Development and validation of a continuous fall risk score in community-dwelling older people: an ecological approach

Abstract Background Fall risk assessment in older people is of major importance for providing adequate preventive measures. Current predictive models are mainly focused on intrinsic risk factors and do not adjust for contextual exposure. The validity and utility of continuous risk scores have alread...

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Autores principales:	Jorge Bravo, Hugo Rosado, Pablo Tomas-Carus, Cristina Carrasco, Nuno Batalha, Hugo Folgado, Catarina Pereira
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	Dynamic fall risk assessment Fall prevention Intrinsic-exposure risk Older adults Predictive accuracy Public aspects of medicine RA1-1270
Acceso en línea:	https://doaj.org/article/6129b90ee8d946559084c677596a3042
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spelling	oai:doaj.org-article:6129b90ee8d946559084c677596a30422021-11-14T12:13:58ZDevelopment and validation of a continuous fall risk score in community-dwelling older people: an ecological approach10.1186/s12889-021-10813-w1471-2458https://doaj.org/article/6129b90ee8d946559084c677596a30422021-11-01T00:00:00Zhttps://doi.org/10.1186/s12889-021-10813-whttps://doaj.org/toc/1471-2458Abstract Background Fall risk assessment in older people is of major importance for providing adequate preventive measures. Current predictive models are mainly focused on intrinsic risk factors and do not adjust for contextual exposure. The validity and utility of continuous risk scores have already been demonstrated in clinical practice in several diseases. In this study, we aimed to develop and validate an intrinsic-exposure continuous fall risk score (cFRs) for community-dwelling older people through standardized residuals. Methods Self-reported falls in the last year were recorded from 504 older persons (391 women: age 73.1 ± 6.5 years; 113 men: age 74.0 ± 6.1 years). Participants were categorized as occasional fallers (falls ≤1) or recurrent fallers (≥ 2 falls). The cFRs was derived for each participant by summing the standardized residuals (Z-scores) of the intrinsic fall risk factors and exposure factors. Receiver operating characteristic (ROC) analysis was used to determine the accuracy of the cFRs for identifying recurrent fallers. Results The cFRs varied according to the number of reported falls; it was lowest in the group with no falls (− 1.66 ± 2.59), higher in the group with one fall (0.05 ± 3.13, p < 0.001), and highest in the group with recurrent fallers (2.82 ± 3.94, p < 0.001). The cFRs cutoff level yielding the maximal sensitivity and specificity for identifying recurrent fallers was 1.14, with an area under the ROC curve of 0.790 (95% confidence interval: 0.746–0.833; p < 0.001). Conclusions The cFRs was shown to be a valid dynamic multifactorial fall risk assessment tool for epidemiological analyses and clinical practice. Moreover, the potential for the cFRs to become a widely used approach regarding fall prevention in community-dwelling older people was demonstrated, since it involves a holistic intrinsic-exposure approach to the phenomena. Further investigation is required to validate the cFRs with other samples since it is a sample-specific tool.Jorge BravoHugo RosadoPablo Tomas-CarusCristina CarrascoNuno BatalhaHugo FolgadoCatarina PereiraBMCarticleDynamic fall risk assessmentFall preventionIntrinsic-exposure riskOlder adultsPredictive accuracyPublic aspects of medicineRA1-1270ENBMC Public Health, Vol 21, Iss S2, Pp 1-11 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Dynamic fall risk assessment Fall prevention Intrinsic-exposure risk Older adults Predictive accuracy Public aspects of medicine RA1-1270
spellingShingle	Dynamic fall risk assessment Fall prevention Intrinsic-exposure risk Older adults Predictive accuracy Public aspects of medicine RA1-1270 Jorge Bravo Hugo Rosado Pablo Tomas-Carus Cristina Carrasco Nuno Batalha Hugo Folgado Catarina Pereira Development and validation of a continuous fall risk score in community-dwelling older people: an ecological approach
description	Abstract Background Fall risk assessment in older people is of major importance for providing adequate preventive measures. Current predictive models are mainly focused on intrinsic risk factors and do not adjust for contextual exposure. The validity and utility of continuous risk scores have already been demonstrated in clinical practice in several diseases. In this study, we aimed to develop and validate an intrinsic-exposure continuous fall risk score (cFRs) for community-dwelling older people through standardized residuals. Methods Self-reported falls in the last year were recorded from 504 older persons (391 women: age 73.1 ± 6.5 years; 113 men: age 74.0 ± 6.1 years). Participants were categorized as occasional fallers (falls ≤1) or recurrent fallers (≥ 2 falls). The cFRs was derived for each participant by summing the standardized residuals (Z-scores) of the intrinsic fall risk factors and exposure factors. Receiver operating characteristic (ROC) analysis was used to determine the accuracy of the cFRs for identifying recurrent fallers. Results The cFRs varied according to the number of reported falls; it was lowest in the group with no falls (− 1.66 ± 2.59), higher in the group with one fall (0.05 ± 3.13, p < 0.001), and highest in the group with recurrent fallers (2.82 ± 3.94, p < 0.001). The cFRs cutoff level yielding the maximal sensitivity and specificity for identifying recurrent fallers was 1.14, with an area under the ROC curve of 0.790 (95% confidence interval: 0.746–0.833; p < 0.001). Conclusions The cFRs was shown to be a valid dynamic multifactorial fall risk assessment tool for epidemiological analyses and clinical practice. Moreover, the potential for the cFRs to become a widely used approach regarding fall prevention in community-dwelling older people was demonstrated, since it involves a holistic intrinsic-exposure approach to the phenomena. Further investigation is required to validate the cFRs with other samples since it is a sample-specific tool.
format	article
author	Jorge Bravo Hugo Rosado Pablo Tomas-Carus Cristina Carrasco Nuno Batalha Hugo Folgado Catarina Pereira
author_facet	Jorge Bravo Hugo Rosado Pablo Tomas-Carus Cristina Carrasco Nuno Batalha Hugo Folgado Catarina Pereira
author_sort	Jorge Bravo
title	Development and validation of a continuous fall risk score in community-dwelling older people: an ecological approach
title_short	Development and validation of a continuous fall risk score in community-dwelling older people: an ecological approach
title_full	Development and validation of a continuous fall risk score in community-dwelling older people: an ecological approach
title_fullStr	Development and validation of a continuous fall risk score in community-dwelling older people: an ecological approach
title_full_unstemmed	Development and validation of a continuous fall risk score in community-dwelling older people: an ecological approach
title_sort	development and validation of a continuous fall risk score in community-dwelling older people: an ecological approach
publisher	BMC
publishDate	2021
url	https://doaj.org/article/6129b90ee8d946559084c677596a3042
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Development and validation of a continuous fall risk score in community-dwelling older people: an ecological approach

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