Predicting risk of the fall among aged adult residents of a nursing home

doi:10.1016/j.archger.2015.06.014

Archives of Gerontology and Geriatrics

Volume 61, Issue 2, September–October 2015, Pages 124-130

https://doi.org/10.1016/j.archger.2015.06.014 Get rights and content

Highlights

•
EASY-Care risk of fall scores (ECRF) has relatively good concurrent validity.
•
Hazard ratio of fall for each score increasing of ECRF was 1.04 (CI: 1.00–1.07).
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The sensitivity and specificity of the ECRF were 85.7% and 64.5% respectively.

Abstract

Background

Fall is one of the most important outcomes of geriatric medicine. The European Assessment System (EASY) Care Standard provides a tool for assessing the risk of the falls. We aimed to evaluate the validity of the Easy-Care risk of the falls (ECRF) sub-score among the residents of a large nursing home.

Method

A longitudinal study was conducted within a maximum of 34 months following up for falling in Kahrizak Charity Foundation. At the baseline the demographic, mental status and the depression data of 194 subjects aged ≥60 was collected. The Easy-Care standard tools and Performance-Oriented Mobility Assessment (POMA) were also used for data collecting. The time, location, and cause of the falls were recorded immediately after each fall incident. The Correlation between POMA and ECRF scores and the factor analysis of ECRF were considered as the concurrent and construct validity respectively. The Factor affecting the fall occurrence was assessed using the Cox-regression model.

Result

The mean age of the participants was 76.02 (SD 8.82). Fifty two individuals (27.3%) fell at least once during the mean 756 (SD 187)-day follow up. The Spearman correlation coefficient between ECRF and POMA scores was -0.458 (P < 0.01). Three components were detected in the factor analysis of the ECRF. In the univariate Cox-regression model, the hazard ratio was 1.04 (CI: 1.00–1.07) for each score increase of the ECRF. For the six-month follow-up, at the ECRF cut-off point two of eight, the sensitivity and specificity were calculated as 85.7% and 64.5% respectively.

Conclusion

It seems that the ECRF is a valid tool for predicting the next 6 months’ fall incidents in older adults.

Introduction

The European Assessment System (EASY) was developed by Ian Philp et al. in 1994 (Philp, 1997) to assess Activity of Daily Living (ADL), items from a former world health organization (WHO) multinational survey, instrumental activities of daily life (IADL) and specific items on well-being among older people. In 2008/2009, the Easy-Care Standard was introduced as an international system for the evaluation of older people’s health and social care needs in primary care settings. The reliability and validity of this system have been recognized by several researchers in many countries and there are ongoing projects in many other countries and languages (Philip et al., 2014). The Easy-Care Standard is a holistic assessment tool that can provide a comprehensive view of the elderly’s needs and health condition (Olde-Rikkert, Long, & Philp, 2013). Easy-Care standard could evaluate at least seven domains of the elderly’s health including; sensation, communication, self-care, getting around, safety, accommodation, finance, staying healthy, mental health, and well-being. As well as 3 summarized scores, including the independent score, the risk of breakdown in care and the risk of fall with total scores of 100, 12 and 8, respectively (Davis, Philp, & Ritters, 2011). The Easy-Care Standard was translated into Persian and its psychometric properties were assessed by Alizad, Philp, Sharifi, and Fadayevatan, 2011 in Iran.

Fall is one of the important causes of the health problems among older people. It results in many health complications such as immobility, hip fractures, head traumas, nursing home admission and even premature mortality and morbidity (Rubenstein, 2006). Falls are also very common in the older people, e.g. a cohort study has shown that the cumulative incidences of any fall among ≥65 year-old individuals were 29.3% and 37.2% among men and women respectively. The health complications caused by falls are the fifth leading cause of the mortality in the elderly. A total of 5% of the falls lead to at least a fracture in the community-dwelling elderly (Tromp et al., 2001). Among the institutionalized elderly, the rate and complications of falls are more serious than older people living at home and 10–25% of falls in this group result in serious complications such as fractures and lacerations (Rubenstein, 2006).

As the population ages, we have an increasing number of people who are at the risk of fall and fall-related injuries (Hanley, Silke, & Murphy, 2011). The number of fall occurrences could be considered as a criterion for assessing the quality of care in nursing homes as well (Oliver & Healy, 2009). Fall’s risk-predicting instruments may provide a means to recognize aged adults who need more comprehensive assessment regarding the balance and gait (Guidelines for Acute, Sub-acute and Residential Care Settings, 2004).

Based on our knowledge, there has not been any published data about the validity and reliability of the Easy-Care risk of falls (ECRF) yet. Therefore, this study was conducted to assess the validity and reliability of the Persian version of Easy-Care risk of fall subscale to detect older people who were at the risk of fall in a large long-term care setting in Iran.

Section snippets

Setting of the study

This is a prospective longitudinal study, which was conducted in Kahrizak Charity Foundation (KCF). The participants were followed for a maximum period of 34 months from November 2010 to September 2013. KCF is the leading residential and nursing care institute for older people in Iran that provides care services for more than 950 older adults.

The residents, who aged ≥60, were considered as the study population. However, the end-stage people with known cancer, severe renal failure (cratinine ≥2.5

Results

One hundred and ninety four subjects aged 60 or higher with a mean age of 76.02 (SD: 8.82) were enrolled in this study. Out of them, 112 (57.7%) were female. From the enrolled subjects, 146 participants finished the follow up. The decrease in the number of the participants during the period of follow up was due to the death of 43 (22.2%) and discharge of 5 (2.6%) participants. Based on the present study, 52 (27.3%) of the participants fell at least once during the follow up period, (Table 1).

Discussion

In this study, we found that the ECRF summary score could predict the incidences of fall in older adults for the next 6-month period, with an acceptable sensitivity, good accuracy and specificity. However, the ECRF score could not predict fall incidence in older adults for a period longer than 6 months. Moreover, a correlation between ECRF scores and POMA scores were not strong and this may be an indication of a low concurrent validity of the ECRF score. However, the relationship between the

Acknowledgements

Hereby we express our sincerest appreciation of the hard work of the president of Kahrizak charity foundation, Professor Hassan Ahmadi and the vice president of this foundation, Mr. Mohamadreza Soufinejad in supporting us to conduct this study. We declare our great thanks to Miss Maryam Kouhpaiee and Mrs. Zahra Sayf for helping us collecting the data as well.

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View full text

Predicting risk of the fall among aged adult residents of a nursing home

Highlights

Abstract

Background

Method

Result

Conclusion

Introduction

Section snippets

Setting of the study

Results

Discussion

Acknowledgements

Bone

International Journal of Nursing Studies

Journal of the American Medical Directors Association

Journal of Clinical Epidemiology

Easy-care: a holistic geriatric assessment

Validation of the Persian version of Abbreviated Mental Test (AMT) in elderly residents of Kahrizak Charity

Journal of Diabetes & Metabolic Disorders

Easy-care: improving the lives of older people through better assessment and response to their health and care needs

SPSS for windows step by step: a simple guide

Minimising the risk of falls and fall-related injuries

Guidelines for acute, sub-acute and residential care settings