Comparison of Retrospective and Prospective Falls Reporting Among Community-Dwelling Older People: Findings From Two Cohort Studies

Predictive value of the World falls guidelines algorithm within the AGELESS-MELoR cohort

AIM

The World Falls Guidelines (WFG) Task Force published a falls risk stratification algorithm in 2022. However, its adaptability is uncertain in low- and middle-income settings such as Malaysia due to different risk factors and limited resources. We evaluated the effectiveness of the WFG risk stratification algorithm in predicting falls among community-dwelling older adults in Malaysia.

METHODS

Data from the Malaysian Elders Longitudinal Research subset of the Transforming Cognitive Frailty into Later-Life Self-Sufficiency cohort study was utilized. From 2013-2015, participants aged ≥55 years were selected from the electoral rolls of three parliamentary constituencies in Klang Valley. Risk categorisation was performed using baseline data. Falls prediction values were determined using follow-up data from wave 2 (2015-2016), wave 3 (2019) and wave 4 (2020-2022).

RESULTS

Of 1,548 individuals recruited, 737 were interviewed at wave 2, 858 at wave 3, and 742 at wave 4. Falls were reported by 13.4 %, 29.8 % and 42.9 % of the low-, intermediate- and high-risk groups at wave 2, 19.4 %, 25.5 % and 32.8 % at wave 3, and 25.8 %, 27.7 % and 27.0 % at wave 4, respectively. At wave 2, the algorithm generated a sensitivity of 51.3 % (95 %CI, 43.1-59.2) and specificity of 80.1 % (95 %CI, 76.6-83.2). At wave 3, sensitivity was 29.4 % (95 %CI, 23.1-36.6) and specificity was 81.6 % (95 %CI, 78.5-84.5). At wave 4, sensitivity was 26.0 % (95 %CI, 20.2-32.8) and specificity was 78.4 % (95 %CI, 74.7-81.8).

CONCLUSION

The algorithm has high specificity and low sensitivity in predicting falls, with decreasing sensitivity over time. Therefore, regular reassessments should be made to identify individuals at risk of falling.

Comparison across age groups of causes, circumstances, and consequences of falls among individuals living in Canada: A cross-sectional analysis of participants aged 45 to 85 years from the Canadian Longitudinal Study on Aging

Falls are a leading cause of injury-related deaths and hospitalizations among Canadians. Falls risk has been reported to be increased in individuals who are older and with certain health conditions. It is unclear whether rurality is a risk factor for falls. This study aimed to investigate: 1) fall profiles by age group e.g., 45 to 54 years, 55 to 64 years, 65 to 74 years, 75 to 85 years; and 2) falls profiles of individuals, by age group, living in rural versus urban areas of Canada. Data (N = 51,338) from the Canadian Longitudinal Study on Aging was used to examine the relationship between falls and age, rurality, chronic conditions, need for medical attention, and fall characteristics (manner, location, injury). Self-reported falls within a twelve-month period occurred in only 4.8% (single fall) and 0.8% (multiple falls) of adults. Falls were not related to rural residence or age, but those with memory impairment, multiple sclerosis, as well as other chronic conditions such as mood disorder, anxiety disorder, and hyperthyroidism not often thought to be associated with falls, were also more likely to fall. Older individuals were more likely to fall indoors or fall while standing or walking. In contrast, middle-aged individuals were more likely to fall outdoors or while exercising. Type of injury was not associated with age, but older individuals were more likely to report hospitalization after a fall. This study shows that falls occur with a similar frequency in individuals regardless of age or urban/rural residence. Age was associated with fall location and activity. A more universally applicable multi-facted approach, rather than one solely based on older age considerations, to screening, primary prevention and management may reduce the personal, social, and economic burden of falls and fall-related injuries.

A multifactorial fall risk assessment system for older people utilizing a low-cost, markerless Microsoft Kinect

Falls among older people are a major health concern. This study aims to develop a multifactorial fall risk assessment system for older people using a low-cost, markerless Microsoft Kinect. A Kinect-based test battery was designed to comprehensively assess major fall risk factors. A follow-up experiment was conducted with 102 older participants to assess their fall risks. Participants were divided into high and low fall risk groups based on their prospective falls over a 6-month period. Results showed that the high fall risk group performed significantly worse on the Kinect-based test battery. The developed random forest classification model achieved an average classification accuracy of 84.7%. In addition, the individual's performance was computed as the percentile value of a normative database to visualise deficiencies and targets for intervention. These findings indicate that the developed system can not only screen out 'at risk' older individuals with good accuracy, but also identify potential fall risk factors for effective fall intervention.Practitioner summary: Falls are the leading cause of injuries in older people. We newly developed a multifactorial fall risk assessment system for older people utilising a low-cost, markerless Kinect. Results showed that the developed system can screen out 'at risk' individuals and identify potential risk factors for effective fall intervention.

Validity of 2 Fall Prevention Strategy Scales for People With Stroke, Parkinson's Disease, and Multiple Sclerosis

BACKGROUND AND PURPOSE

Falls are a common and persistent concern among people with neurological disorders (PwND), as they frequently result in mobility deficits and may lead to loss of functional independence. This study investigated the ceiling and floor effects, internal consistency, and convergent validity of 2 patient-reported fall prevention strategy scales in PwND.

METHODS

This is a prospective cohort study. Two-hundred and ninety-nine PwND (111 people with multiple sclerosis, 94 people with Parkinson's disease, and 94 people with stroke) were seen for rehabilitation and assessed. The number of retrospective and prospective falls, use of walking assistive devices, scores on the Fall Prevention Strategy Survey (FPSS), Falls Behavioural Scale (FaB), and balance and mobility scales (Berg Balance Scale, Dynamic Gait Index, Timed Up and Go, 10-m walking test, and Activities-specific Balance Confidence) were analyzed.

RESULTS

Total score distributions showed negligible ceiling and floor effects for both the FPSS (ceiling: 0.3%, floor: 0.3%) and the FaB (ceiling: 0%, floor: 0%). The Cronbach α (CI) was of 0.87 (0.85-0.89) for the FPSS and 0.86 (0.84-0.88) for the FaB. In terms of convergent validity, the FPSS and FaB were moderately correlated (Spearman correlation coefficient = 0.65). Moreover, the correlations between the FPSS and FaB and balance and mobility scales ranged from 0.25 to 0.49 ( P < .01). Both scales are slightly better able to distinguish between retrospective fallers/nonfallers [area under the curve, AUC (95% CI): FPSS: 0.61 (0.5-0.7); FaB: 0.60 (0.5-0.6)] compared with prospective fallers/nonfallers [AUC (95% CI): FPSS: 0.56 (0.4-0.6); FaB: 0.57 (0.4-0.6)]. Both scales accurately identified individuals who typically required the use of a walking assistive device for daily ambulation [AUC (95% CI): FPSS: 0.74 (0.7-0.8); FaB: 0.69 (0.6-0.7)]. Multiple regression analysis showed that previous falls, use of an assistive device, and balance confidence significantly predicted participants' prevention strategies (FPSS: R2 = 0.31, F(8,159) = 10.5, P < .01; FaB: R2 = 0.31, F(8,164) = 10.89, P < .01).

CONCLUSION

The FPSS and the FaB appear to be valid tools to assess fall prevention strategies in people with neurological disorders. Both scales provide unique and added value in providing information on individual behavior for fall prevention.

Cognitive frailty and 5-year adverse health-related outcomes for the Malaysian elders longitudinal research (MELoR) study

PURPOSE

To determine the risk of adverse outcomes among prefrail and frail individuals with and without cognitive impairment as well as those with isolated cognitive impairment compared to robust individuals without cognitive impairment.

METHODS

Data from the Malaysian elders longitudinal research (MELoR) study were utilised. Baseline data were obtained from home-based computer-assisted interviews and hospital-based health-checks from 2013 to 2015. Protocol of MELoR study has been described in previous study (Lim in PLoS One 12(3):e0173466, 2017). Follow-up interviews were conducted in 2019 during which data on the adverse outcomes of falls, sarcopenia, hospitalization, and memory worsening were obtained. Sarcopenia at follow-up was determined using the strength, assistance with walking, rising from a chair, climbing stairs, and falls (SARC-F) questionnaire.

RESULTS

Follow-up data was available for 776 participants, mean (SD) age 68.1 (7.1) years and 57.1% women. At baseline, 37.1% were robust, 12.8% had isolated cognitive impairment, 24.1% were prefrail, 1.0% were frail, 20.2% were prefrail with cognitive impairment, and 4.8% had CF. Differences in age, ethnicity, quality of life, psychological status, function and comorbidities were observed across groups. The association between CF with hospitalisation and falls compared to robust individuals was attenuated by ethnic differences. Pre-frail individuals were at increased risk of memory worsening compared robust individuals [aOR(95%CI) = 1.69 (1.09-2.60)]. Frail [7.70 (1.55-38.20)], prefrail with cognitive impairment [3.35 (1.76-6.39)] and CF [6.15 (2.35-16.11)] were significantly more likely to be sarcopenic at 5-year follow-up compared to the robust group.

CONCLUSIONS

Cognitive frailty was an independently predictor of sarcopenia at 5-year follow-up. The relationship between CF with falls and hospitalization, however, appeared to be accounted for by ethnic disparities. Future studies should seek to unravel the potential genetic and lifestyle variations between ethnic groups to identify potential interventions to reduce the adverse outcomes associated with CF.