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Frisendahl N, Karlsson P, Sandlund C, Ek S, Franzén E, Boström AM, Welmer AK. Health Care Professionals' Views of Barriers and Facilitators for Implementing a Fall Risk Screening Tool in Clinical and Public Health Settings. Phys Ther 2025; 105:pzaf018. [PMID: 39964354 PMCID: PMC12017392 DOI: 10.1093/ptj/pzaf018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 10/01/2024] [Accepted: 11/21/2024] [Indexed: 04/25/2025]
Abstract
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.
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Affiliation(s)
- Nathalie Frisendahl
- Division of Physiotherapy, Department of Neurobiology Care Sciences and Society, Karolinska Institutet, 14152 Huddinge, Sweden
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, 17165 Solna, Sweden
| | - Patrik Karlsson
- Division of Physiotherapy, Department of Neurobiology Care Sciences and Society, Karolinska Institutet, 14152 Huddinge, Sweden
| | - Christina Sandlund
- Division of Physiotherapy, Department of Neurobiology Care Sciences and Society, Karolinska Institutet, 14152 Huddinge, Sweden
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, 14152 Huddinge, Sweden
- Academic Primary Health Care Centre, Region Stockholm, 11365 Stockholm, Sweden
| | - Stina Ek
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Nobelsväg 12A, 17165 Solna, Sweden
| | - Erika Franzén
- Division of Physiotherapy, Department of Neurobiology Care Sciences and Society, Karolinska Institutet, 14152 Huddinge, Sweden
- Women’s Health and Allied Health Professionals Theme, Medical Unit Occupational Therapy & Physiotherapy, Karolinska University Hospital, 17164 Stockholm, Sweden
- Research and Development Unit, Stockholms Sjukhem, 11219 Stockholm, Sweden
| | - Anne-Marie Boström
- Research and Development Unit, Stockholms Sjukhem, 11219 Stockholm, Sweden
- Division of Nursing, Department of Neurobiology, Care Science and Society, Karolinska Institutet, 14152 Huddinge, Sweden
- Theme Inflammation and Aging, Medical Unit Aging, Karolinska University Hospital, 14157 Huddinge, Sweden
| | - Anna-Karin Welmer
- Division of Physiotherapy, Department of Neurobiology Care Sciences and Society, Karolinska Institutet, 14152 Huddinge, Sweden
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, 17165 Solna, Sweden
- Women’s Health and Allied Health Professionals Theme, Medical Unit Medical Psychology, Karolinska University Hospital, 17164 Stockholm, Sweden
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Frisendahl N, Karlsson P, Ek S, Franzén E, Boström AM, Welmer AK. Older adults' experiences of being screened for fall risk in a clinical setting: a focus group study. Eur Geriatr Med 2024; 15:1771-1782. [PMID: 39297927 PMCID: PMC11632049 DOI: 10.1007/s41999-024-01056-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Accepted: 09/02/2024] [Indexed: 09/21/2024]
Abstract
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.
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Affiliation(s)
- Nathalie Frisendahl
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, 141 83 Huddinge, 23100, Stockholm, Sweden.
- Department of Neurobiology, Care Sciences and Society, Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden.
| | - Patrik Karlsson
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, 141 83 Huddinge, 23100, Stockholm, Sweden
| | - Stina Ek
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Erika Franzén
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, 141 83 Huddinge, 23100, Stockholm, Sweden
- Women's Health and Allied Health Professionals Theme, Medical Unit Occupational Therapy and Physiotherapy, Karolinska University Hospital, Stockholm, Sweden
- Research and Development Unit, Stockholms Sjukhem, Stockholm, Sweden
| | - Anne-Marie Boström
- Research and Development Unit, Stockholms Sjukhem, Stockholm, Sweden
- Division of Nursing, Department of Neurobiology, Care Science and Society, Karolinska Institutet, Huddinge, Sweden
- Theme Inflammation and Aging, Medical Unit Aging, Karolinska University Hospital, Huddinge, Sweden
| | - Anna-Karin Welmer
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, 141 83 Huddinge, 23100, Stockholm, Sweden
- Department of Neurobiology, Care Sciences and Society, Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden
- Women's Health and Allied Health Professionals Theme, Medical Unit Medical Psychology, Karolinska University Hospital, Stockholm, Sweden
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Dormosh N, van de Loo B, Heymans MW, Schut MC, Medlock S, van Schoor NM, van der Velde N, Abu-Hanna A. 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. Age Ageing 2024; 53:afae131. [PMID: 38979796 PMCID: PMC11231951 DOI: 10.1093/ageing/afae131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Indexed: 07/10/2024] Open
Abstract
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.
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Affiliation(s)
- Noman Dormosh
- Department of Medical Informatics, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health, Aging and Later Life & Methodology, Amsterdam, The Netherlands
| | - Bob van de Loo
- Department of Epidemiology and Data Science, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health, Aging and Later Life, Amsterdam, The Netherlands
| | - Martijn W Heymans
- Department of Epidemiology and Data Science, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health, Methodology & Personalized Medicine, Amsterdam, The Netherlands
| | - Martijn C Schut
- Department of Medical Informatics, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Department of Laboratory Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health, Methodology & Quality of Care, Amsterdam, The Netherlands
| | - Stephanie Medlock
- Department of Medical Informatics, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health, Aging and Later Life & Methodology, Amsterdam, The Netherlands
| | - Natasja M van Schoor
- Department of Epidemiology and Data Science, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health, Aging and Later Life, Amsterdam, The Netherlands
| | - Nathalie van der Velde
- Amsterdam Public Health, Aging and Later Life, Amsterdam, The Netherlands
- Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | - Ameen Abu-Hanna
- Department of Medical Informatics, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health, Aging and Later Life & Methodology, Amsterdam, The Netherlands
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Frisendahl N, Ek S, Rosendahl E, Franzén E, Boström AM, Welmer AK. Can the 1-Leg Standing Test Be Replaced by Self-reported Balance in the First-Time Injurious Fall Screening Tool? J Geriatr Phys Ther 2023; 46:103-109. [PMID: 35947043 PMCID: PMC10032368 DOI: 10.1519/jpt.0000000000000362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
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.
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Affiliation(s)
- Nathalie Frisendahl
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Stina Ek
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Erik Rosendahl
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
| | - Erika Franzén
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Allied Health Professionals, Medical Unit Occupational Therapy & Physiotherapy, Karolinska University Hospital, Stockholm, Sweden
- Research and Development Unit, Stockholms Sjukhem, Stockholm, Sweden
| | - Anne-Marie Boström
- Research and Development Unit, Stockholms Sjukhem, Stockholm, Sweden
- Division of Nursing, Department of Neurobiology, Care Science and Society, Karolinska Institutet, Huddinge, Sweden
- Theme Aging, Karolinska University Hospital, Huddinge, Sweden
| | - Anna-Karin Welmer
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Stockholm Gerontology Research Center, Stockholm, Sweden
- Women's Health and Allied Health Professionals Theme, Medical Unit Medical Psychology, Karolinska University Hospital, Stockholm, Sweden
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Ong MF, Soh KL, Saimon R, Myint WW, Pawi S, Saidi HI. Falls risk screening tools intended to reduce fall risk among independent community‐dwelling older adults: A systematic review. Int J Nurs Pract 2022:e13083. [PMID: 35871775 DOI: 10.1111/ijn.13083] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 06/28/2022] [Accepted: 07/08/2022] [Indexed: 11/29/2022]
Abstract
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.
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Affiliation(s)
- Mei Fong Ong
- Department of Nursing Universiti Putra Malaysia Serdang Malaysia
- Department of Nursing Universiti Malaysia Sarawak Kota Samarahan Malaysia
| | - Kim Lam Soh
- Department of Nursing Universiti Putra Malaysia Serdang Malaysia
| | - Rosalia Saimon
- Community Medicine and Public Health Universiti Malaysia Sarawak Kota Samarahan Malaysia
| | - Wai Wai Myint
- Medicine and Rehabilitation Universiti Malaysia Sarawak Kota Samarahan Malaysia
| | - Saloma Pawi
- Department of Nursing Universiti Malaysia Sarawak Kota Samarahan Malaysia
| | - Hasni Idayu Saidi
- Department of Biomedical Science Universiti Putra Malaysia Serdang Malaysia
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