Predictive Performance of the FIF Screening Tool in 2 Cohorts of Community-Living Older Adults

Health Care Professionals' Views of Barriers and Facilitators for Implementing a Fall Risk Screening Tool in Clinical and Public Health Settings

OBJECTIVE

The experiences of health care professionals using new screening tools in clinical and public health settings are crucial to the implementation process. However, further research is needed on their experiences with fall risk screening. This study utilized the integrated-Promoting Action on Research Implementation in Health Services (i-PARIHS) framework to explore health care professionals' experiences with the First-time Injurious Falls (FIF) screening tool, aiming to identify barriers and facilitators for implementing the FIF tool in primary health care and public health settings.

METHODS

A qualitative study with 4 focus group interviews and 7 individual interviews was carried out, using a semistructured interview guide. The interviews were recorded, transcribed verbatim, and analyzed with reflexive thematic analysis. The study included 20 participants (13 females and 7 males), with a mean age of 39 years (range 24 to 54). The participants were working in the primary health care setting (8 physical therapists, 3 occupational therapists, 3 managers, 2 registered nurses, and 1 dietician) and in a public health project (1 physical therapist and 2 health educators).

RESULTS

The analysis resulted in 3 themes: "a valuable tool in clinical practice," "how to get everyone onboard when implementing fall risk screening," and "applicable in many areas of health services but not in all" with 4 related subthemes "quick and easy to use for all health care professionals," "simplifies assessment and creates a platform for discussion," "need for clear instructions and action list," and "should be incorporated into daily routines."

CONCLUSION

The FIF tool was well-received by participants in practice as it was user-friendly and potentially effective in preventing falls. However, there is room for improvement, particularly in clarifying instructions to mitigate possible misinterpretations. The participants emphasized that implementation of a new screening tool requires favorable organizational conditions such as managerial support, that the tool is easily accessible, and the results are easy to document.

IMPACT

The FIF tool seems to be a valuable screening tool for predicting first-time injurious falls in older adults, suitable for use by various health care professionals.

Older adults' experiences of being screened for fall risk in a clinical setting: a focus group study

PURPOSE

There is a need for further research on older adults' experiences of fall risk screening to improve health communication strategies. The purpose of this study was to describe and explore older adults' experiences of being screened for risk of an injurious fall, using the first-time injurious falls (FIF) screening tool.

METHODS

A qualitative study with five focus group interviews was carried out including 17 older adults (11 women and six men, with a mean age of 77.4 years) who were recruited from two primary healthcare rehabilitation clinics in Sweden. Data were analyzed using reflexive thematic analysis.

RESULTS

The analysis generated one overarching theme, "Screening for fall risk promotes engagement by raising older adults' awareness of their own abilities", and four categories; "Screening may motivate to take action but can also create a false sense of security", "Self-sufficiency is affected by the screening result and level of control over the environment", "Easy-to-perform and helps to facilitate a discussion with the healthcare professional" and "Ideas of how FIF tool could be used in healthcare".

CONCLUSION

Older adults considered screening for fall risk to be meaningful insofar as it raises awareness of their own abilities and motivates them to prevent falls. On the other hand, a low fall risk could create a false sense of security, and lack of control over environmental factors related to fall risk could negatively impact their sense of self-sufficiency. They emphasized the need to receive support from healthcare providers and to be involved in care decisions if the screening indicates a high fall risk.

A systematic review of fall prediction models for community-dwelling older adults: comparison between models based on research cohorts and models based on routinely collected data

BACKGROUND

Prediction models can identify fall-prone individuals. Prediction models can be based on either data from research cohorts (cohort-based) or routinely collected data (RCD-based). We review and compare cohort-based and RCD-based studies describing the development and/or validation of fall prediction models for community-dwelling older adults.

METHODS

Medline and Embase were searched via Ovid until January 2023. We included studies describing the development or validation of multivariable prediction models of falls in older adults (60+). Both risk of bias and reporting quality were assessed using the PROBAST and TRIPOD, respectively.

RESULTS

We included and reviewed 28 relevant studies, describing 30 prediction models (23 cohort-based and 7 RCD-based), and external validation of two existing models (one cohort-based and one RCD-based). The median sample sizes for cohort-based and RCD-based studies were 1365 [interquartile range (IQR) 426-2766] versus 90 441 (IQR 56 442-128 157), and the ranges of fall rates were 5.4% to 60.4% versus 1.6% to 13.1%, respectively. Discrimination performance was comparable between cohort-based and RCD-based models, with the respective area under the receiver operating characteristic curves ranging from 0.65 to 0.88 versus 0.71 to 0.81. The median number of predictors in cohort-based final models was 6 (IQR 5-11); for RCD-based models, it was 16 (IQR 11-26). All but one cohort-based model had high bias risks, primarily due to deficiencies in statistical analysis and outcome determination.

CONCLUSIONS

Cohort-based models to predict falls in older adults in the community are plentiful. RCD-based models are yet in their infancy but provide comparable predictive performance with no additional data collection efforts. Future studies should focus on methodological and reporting quality.

Can the 1-Leg Standing Test Be Replaced by Self-reported Balance in the First-Time Injurious Fall Screening Tool?

BACKGROUND AND PURPOSE

The First-time Injurious Fall (FIF) screening tool was created to identify fall risk in community-living older men and women, who may be targets for primary preventive interventions. The FIF tool consists of 3 self-reported questions and 1 physical test (1-leg standing balance). The purpose of this study was to examine the predictive ability of the FIF tool and a modified FIF tool (in which 1-leg standing is replaced by self-reported balance) for first-time injurious falls.

METHODS

A cohort of 1194 community-living people 60 years and older from the Swedish National Study on Aging and Care in Kungsholmen (SNAC-K), Sweden, was followed longitudinally for 5 years. Data on injurious falls were collected from registered data and were defined as receipt of care after a fall. The predictive ability of the FIF tool and the m-FIF tool was explored using Harrell's C statistic, stratified by sex.

RESULTS AND DISCUSSION

The injurious fall rate per 1000 person-years was 54.9 (95% CI: 47.22-63.78) for women and 36.3 (95% CI: 28.84-45.78) for men. The predictive ability for women and men according to Harrell's C statistic was 0.70 and 0.71 for the FIF tool and the m-FIF tool. The predictive ability was 0.70 and 0.69 for 1-leg standing, and 0.65 and 0.60 for self-reported balance problems.

CONCLUSIONS

The m-FIF tool presented similar predictive ability as the FIF tool regarding first-time injurious falls. This finding could extend the usefulness of the tool to other settings, such as to electronic health (eHealth). A quickly and easily administered screening tool can help physical therapists to identify people with a high risk of falling who may need to undergo a more comprehensive fall risk assessment.

Falls risk screening tools intended to reduce fall risk among independent community‐dwelling older adults: A systematic review

AIMS

The aim of this study is to evaluate an evidence-based fall risk screening tool to predict the risk of falls suitable for independent community-dwelling older adults guided by the World Health Organization's International Classification of Functioning, Disability and Health (WHO-ICF) components, and to examine the reliability and validity of the fall risk screening tool to predict fall risks, and to examine the feasibility of tools among independent community-dwelling older adults.

METHODS

A systematic literature search guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement was performed using the EBSCOHost® platform, ScienceDirect, Scopus and Google Scholar between July and August 2021. Studies from January 2010 to January 2021 were eligible for review. Nine articles were eligible and included in this systematic review. The risk of bias assessment used the National Institutes of Health quality assessment tool for observational cohort and cross-sectional studies. The WHO-ICF helped to guide the categorization of fall risk factors.

RESULTS

Seven screening tools adequately predicted fall risk among community-dwelling older adults. Six screening tools covered most of the components of the WHO-ICF, and three screening tools omitted the environmental factors. The modified 18-item Stay Independent Brochure demonstrated most of the predictive values in predicting fall risk. All tools are brief and easy to use in community or outpatient settings.

CONCLUSION

The review explores the literature evaluating fall risk screening tools for nurses and other healthcare providers to assess fall risk among independent community-dwelling older adults. A fall risk screening tool consisting of risk factors alone might be able to predict fall risk. However, further refinements and validations of the tools before use are recommended.