Community-based fall assessment compared with hospital-based assessment in community-dwelling older people over 65 at high risk of falling: a randomized study

2011 ◽  
Vol 23 (1) ◽  
pp. 35-41 ◽  
Author(s):  
Sanjay Suman ◽  
Phyo K. Myint ◽  
Allan Clark ◽  
Partha Das ◽  
Liam Ring ◽  
...  
Keyword(s):  
High Risk ◽  
Older People ◽  
Randomized Study ◽  
Community Dwelling ◽  
Risk Of Falling ◽  
Community Based ◽  
Community Dwelling Older People

P2.034 Interactive gait and the risk of falling in community dwelling older people

2008 ◽  
Vol 14 ◽  
pp. S52
Author(s):  
E. Nordin ◽  
R. Moe-Nilssen ◽  
A. Ramnemark ◽  
L. Lundin-Olsson
Keyword(s):  
Older People ◽  
Community Dwelling ◽  
Risk Of Falling ◽  
Community Dwelling Older People

scholarly journals Development and internal validation of a risk prediction model for falls among older people using primary care electronic health records

2021 ◽  
Author(s):  
Noman Dormosh ◽  
Martijn C Schut ◽  
Martijn W Heymans ◽  
Nathalie van der Velde ◽  
Ameen Abu-Hanna
Keyword(s):  
Primary Care ◽  
High Risk ◽  
Older People ◽  
Prediction Model ◽  
Community Dwelling ◽  
Receiver Operating Curve ◽  
Free Text ◽  
Medical Conditions ◽  
History Of ◽  
Community Dwelling Older People

Abstract Background Currently used prediction tools have limited ability to identify community-dwelling older people at high risk for falls. Prediction models utilizing Electronic Heath Records (EHR) provide opportunities but up to now showed limited clinical value as risk stratification tool; because of among others the underestimation of falls prevalence. The aim of this study was to develop a fall prediction model for community-dwelling older people using a combination of structured data and free text of primary care EHR and to internally validate its predictive performance. Methods EHR data of individuals aged 65 or over. Age, sex, history of falls, medications and medical conditions were included as potential predictors. Falls were ascertained from the free text. We employed the Bootstrap-enhanced penalized logistic regression with the least absolute shrinkage and selection operator to develop the prediction model. We used 10-fold cross-validation to internally validate the prediction strategy. Model performance was assessed in terms of discrimination and calibration. Results Data of 36,470 eligible participants were extracted from the dataset. The number of participants who fell at least once was 4,778 (13.1%). The final prediction model included age, sex, history of falls, two medications and five medical conditions. The model had a median area under the receiver operating curve of 0.705 (IQR 0.700-0.714) . Conclusions Our prediction model to identify older people at high risk for falls achieved fair discrimination, and had reasonable calibration. It can be applied in clinical practice as it relies on routinely collected variables and does not require mobility assessment tests.

scholarly journals The cost of community research—recruiting community-dwelling participants to a feasibility primary care cluster randomised controlled trial

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Nicola Harrison ◽  
Caroline Brundle ◽  
Anne Heaven ◽  
Andrew Clegg
Keyword(s):  
Primary Care ◽  
Older People ◽  
Controlled Trial ◽  
Cluster Randomised Controlled Trial ◽  
Community Dwelling ◽  
Baseline Data ◽  
Community Based ◽  
Cluster Randomised ◽  
Community Dwelling Older People ◽  
Randomised Controlled

Abstract Background To support a robust evidence base for the organisation and provision of community-delivered health services for older people, clinical trials need to be designed to account for community-based participant recruitment. There is currently little reported information available on the time and cost of recruiting community-dwelling older people, which makes the completion of cost attribution documentation problematic when applying for research funding. Main body We aimed to establish the amount of researcher time it takes to recruit community-dwelling older people to a feasibility primary care cluster randomised controlled trial, including collecting baseline data. The trial was part of a programme of work investigating an intervention to improve the quality of life for older people with frailty. Two researchers conducting home visits to recruit and collect baseline data from participants recorded the time spent on travelling to and from the visit, at the visit itself and any associated administration. The median total researcher activity time per visit was 148 min. We discuss the various elements of recruitment and data collection activity and the factors that impacted the length of time taken, including location, individuals’ capacity and cognition, hearing and visual impairment and the desire for social contact. Conclusion Studies cannot reach their recruitment targets if they are unrealistically planned and resourced. We recommend that trials recruiting older people in the community allocate two and a half hours of researcher time per person, on average, for consent, baseline data collection, travel and administration. We acknowledge that a variety of different factors will mean that researcher activity will vary between different community-based trials. Our findings give a good starting point for timing calculations, and evidence on which to base the justification of research activity costings. Trial registration Personalised care planning for older people with frailty ISRCTN12363970. 08/11/2018.

scholarly journals Social isolation and loneliness among older people: issues and future challenges in community and residential settings

2008 ◽  
Vol 32 (3) ◽  
pp. 468 ◽  
Author(s):  
Linda Grenade ◽  
Duncan Boldy
Keyword(s):  
Older People ◽  
Social Isolation ◽  
Protective Factor ◽  
Community Dwelling ◽  
Intervention Programs ◽  
Community Based ◽  
Residential Settings ◽  
Number Of Factors ◽  
Future Challenges ◽  
Community Dwelling Older People

Although often associated with older age, loneliness and social isolation are not well understood in terms of their prevalence, risk and protective factors. Evidence suggests that only a minority of community-dwelling older people are ?severely? lonely or isolated, however a number of factors need to be considered to fully understand the extent and significance of the problem. Community- based studies have identified a variety of risk factors for loneliness/isolation including widowhood, no (surviving) children, living alone, deteriorating health, and life events (eg, loss and bereavement). Having a confidant has been identified as a protective factor for loneliness. However, evidence is often unclear or inconclusive, especially within residential settings. We identified the need to conduct more residential care-focused research; the importance of addressing a variety of methodological concerns; and the need for practitioners to develop intervention programs that are appropriately targeted, evidence-based and evaluated.

scholarly journals 86 Fear of Falling as Measured by the Falls Efficacy Scale International Indicates Gait and Balance Abnormalities in Community Dwelling Older People

2020 ◽  
Vol 49 (Supplement_1) ◽  
pp. i28-i29
Author(s):  
J Gibbon ◽  
H Trundle ◽  
D Green ◽  
V Strassheim ◽  
M Linsley ◽  
...  
Keyword(s):  
Older People ◽  
Fear Of Falling ◽  
Characteristic Curve ◽  
Balance Training ◽  
Community Dwelling ◽  
Falls Prevention ◽  
Risk Of Falling ◽  
Timed Up And Go ◽  
Balance Tests ◽  
Community Dwelling Older People

Abstract Background Falls are common in community dwelling older people, and gait and balance abnormalities (GABAb) are a key modifiable risk factor, through strength and balance training. In addition, there is a strong relationship between fear of falling (FoF) and GABAb , though Falls Efficacy Scale-International version (FES-I) scores have never been examined in this context. Our aim was to determine whether FoF, as measured by the FES-I, is associated with GABAb, as determined by commonly used gait and balance tests. Methods Consecutive patients attending our community falls prevention service completed FES-I questionnaires, and had Gait Speed (GS), Five Times Sit to Stand (FTSTS) and Timed Up and Go (TUG) tests assessed as part of a multifactorial falls prevention assessment. Cut-offs for falls risk are provided in the table. Sensitivity and specificity values for a 16-item FES-I cut-off score of 23.5 (>23 signifying significant FoF) were evaluated using the area under a receiver operating characteristic curve (AUROC), along with positive and negative likelihood ratios (LR+/LR-). Results There were 991 participants, 352 male, 639 female, mean age 74.5 years, mean FES-I score 28.7 and 57.0% had experienced at least one fall in the previous year. Gait and balance test scores were moderately associated with FoF per FES-I ≥23.5 as shown in the table. Specificities and sensitivities for all three are similar to commonly used diagnostic tests such as exercise testing versus coronary angiography for coronary artery disease. Conclusions FoF as measured by the FES-I is associated with scores on commonly used gait and balance tests that indicate a high risk of falling. This study highlights the potential of using FES-I as a screening tool to identify community dwelling older adults at risk of falling who may benefit from strength and balance training rather than relying on physical tests that are rarely performed outside falls clinics and physiotherapy departments. This application may have utility both in opportunistic individual screening and community screening programmes.

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