents/falls_risk_for_older_people_-_community_setting_-_guidelines_-_v10.pdf
  24. National Ageing Research Institute (NARI) (2016) Falls Risk for Older People-Community setting. http://www.nari.net.au/resources/health-professionals/falls-and-balance. Accessed 2016 Sep 03
  25. National Centre for Injury Prevention and Control (2015) Preventing falls: a guide to implementing effective community-based fall prevention programs, 2nd edn. Centre For Disease Control and PreventionGoogle Scholar
  26. National Institute for Health and Care Excellence (2013) Falls in older people: assessing risk and prevention. NICE. https://www.nice.org.uk/guidance/cg161. Accessed 25 Oct 2017
  27. Oliver D, Daly F, Martin FC, McMurdo MET (2004) Risk factors and risk assessment tools for falls in hospital in-patients: a systematic review. Age Ageing 33:122–130.  https://doi.org/10.1093/ageing/afh017 CrossRefGoogle Scholar
  28. Peel NM (2011) Epidemiology of falls in older age. Can J Aging/La Revue Canadienne du Vieillissement 30:7–19.  https://doi.org/10.1017/S071498081000070X CrossRefGoogle Scholar
  29. Perell KL, Nelson A, Goldman RL, Luther SL, Prieto-Lewis N, Rubenstein LZ (2001) Fall risk assessment measures: an analytic review. J Gerontol A Biol Sci Med Sci 56:M761–M766.  https://doi.org/10.1093/gerona/56.12.M761 CrossRefGoogle Scholar
  30. Portney L, Watkins M (1993) Foundations of clinical research: applications to practice. Appleton & Lange, StamfordGoogle Scholar
  31. Price R, Choy N (2018) Investigating the relationship of the functional gait assessment to spatiotemporal parameters of gait and quality of life of individuals with stroke. J Geriatr Phys Ther.  https://doi.org/10.1519/jpt.0000000000000173 CrossRefGoogle Scholar
  32. Registered Nurses’ Association of Ontario (2005) Prevention of Falls and Fall Injuries in the Older Adult. (Revised). Registered Nurses’ Association of Ontario, Toronto, CanadaGoogle Scholar
  33. Rubenstein LZ (2006) Falls in older people: epidemiology, risk factors and strategies for prevention. Age Ageing 35:ii37–ii41.  https://doi.org/10.1093/ageing/afl084 CrossRefGoogle Scholar
  34. Russell MA, Hill KD, Blackberry I, Day LM, Dharmage SC (2008) The reliability and predictive accuracy of the Falls Risk for Older People in the community assessment (FROP-Com) tool. Age Ageing 37:634–639.  https://doi.org/10.1093/ageing/afn129 CrossRefGoogle Scholar
  35. Salter AE et al (2006) Community-dwelling seniors who present to the emergency department with a fall do not receive guideline care and their fall risk profile worsens significantly: a 6-month prospective study. Osteoporos Int 17:672–683.  https://doi.org/10.1007/s00198-005-0032-7 CrossRefGoogle Scholar
  36. Samaras N, Chevalley T, Samaras D, Gold G (2010) Older patients in the emergency department: a review. Ann Emerg Med 56:261–269.  https://doi.org/10.1016/j.annemergmed.2010.04.015 CrossRefGoogle Scholar
  37. Scott V, Votova K, Scanlan A, Close J (2007) Multifactorial and functional mobility assessment tools for fall risk among older adults in community, home-support, long-term and acute care settings. Age Ageing 36:130–139.  https://doi.org/10.1093/ageing/afl165 CrossRefGoogle Scholar
  38. Shumway-Cook A, Ciol MA, Hoffman J, Dudgeon BJ, Yorkston K, Chan L (2009) The bottom line. Falls in the Medicare population: incidence, associated factors, and impact on health care. Phys Ther 89:324–332.  https://doi.org/10.2522/ptj.20070107 CrossRefGoogle Scholar
  39. Stevens JA, Mack KA, Paulozzi LJ, Ballesteros MF (2008) Self-reported falls and fall-related injuries among persons aged ≥ 65 years–United States, 2006. J Saf Res 39:345–349.  https://doi.org/10.1016/j.jsr.2008.05.002 CrossRefGoogle Scholar
  40. Suttanon P, Hill K, Said C, Dodd K (2013a) A longitudinal study of change in falls risk and balance and mobility in healthy older people and people with Alzheimer disease. Am J Phys Med Rehabil 92:676–685.  https://doi.org/10.1097/PHM.0b013e318278dcb3 CrossRefGoogle Scholar
  41. Suttanon P et al (2013b) Feasibility, safety and preliminary evidence of the effectiveness of a home-based exercise programme for older people with Alzheimer’s disease: a pilot randomized controlled trial. Clin Rehabil 27:427–438.  https://doi.org/10.1177/0269215512460877 CrossRefGoogle Scholar
  42. Talley K, Wyman J, Gross C, Lindquist R, Gaugler J (2014) Change in balance confidence and its associations with increasing disability in older community-dwelling women at risk for falling. J Aging Health 26:616–636CrossRefGoogle Scholar
  43. Tiedemann A et al (2013) Identifying older people at high risk of future falls: development and validation of a screening tool for use in emergency departments. Emerg Med J 30:918–922.  https://doi.org/10.1136/emermed-2012-201783 CrossRefGoogle Scholar
  44. Toyabe S-I (2014) Development of a risk assessment tool to predict fall-related severe injuries occurring in a hospital. Glob J Health Sci 6:70–80.  https://doi.org/10.5539/gjhs.v6n5p70 CrossRefGoogle Scholar
  45. Vu T, Day L, Finch CF (2014) The burden of hospitalised fall-related injury in community-dwelling older people in Victoria: a database study. Aust N Z J Public Health 38:128–133.  https://doi.org/10.1111/1753-6405.12156 CrossRefGoogle Scholar
  46. Waldron N, Dey I, Nagree Y, Xiao J, Flicker L (2011) A multi-faceted intervention to implement guideline care and improve quality of care for older people who present to the emergency department with falls. BMC Geriatr 11:1–8.  https://doi.org/10.1186/1471-2318-11-6 CrossRefGoogle Scholar
  47. Watson W, Clapperton A, Mitchell R (2010) The incidence and cost of falls injury among older people in New South Wales 2006/07. NSW Department of Health, SydneyGoogle Scholar
  48. Williams S, Brand C, Hill K, Hunt S, Moran H (2010) Feasibility and outcomes of a home-based exercise program on improving balance and gait stability in women with lower-limb osteoarthritis or rheumatoid arthritis: a pilot study. Arch Phys Med Rehabil 91:106–114.  https://doi.org/10.1016/j.apmr.2009.08.150 CrossRefGoogle Scholar
  49. World Health Organisation (2016) WHO global report on falls prevention in older age. Ageing and Life Course, Family and Community Health, p 2016Google Scholar
  50. Yau RK et al (2013) Diabetes and risk of hospitalized fall injury among older adults. Diabetes Care 36:3985–3991CrossRefGoogle Scholar
  51. Youden WJ (1950) Index for rating diagnostic tests. Cancer 3:32–35.  https://doi.org/10.1002/1097-0142(1950)3:1%3c32:AID-CNCR2820030106%3e3.0.CO;2-3 CrossRefGoogle Scholar
  52. Zimba Kalula S, Ferreira M, Swingler G, Badri M, Aihie Sayer A (2015) Prevalence of falls in an urban community-dwelling older population of Cape Town, South Africa. J Nutr Health Aging 19:1024–1031.  https://doi.org/10.1007/s12603-015-0664-z CrossRefGoogle Scholar

Copyright information

© Springer Nature B.V. 2019

Authors and Affiliations

  1. 1.School of Physiotherapy and Exercise ScienceCurtin UniversityPerthAustralia
  2. 2.Department of Epidemiology and Preventative Medicine, The Alfred CentreMonash UniversityMelbourneAustralia

Personalised recommendations