Fall risk assessment: a prospective investigation of nurses' clinical judgement and risk assessment tools in predicting patient falls. Interventions to reduce the incidence of falls in older adult patients in acute care hospitals: a systematic review Implementation fidelity of a nurse-led falls prevention program in acute hospitals during the 6-PACK trial The reliability and predictive accuracy of the falls risk for older people in the community assessment (FROP-Com) tool. A new instrument for targeting falls prevention interventions was accurate and clinically applicable in a hospital setting. Which Neuromuscular or Cognitive Test Is the Optimal Screening Tool to Predict Falls in Frail Community-Dwelling Older People? A comparative study of the use of four fall risk assessment tools on acute medical wards. Development and evaluation of evidence based risk assessment tool (STRATIFY) to predict which elderly inpatients will fall: case-control and cohort studies Multitarget stepping program in combination with a standardized multicomponent exercise program can prevent falls in community-dwelling older adults: a randomized, controlled trial. Evaluation of a fall-prevention program in older people after femoral neck fracture: a one-year follow-up Prediction of falls using a risk assessment tool in the acute care setting Evaluation of the STRATIFY falls prediction tool on a geriatric unit. The 6-PACK programme to decrease falls and fall-related injuries in acute hospitals: protocol for an economic evaluation alongside a cluster randomised controlled trial Efficacy of a short multidisciplinary falls prevention program for elderly persons with osteoporosis and a fall history: a randomized controlled trial. Rehabilitation of elderly fallers: pilot study of a low to moderate intensity exercise program. Three simple clinical tests to accurately predict falls in people with Parkinson's disease. Community-based fall assessment compared with hospital-based assessment in community-dwelling older people over 65 at high risk of falling: a randomized study The FLASSH study: protocol for a randomised controlled trial evaluating falls prevention after stroke and two sub-studies Evaluating the effectiveness of a home-based fall risk reduction program for rural community-dwelling older adults. Effects of a Randomized Controlled Recurrent Fall Prevention Program on Risk Factors for Falls in Frail Elderly Living at Home in Rural Communities The Diagnostic Accuracy of Static Posturography in Predicting Accidental Falls in People With Multiple Sclerosis Use of the 'STRATIFY' falls risk assessment in patients recovering from acute stroke. Fall Risk Assessment in Geriatric-Psychiatric Inpatients to Lower Events (FRAGILE).
A prospect i ve cohort study was used to determine the reliability and validity of two fall risk assessment tools and  nurses ' clinical judgement in predicting patient falls .  The study wards comprised two aged care and rehabilitation wards within a 570 bed acute care tertiary teaching hospital in Western Australia . Instrument testing included test-retest reliability and calculations of sensitivity , specificity , positive predictive value , negative predictive value and accuracy . The test retest reliability of all methods was good . In this setting , the three methods of assessing fall risk showed good sensitivity but poor specificity . Also , all methods had limited accuracy , and overall , exhibited an inability to adequately discriminate between patient population s at risk of falling and those not at risk of falling . Consequently , neither nurses ' clinical judgement nor the fall risk assessment tools could be recommended for assessing fall risk in this clinical setting Background Falls can have a considerable impact on a patients ' well being , they can result in serious physical and emotional injury , poor quality of life and increased length of hospital stay . Most of the current literature recommends a comprehensive approach to fall prevention that addresses a wide variety of risk factors and involves the use of risk assessment . Objective The objective of this review was to present the best available evidence for the effectiveness of interventions design ed to reduce the incidence of falls in older adult patients in acute care hospitals . Inclusion Criteria Types of Studies Only r and omised controlled trials ( RCTs ) assessing the effectiveness of risk assessment or other interventions that aim ed to minimise the number of falls were included . Types of Participants Participants were older adult in patients ( defined as aged 65 years or over ) in acute care hospitals . Types of Interventions This review focused on interventions design ed to assess the risk of falling or those used to minimise the risk of falling in older adult hospital patients . These interventions were compared to either st and ard practice , which included any method or technique already in place at the facility , or no intervention . Types of Outcome measures The primary outcome was the number of patient falls during hospitalisation . Search Strategy A search for published and unpublished literature from 1998 to 2008 published in the English language was conducted using all major electronic data bases . A three‐step search strategy was developed using MeSH terminology and keywords to ensure that all material relevant to the review was captured . Assessment of Quality The method ological quality of included studies was assessed by two review ers , who appraised each study independently , using st and ardised Joanna Briggs Institute ( JBI ) critical appraisal tools Data Collection and Analysis Data was extracted from the studies that were identified as meeting the criteria for method ological quality using the st and ard JBI data extraction tools . Due to the heterogeneity of population s and interventions , meta‐analyses were not possible and results are presented in narrative form . Results and Conclusions Seven studies were included in the review . The evidence on interventions for reducing the number of falls in older adults during their stay in an acute health care facility is sparse . There is some evidence to suggest that certain multifactorial interventions are more effective than others and that increasing patient education or targeting fall risk factors may be of benefit . Further high quality research is needed in order to ascertain effective fall prevention strategies in acute care facilities . Implication s for Practice There are some evidence to suggest that implementing the following interventions in acute hospitals may be effective in reducing the amount of falls of older adult in patients : ˙ a multidisciplinary multifactorial intervention program consisting of a falls risk alert card , an exercise program , an education program and the use of hip protectors after approximately 45 days ˙ a one‐on‐one patient education package entailing information on risk factors and preventative strategies for falls as well as goal setting ˙ a targeted falls risk factor reduction intervention that includes a falls risk factor screen , recommended interventions encompassing local advice and a summary of the evidence There is some evidence to suggest that implementing a multidisciplinary multifactorial intervention that consists of systematic assessment and treatment of fall risk factors , as well as active management of postoperative complications can reduce the amount of falls in patients with femoral neck fracture following surgery . Implication s for Research Better design ed RCTs that distinguish subgroups of population s ( for example people with or without cognitive impairment ) and that targets interventions at specific groups is required . Further research that focuses on individual intervention components that are part of larger multifactorial interventions are also warranted Background When tested in a r and omized controlled trial ( RCT ) of 31,411 patients , the  nurse-led 6-PACK falls prevention program  did not reduce falls . Poor implementation fidelity ( i.e. , program not implemented as intended ) may explain this result . Despite repeated calls for the examination of implementation fidelity as an essential component of evaluating interventions design ed to improve the delivery of care , it has been neglected in prior falls prevention studies . This study examined implementation fidelity of the 6-PACK program during a large multi-site RCT . Methods Based on the 6-PACK implementation framework and intervention description , implementation fidelity was examined by quantifying adherence to program components and organizational support . Adherence indicators were : 1 ) falls-risk tool completion ; and for patients classified as high-risk , provision of 2 ) a ‘ Falls alert ’ sign ; and 3 ) at least one additional 6-PACK intervention . Organizational support indicators were : 1 ) provision of re sources ( executive sponsorship , site clinical leaders and equipment ) ; 2 ) implementation activities ( modification of patient care plans ; training ; implementation tailoring ; audits , reminders and feedback ; and provision of data ) ; and 3 ) program acceptability . Data were collected from daily bedside observation , medical records , re source utilization diaries and nurse surveys . Results All seven intervention components were delivered on the 12 intervention wards . Program adherence data were collected from 103,398 observations and medical record audits . The falls-risk tool was completed each day for 75 % of patients . Of the 38 % of patients classified as high-risk , 79 % had a ‘ Falls alert ’ sign and 63 % were provided with at least one additional 6-PACK intervention , as recommended . All hospitals provided the recommended re sources and undertook the nine outlined program implementation activities . Most of the nurses surveyed considered program components important for falls prevention . Conclusions While implementation fidelity was variable across wards , overall it was found to be acceptable during the RCT . Implementation failure is unlikely to be a key factor for the observed lack of program effectiveness in the 6-PACK trial . Trial registration The 6-PACK cluster RCT is registered with the Australian New Zeal and Clinical Trials Registry , number ACTRN12611000332921 ( 29 March 2011 ) BACKGROUND the Falls Risk for Older People in the Community assessment ( FROP-Com ) tool was design ed for use in targeted multi-factorial falls prevention programmes . It fills the gap between the short screening tools and the longer assessment tools , e.g. the physiological profile assessment ( PPA ) . The aim of this study was to determine the reliability and predictive accuracy of the FROP-Com . METHODS the intra-rater and inter-rater reliability studies were performed with 20 participants each . The prospect i ve study was performed with 344 community-dwelling older people presenting to an emergency department after a fall and being discharged directly home . Following a home-based assessment , including the FROP-Com , Timed Up and Go ( TUG ) and functional Reach ( FR )  , participants were monitored for falls for 12 months . RESULTS the intra-class correlation coefficient ( ICC ) for intra-rater reliability and inter-rater reliability for the FROP-Com was 0.93 ( 95 % CI 0.84 - 0.97 ) and 0.81 ( 95 % CI 0.59 - 0.92 ) respectively . The AUC for the  FROP-Com  was 0.68 ( 95 % CI 0.63 - 0.74 ) . At the cut-off 18/19 , sensitivity was 71.3 % ( 95 % CI 64.4 - 78.3 ) and specificity was 56.1 % ( 95 % CI 48.9 - 63.4 ) . The AUC for the TUG was 0.63 ( 95 % CI 0.57 - 0.69 ) and for the FR was 0.60 ( 95 % CI 0.54 - 0.66 ) . CONCLUSION the FROP-Com demonstrated good reliability and a moderate capacity to predict falls BACKGROUND AND OBJECTIVE To describe the diagnostic accuracy and practical application of the Peter James Centre Falls Risk Assessment Tool ( PJC-FRAT ) , a multidisciplinary falls risk screening and intervention deployment instrument . METHODS In phase 1 , the accuracy of the PJC-FRAT was prospect ively compared to a gold st and ard ( the STRATIFY ) on a cohort of subacute hospital patients ( n = 122 ) . In phase 2 , the PJC-FRAT was temporally reassessed using a subsequent cohort ( n = 316 ) , with results compared to those of phase 1 . Primary outcomes were falls ( events ) , fallers ( patients who fell ) , and hospital completion rates of the PJC-FRAT . RESULTS In phase 1 , PJC-FRAT accuracy of identifying fallers showed sensitivity of 73 % ( bootstrap 95 % confidence interval CI = 55 , 90 ) and specificity of 75 % ( 95 % CI = 66 , 83 ) , compared with the STRATIFY ( cutoff > or = 2/5 ) sensitivity of 77 % ( 95 % CI = 59 , 92 ) and specificity of 51 % ( 95 % CI = 41 , 61 ) . This difference was not significant . In phase 2 , accuracy of nursing staff using the PJC-FRAT was lower .  PJC-FRAT completion rates varied among disciplines over both phases : nurses and physiotherapists , > or = 90 % ; occupational therapists , > or = 82 % ; and medical officers , > or = 57 % . CONCLUSION The PJC-FRAT was practical and relatively accurate as a predictor of falls and a deployment instrument for falls prevention interventions , although continued staff education may be necessary to maintain its accuracy Background : The use of falls risk screening tools may aid in targeting fall prevention interventions in older individuals most likely to benefit . Objective : To determine the optimal physical or cognitive test to screen for falls risk in frail older people . Methods : This prospect i ve cohort study involved recruitment from 213 day-care centers in Japan . The feasibility study included 3,340 ambulatory individuals aged 65 years or older enrolled in the Tsukui Ordered Useful Care for Health ( TOUCH ) program . The external validation study included a sub sample of 455 individuals who completed all tests . Physical tests included  grip strength ( GS ) , chair st and test ( CST ) , one-leg st and ing test ( OLS ) , functional reach test ( FRT ) , t and em walking test ( TWT ) , 6-meter walking speed at a comfortable pace ( CWS ) and at maximum pace ( MWS )  , and timed up- and -go test ( TUG ) . The  mental status question naire ( MSQ )  was used to measure  cognitive function . The incidence of falls during 1 year was investigated by self-report or an interview with the participant ’s family and care staff . Results : The most practicable tests were the GS and MSQ , which could be administered to more than 90 % of the participants regardless of the activities of daily living status . The FRT and TWT had lower feasibility than other lower limb function tests . During the 1-year retrospective analysis of falls , 99 ( 21.8 % ) of the 455 validation study participants had fallen at least once . Fallers showed significantly poorer performance than non-fallers in the OLS ( p = 0.003 ) , TWT ( p = 0.001 ) , CWS ( p = 0.013 ) , MWS ( p = 0.007 ) , and TUG ( p = 0.011 ) . The OLS , CWS , and MWS remained significantly associated with falls when performance cut-points were determined . Logistic regression analysis revealed that the TWT was a significant and independent , yet weak predictor of falls . A weighting system which considered feasibility and validity scored the CWS ( at a cut-point of 0.7 m/s ) as the best test to predict risk of falls . Conclusion : Clinical tests of neuromuscular function can predict risk of falls in frail older people . When feasibility and validity were considered , the CWS was the best test for use as a screening tool in frail older people , however , these preliminary results require confirmation in further research OBJECTIVES To compare the effectiveness of four falls risk assessment tools ( STRATIFY , Downton , Tullamore , and Tinetti ) by using them simultaneously in the same environment . DESIGN Prospect i ve , open , observational study . SETTING Two acute medical wards admitting predominantly older patients . PARTICIPANTS One hundred thirty-five patients , 86 female , mean age+/-st and ard deviation 83.8+/-8.01 ( range 56 - 100 ) . MEASUREMENTS A single clinician prospect ively completed the four falls risk assessment tools . The extent of completion and time to complete each tool was recorded . Patients were followed until discharge , noting the occurrence of falls . The sensitivity , specificity , negative predictive accuracy , positive predictive accuracy , and total predictive accuracy were calculated . RESULTS The number of patients that the STRATIFY correctly identified ( n=90 ) was significantly higher than the Downton ( n=46 ; P<.001 ) , Tullamore ( n=66 ; P=.005 ) , or Tinetti ( n=52 ; P<.001 ) tools , but the STRATIFY had the poorest sensitivity ( 68.2 % ) . The STRATIFY was also the only tool that could be fully completed in all patients ( n=135 ) , compared with the Downton ( n=130 ; P=.06 ) , Tullamore ( n=130 ; P=.06 ) , and Tinetti ( n=17 ; P<.001 ) . The time required to complete the STRATIFY tool ( average 3.85 minutes ) was significantly less than for the Downton ( 6.34 minutes ; P<.001 ) , Tinetti ( 7.4 minutes ; P<.001 ) , and Tullamore ( 6.25 minutes ; P<.001 ) . The Kaplan-Meier test showed that the STRATIFY ( log rank P=.001 ) and Tullamore tools ( log rank P<.001 ) were effective at predicting falls over the first week of admission . The Downton ( log rank P=.46 ) and Tinetti tools ( log rank P=.41 ) did not demonstrate this characteristic . CONCLUSION Significant differences were identified in the performance and complexity between the four risk assessment tools studied . The STRATIFY tool was the shortest and easiest to complete and had the highest predictive value but the lowest sensitivity Abstract Objectives : To identify clinical characteristics of elderly in patients that predict their chance of falling ( phase 1 ) and to use these characteristics to derive a risk assessment tool and to evaluate its power in predicting falls ( phases 2 and 3 ) . Design : Phase 1 : a prospect i ve case-control study . Phases 2 and 3 : prospect i ve evaluations of the derived risk assessment tool in predicting falls in two cohorts . Setting : Elderly care units of St Thomas 's Hospital ( phase 1 and 2 ) and Kent and Canterbury Hospital ( phase 3 ) . Subjects : Elderly hospital in patients ( aged 65 years ) : 116 cases and 116 controls in phase 1 , 217 patients in phase 2 , and 331 in phase 3 . Main outcome measures : 21 separate clinical characteristics were assessed in phase 1 , including the abbreviated mental test score , modified Barthel index , a transfer and mobility score obtained by combining the transfer and mobility sections of the Barthel index , and several nursing judgments . Results : In phase 1 five factors were independently associated with a higher risk of falls : fall as a presenting complaint ( odds ratio 4.64 ( 95 % confidence interval 2.59 to 8.33 ) ; a transfer and mobility score of 3 or 4 ( 2.10 ( 1.22 to 3.61 ) ) ; and primary nurses ' judgment that a patient was agitated ( 20.9 ( 9.62 to 45.62 ) ) , needed frequent toileting ( 2.48 ( 1.08 to 5.70 ) ) , and was visually impaired ( 3.56 ( 1.26 to 10.05 ) ) . A risk assessment score ( range 0 - 5 ) was derived by scoring one point for each of these five factors . In phases 2 and 3 a risk assessment score > 2 was used to define high risk : the sensitivity and specificity of the score to predict falls during the following week was 93 % and 88 % respectively in phase 2 and 92 % and 68 % respectively in phase 3 . Conclusion : This simple risk assessment tool predicted with clinical ly useful sensitivity and specificity a high percentage of falls among elderly hospital in patients OBJECTIVES To investigate the effects of a twice-weekly multitarget stepping ( MTS ) task combined with a multicomponent exercise program on stepping accuracy , gaze behavior , fall risk factors , and fall rates . DESIGN R and omized controlled trial . SETTING Community . PARTICIPANTS Community-dwelling adults aged 65 and older in Japan ( N = 264 ) were r and omized into an MTS group ( n = 132 ) and a control group ( n = 132 ) . INTERVENTION Twenty-four weeks of a twice-weekly community-based MTS program in combination with a st and ardized multicomponent exercise program . MEASUREMENTS Number of falls and fall-related fractures during a 12-month follow-up period after completion of the intervention , stepping accuracy , gaze behavior while performing the MTS test , and results of four clinical tests relevant to assessment of risk of falls ( Timed Up and Go ( TUG ) , functional reach ( FR ) , 10-m walking , and Five Chair St and ( 5CS ) ) were measured . RESULTS Thirteen participants ( 11.6 % ) in the MTS group and 39 ( 33.0 % ) in the control group fell during the 12-month follow-up period ( incidence rate ratio = 0.35 , 95 % confidence interval ( CI ) = 0.19 - 0.66 ) . Three participants in the MTS group and 13 in the control group experienced fall-related fractures during the 12-month follow-up period ( relative risk = 0.22 , 95 % CI = 0.06 - 0.80 ) . After the intervention , a subset of participants in the MTS group had significantly greater improvement in stepping accuracy and gaze behavior during the MTS test , and all participants in the MTS group had significantly greater improvement in performing the TUG and 10-m walking ( P < .001 ) . CONCLUSION Participants who performed MTS tests combined with a multicomponent exercise program showed greater improvements in stepping accuracy , gaze behavior , and physical performance in a virtually complex environment . Considering the less-frequent fall rate in the follow-up assessment , these improvements could contribute to preventing falls in community-dwelling older adults Summary A r and omized , controlled fall-prevention study including 199 patients operated on for femoral neck fracture reduced inpatient falls and injuries . No statistically significant effects of the intervention program could be detected after discharge . It seems that fall-prevention must be part of everyday life in fall-prone old people . Introduction This study evaluates whether a postoperative multidisciplinary , multifactorial fall-prevention program performed by a geriatric team that reduced inpatient falls and injuries had any continuing effect after discharge . The intervention consisted of staff education , systematic assessment and treatment of fall risk factors and vitamin D and calcium supplementation . Methods The r and omized , controlled trial with a one-year follow-up at Umeå University Hospital , Sweden , included 199 patients operated on for femoral neck fracture , aged ≥70 years . Results After one year 44 participants had fallen 138 times in the intervention group compared with 55 participants and 191 falls in the control group . The crude postoperative fall incidence was 4.16/1,000 days in the intervention group vs. 6.43/1,000 days in the control group . The incidence rate ratio was 0.64 ( 95 % CI : 0.40–1.02 , p = 0.063 ) . Seven new fractures occurred in the intervention group and 11 in the control group . Conclusion A team applying comprehensive geriatric assessment and rehabilitation , including prevention and treatment of fall-risk factors , reduced inpatient falls and injuries , but no statistically significant effects of the program could be detected after discharge . It seems that fall-prevention must be part of everyday life in fall-prone elderly Background The British STRATIFY tool was previously developed to predict falls in hospital . Although the tool has several strengths , certain limitations exist which may not allow generalizability to a Canadian setting . Thus , we tested the STRATIFY tool with some modification and re-weighting of items in Canadian hospitals . Methods This was a prospect i ve validation cohort study in four acute care medical units of two teaching hospitals in Hamilton , Ontario . In total , 620 patients over the age of 65 years admitted during a 6-month period . Five patient characteristics found to be risk factors for falls in the British STRATIFY study were tested for predictive validity . The characteristics included history of falls , mental impairment , visual impairment , toileting , and dependency in transfers and mobility . Multivariate logistic regression was used to obtain optimal weights for the construction of a risk score . A receiver-operating characteristic curve was generated to show sensitivities and specificities for predicting falls based on different threshold scores for considering patients at high risk . Results Inter-rater reliability for the weighted risk score indicated very good agreement ( inter-class correlation coefficient = 0.78 ) . History of falls , mental impairment , toileting difficulties , and dependency in transfer / mobility significantly predicted fallers . In the multivariate model , mental status was a significant predictor ( P < 0.001 ) while history of falls and transfer / mobility difficulties approached significance ( P = 0.089 and P = 0.077 respectively ) . The logistic regression model led to weights for a risk score on a 30-point scale . A risk score of 9 or more gave a sensitivity of 91 % and specificity of 60 % for predicting who would fall . Conclusion Good predictive validity for identifying fallers was achieved in a Canadian setting using a simple-to-obtain risk score that can easily be incorporated into practice Accurate prediction of fall-prone hospitalized older adults may be integral to reducing falls . The STRATIFY , a simple 5-point falls prediction tool , was prospect ively vali date d on a Geriatric Assessment and Rehabilitation Unit as a one-time initial predictor of patients likely to fall . Sensitivity and specificity were lower than in the original British study . Introducing risk assessment s vali date d elsewhere on a patient care unit or on a hospital-wide scale requires caution Background Falls are a common hospital occurrence complicating the care of patients . From an economic perspective , the impact of in-hospital falls and related injuries is substantial . However , few studies have examined the economic implication s of falls prevention interventions in an acute care setting . The 6-PACK programme is a targeted  nurse  delivered falls prevention programme design ed specifically for acute hospital wards . It includes a risk assessment tool and six simple strategies that nurses apply to patients classified as high-risk by the tool . Objective To examine the incremental cost-effectiveness of the 6-PACK programme for the prevention of falls and fall-related injuries , compared with usual care practice , from an acute hospital perspective . Methods and design The 6-PACK project is a multicentre cluster r and omised controlled trial ( RCT ) that includes 24 acute medical and surgical wards from six hospitals in Australia to investigate the efficacy of the 6-PACK programme . This economic evaluation will be conducted alongside the 6-PACK cluster RCT . Outcome and hospitalisation cost data will be prospect ively collected on approximately 16 000 patients admitted to the participating wards during the 12-month trial period . The results of the economic evaluation will be expressed as ‘ cost or saving per fall prevented ’ and ‘ cost or saving per fall-related injury prevented ’ calculated from differences in mean costs and effects in the intervention and control groups , to generate an incremental cost-effectiveness ratio ( ICER ) . Discussion This economic evaluation will provide an opportunity to explore the cost-effectiveness of a targeted nurse delivered falls prevention programme for reducing in-hospital falls and fall-related injuries . This protocol provides a detailed statement of a planned economic evaluation conducted alongside a cluster RCT to investigate the efficacy of the 6-PACK programme to prevent falls and fall-related injuries . Trial registration number The protocol for the cluster RCT is registered with the Australian New Zeal and Clinical Trials Registry ( ACTRN12611000332921 ) OBJECTIVE To evaluate the efficacy of the Nijmegen Falls Prevention Program ( NFPP ) for persons with osteoporosis and a fall history in a r and omized controlled trial . Persons with osteoporosis are at risk for fall-related fractures because of decreased bone strength . A decrease in the number of falls therefore is expected to be particularly beneficial for these persons . DESIGN R and omized controlled trial . SETTING Hospital . PARTICIPANTS Persons with osteoporosis and a fall history ( N=96 ; mean ± SD age , 71.0±4.7y ; 90 women ) . INTERVENTION After baseline assessment , participants were r and omly assigned to the exercise ( n=50 ; participated in the NFPP for persons with osteoporosis [ 5.5wk ] ) or control group ( n=46 ; usual care ) . MAIN OUTCOME MEASURES Primary outcome measure was fall rate , measured by using monthly fall calendars for 1 year . Secondary outcomes were balance confidence ( Activity-specific Balance Confidence Scale ) , quality of life ( QOL ; Quality of Life Question naire of the European Foundation for Osteoporosis ) , and activity level ( LASA Physical Activity Question naire , pedometer ) , assessed posttreatment subsequent to the program and after 1 year of follow-up . RESULTS The fall rate in the exercise group was 39 % lower than for the control group ( .72 vs 1.18 falls/person-year ; risk ratio , .61 ; 95 % confidence interval , .40-.94 ) . Balance confidence in the exercise group increased by 13.9 % ( P=.001 ) . No group differences were observed in QOL and activity levels . CONCLUSION The NFPP for persons with osteoporosis was effective in decreasing the number of falls and improving balance confidence . Therefore , it is a valuable new tool to improve mobility and independence of persons with osteoporosis OBJECTIVE The role of exercise in the prevention of falls and fall-related injuries among elderly persons is unclear . The objective of this study was to assess the response to an exercise-based rehabilitation program intended to improve balance and mobility and reduce or prevent falls . DESIGN Pretest-posttest experimental design with repeated measures at baseline , immediately postintervention , and 6 months postintervention . To assess the effect of repeated exposure to our main outcome measure ( the obstacle course ) , half of the participants ( r and omly selected ) were allowed to practice on the obstacle course . SETTING A veterans affairs medical center . PARTICIPANTS Elderly , ambulatory , community-dwelling volunteers recruited from among local out patients at our medical center . INTERVENTION Sixty-five volunteers completed a 6-week supervised low to moderate intensity program of stretching , postural control , endurance walking , and coordination exercises design ed to improve balance and mobility . Participants were divided into 2 groups : 34 participants who did not practice on the obstacle course during their exercise program and 31 participants who practice d on the obstacle course in addition to their otherwise identical exercise program . MAIN OUTCOME MEASURES Performance on a functionally oriented obstacle course and self-reported falls and fall-related injuries . RESULTS No significant performance differences were found between the two groups . After intervention , mean qualitative obstacle course scores improved modestly ( 5 % ) and mean obstacle course completion time decreased by 15 % from baseline . These postintervention pairwise performance differences were clinical ly important but not statistically significant . Relative to baseline levels , postintervention falls and injuries did not change significantly . CONCLUSIONS Our exercise intervention may have the potential to improve functional performance . However , some modifications are necessary to enhance efficacy . The obstacle course may be a useful tool in the evaluation of elderly persons with balance and mobility impairment in the rehabilitation setting Falls are a major cause of morbidity in Parkinson 's disease ( PD ) . The objective of this study was to identify predictors of falls in PD and develop a simple prediction tool that would be useful in routine patient care . Potential predictor variables ( falls history , disease severity , cognition , leg muscle strength , balance , mobility , freezing of gait [ FOG ] , and fear of falling ) were collected for 205 community-dwelling people with PD .  Falls were monitored prospect ively for 6 months using monthly falls diaries . In total , 125 participants ( 59 % ) fell during follow-up . A model that included a history of falls , FOG , impaired postural sway , gait speed , sit-to-st and , st and ing balance with narrow base of support , and coordinated stability had high discrimination in identifying fallers ( area under the receiver-operating characteristic curve [ AUC ] , 0.83 ; 95 % confidence interval [ CI ] , 0.77 - 0.88 ) . A clinical tool that incorporated 3 predictors easily determined in a clinical setting ( falling in the previous year : odds ratio [ OR ] , 5.80 ; 95 % CI , 3.00 - 11.22 ; FOG in the past month : OR , 2.39 ; 95 % CI , 1.19 - 4.80 ; and self-selected gait speed < 1.1 meters per second : OR , 1.86 ; 95 % CI , 0.96 - 3.58 ) had similar discrimination ( AUC , 0.80 ; 95 % CI , 0.73 - 0.86 ) to the more complex model ( P = 0.14 for comparison of AUCs ) . The absolute probability of falling in the next 6 months for people with low , medium , and high risk using the simple , 3-test tool was 17 % , 51 % , and 85 % , respectively . In people who have PD without significant cognitive impairment , falls can be predicted with a high degree of accuracy using a simple , 3-test clinical tool . This tool enables individualized quantification of the risk of falling . © 2013 Movement Disorder Society Background and aims : The effectiveness of community-based fall assessment programs in older people is unclear . In this study , we examined the effectiveness of community-based fall assessment compared with hospital-based assessment . Methods : A r and omized un-blind study was conducted in 369 older adults aged 65 years and over at high risk of falling . Participants were drawn from a larger cohort of community-dwelling older people . Eligible participants were identified by means of a simple five-item screening tool . A r and omly chosen subset population of people at high risk of falling was then r and omized into two arms , community-based and hospital-based fall assessment s. The total number of falls in both groups was recorded by following up subjects ’ diaries and telephone interviews at 3 , 6 and 12 months . Incidence Rate Ratios ( IRR ) for the rate of falls at 12 months between community- and hospital-based assessment s were analysed as primary outcome , by intention-to-treat analysis . Results : A total of 349 participants completed the study .  Attendance to community-based assessment  was significantly higher compared with hospital-based assessment in this older population ( p=0.012 ) . There were no statistically significant differences between the two groups in total number of falls at the 12 month follow-up . According to Negative Binomial regression , the adjusted IRR of falls in the communitybased arm was not significantly different from the hospital-based one ( IRR 0.95 ; 95 % CI 0.58–1.45 , p=0.83 ) . Conclusion : This study showed the increased risk of falling according to community-based fall assessment program with respect to a traditional hospital-based one in community-dwelling older adults at high risk of falling Background Falls are common in stroke survivors returning home after rehabilitation , however there is currently a lack of evidence about preventing falls in this population . This paper describes the study protocol for the FLASSH ( FaLls prevention After Stroke Survivors return Home ) project . Methods and design This r and omised controlled trial aims to evaluate the effectiveness of a multi-factorial falls prevention program for stroke survivors who are at high risk of falling when they return home after rehabilitation . Intervention will consist of a home exercise program as well as individualised falls prevention and injury minimisation strategies based on identified risk factors for falls . Additionally , two sub- studies will be implemented in order to explore other key areas related to falls in this population . The first of these is a longitudinal study evaluating the relationship between fear of falling , falls and function over twelve months , and the second evaluates residual impairment in gait stability and obstacle crossing twelve months after discharge from rehabilitation . Discussion The results of the FLASSH project will inform falls prevention practice for stroke survivors . If the falls prevention program is shown to be effective , low cost strategies to prevent falls can be implemented for those at risk around the time of discharge from rehabilitation , thus improving safety and quality of life for stroke survivors . The two sub- studies will contribute to the overall underst and ing and management of falls risk in stroke survivors . Trial registration This trial is registered with the Australian and New Zeal and Clinical Trials Registry ( ACTRN012607000398404 ) BACKGROUND We investigated the effectiveness of a low-cost , multifactor fall risk reduction program in a group of rural community-dwelling older adults . The goal of the program was to provide health care workers and communities with a primary prevention tool that can be used to teach seniors about fall-related risks . The long-term goal of this program is to reduce the incidence of falling among community-dwelling older adults . METHODS Complete data were collected on 37 community-dwelling subjects , aged 67 to 90 , who participated in a 10-week fall risk reduction program . The subjects were r and omly assigned to an intervention group or to a control group . The intervention group received fall risk education , home-based exercise programming , nutrition counseling , and environmental hazards education . Both groups completed a variety of physiologic , psychometric , and environmental fall-related risk assessment s before and after the intervention period . RESULTS The intervention group showed statistically significant improvement in balance , bicep endurance , lower extremity power , reduction of environmental hazards , falls efficacy , and nutritious food behavior during the study period . CONCLUSIONS The low-cost , home-based fall risk reduction program for community-dwelling older adults was effective in reducing some of the studied fall-related risk factors over a 10-week period Background Falling can lead to severe health issues in the elderly and importantly contributes to morbidity , death , immobility , hospitalization , and early entry to long-term care facilities . The aim of this study was to devise a recurrent fall prevention program for elderly women in rural areas . Material / Methods This study adopted an assessor-blinded , r and omized , controlled trial methodology . Subjects were enrolled in a 12-week recurrent fall prevention program , which comprised strength training , balance training , and patient education .  Muscle strength and endurance of the ankles and the lower extremities , static balance , dynamic balance , depression , compliance with preventive behavior related to falls , fear of falling , and fall self-efficacy at baseline and immediately after the program were assessed . Sixty-two subjects ( mean age 69.2±4.3 years old ) completed the program – 31 subjects in the experimental group and 31 subjects in the control group . Results When the results of the program in the 2 groups were compared , significant differences were found in ankle heel rise test , lower extremity heel rise test , dynamic balance , depression , compliance with fall preventative behavior , fear of falling , and fall self-efficacy ( p<0.05 ) , but no significant difference was found in static balance . Conclusions This study shows that the fall prevention program described effectively improves muscle strength and endurance , balance , and psychological aspects in elderly women with a fall history Background . Quantitative posturography has been reported as a reliable tool to measure balance in people with multiple sclerosis ( MS ) . However , data on its diagnostic accuracy in predicting the occurrence of falls are lacking . Objective . To determine sensitivity , specificity , predictive values , and accuracy of  posturography  in detecting falls  in MS subjects over a 3-month follow-up period . Methods . One hundred consecutive patients with MS were tested by the  Berg Balance Scale ( BBS ) and by  static posturography on a monoaxial platform . Participants recorded the occurrence of accidental falls for the next 3 months . Abnormal cutoff values for static st and ing balance measures were set at 2 st and ard deviations above the mean values obtained from 50 healthy controls ( HC ) . The diagnostic accuracy of the BBS and static posturography was analyzed with respect to the prospect ively collected data on the occurrence of falls . Results . Posturometric measures in participants with MS were significantly worse than in HC ( all P values < .0001 ) ; however , only the center of pressure ( COP ) path with open eyes condition had substantial test – retest reliability .  Static posturography  was more sensitive ( 88 % vs 37 % ) and accurate ( 75 % vs 63 % ) , but slightly less specific ( 67 % vs 81 % ) , than the BBS in predicting accidental falls . A logistic regression analysis revealed that the worse the COP path , the greater the risk for accidental falls ( odds ratio = 1.08 ; P < .0001 ) , even after adjusting for sex , age , disease duration , body mass index , MS subtype , Exp and ed Disability Status Scale , and BBS score . Conclusion . The COP path measurement in static position is a sensitive and accurate tool to identify people with MS who are at risk of accidental falls OBJECTIVES To investigate the predictive validity and reliability of the STRATIFY falls risk assessment tool as applied to patients recovering from acute stroke . DESIGN Prospect i ve cohort study . SETTING Six stroke rehabilitation units in the North of Engl and . SUBJECTS All patients with a diagnosis of acute stroke admitted to the participating stroke units during a 6-month study period . ASSESSMENT on admission , falls risk ( STRATIFY ) , disability ( Barthel index ) , mobility ( Rivermead mobility index ) , cognitive impairment ( abbreviated mental test score ) and visual neglect ( Albert 's test ) were assessed . Then , STRATIFY was completed weekly and within 48 h of anticipated discharge . Consenting patients were contacted at 3 months after discharge to determine falls . OUTCOME MEASURES Occurrence of a fall within 28 days of the baseline STRATIFY ( in-patient study ) , falls in the first 3 months after discharge ( post-discharge study ) and falls during stroke unit stay ( reliability study ) . RESULTS From 387 patients admitted to the participating units during the study period , 225 contributed to the 28 day in-patient study , and 234 were followed up at 3 months after discharge . STRATIFY performed poorly in predicting falls in the first 28 days ( sensitivity 11.3 % and specificity 89.5 % ) and after discharge ( sensitivity 16.3 % and specificity 86.4 % ) . Agreement was ' fair ' between baseline and discharge scores ( kappa = 0.263 ) and ' good ' between the pre-hospital discharge score and that obtained in the week preceding discharge ( kappa = 0.639 ) . CONCLUSION STRATIFY performed poorly as a predictor of falls in a heterogeneous population of stroke patients . There is a need for a disease-specific rather than a generic falls risk assessment tool The objectives of this retrospective case-control study were to identify risk factors of falls in geriatric-psychiatric in patients and develop a screening tool to accurately predict falls . The study sample consisted of 225 geriatric-psychiatric in patients at a Midwestern referral facility . The sample included 136 in patients who fell and a r and om stratified sample of 89 in patients who did not fall . Data collected included age , gender , activities of daily living , and nursing parameters such as bathing assistance , bed height , use of bed rails , one-on-one observation , fall warning system , Conley Scale fall risk assessment , medical diagnosis , and medications . History of falls , impaired judgment , impaired gait , dizziness , delusions , delirium , chronic use of sedative or antipsychotic agents , and anticholinergic urinary bladder medications significantly increased fall risk . Alzheimer 's disease , acute use of sedative or anti-psychotic agents , and depression reduced fall risk . A falls risk tool , Fall Risk Assessment in Geriatric-psychiatric In patients to Lower Events ( FRAGILE ) , was developed for assessment and risk stratification with new diagnoses or medications
Heterogeneity between studies indicates that the Morse Falls Scale and STRATIFY may still be useful in particular setting s , but that widespread adoption of either is unlikely to generate benefits significantly greater than that of nursing staff clinical judgment
INTRODUCTION Fall risk screening tools are frequently used as a part of falls prevention programs in hospitals .
Design -related bias in evaluations of tool predictive accuracy could lead to overoptimistic results , which would then contribute to program failure in practice .