Predicting The Risk of Fall in Community-Dwelling Older Adults in Iran

Abstract

Background

The European Assessment System (EASY) Care Standard is a self-report fall screening tool for the community-dwelling older adults. A study demonstrated that the EASY-Care Standard 2010’s fall subscale (ECSF) is a valid tool for predicting the risk of fall in a nursing home; however, the validity of ECSF in community-dwelling older adults is still not clear. We aimed to evaluate the performance of the instrument as a screening tool to predict the risk of fall among community-dwelling older adults in Iran for a six-month follow-up period. If this tool is useful for the prediction of fall, it can be used for primary health-care services to detect subjects at a higher risk of fall.

Method

This is a longitudinal validation study that was carried out among 101 community residents ≥60 in Tehran, Iran. The participants were selected using a convenience cluster sampling based on Performance-Oriented Mobility Assessment (POMA) score categorization. The follow-up period of this study was 6 months. The ECFS scores at the baseline of the study were compared between subjects who had fallen and those who had not fallen during the six-month follow-up period. The cutoff was determined using a Receiver Operating Characteristics (ROC) curve analysis. Internal consistency and the sufficient intra-rater reliability were determined.

Results

The mean age of the participants was 71.87 years. The Spearman’s correlation coefficient between ECSF and POMA scores was equal to 0.829. There was also a correlation coefficient >0.8 between ECFS scores and Timed Up and Go test (TUG) seconds. Two components were detected in the factor analysis of the ECSF. The ECSF cutoff point was four out of eight with the sensitivity and specificity of 76.6 and 87.5%, respectively. The total Kuder-Richardson 20 (KR-20) coefficient was calculated as 0.852.

Conclusion

It seems that the EASY-Care Standard 2010 is a valid and reliable tool to predict the risk of fall in the next 6 months in the community-dwelling older adults. A valid simple and useful tool that is a good predictor of fall might help the health providers at primary health care level to easily recognize the older adults who are at a high risk of falling.

What is already known about this topic? (Including key points and/or knowledge gaps

• Several tools exist for the predication of fall among older people.

• The ESAY–Care has been translated into numerous languages.

• In Iran, there is not a report assessing the validity and reliability of this tool.

What this paper adds: (research findings/key new information

• The Persian version of ESAY-Care tool has a high inter-rater reliability and specificity.

• The Persian version of ESAY-Care tool could predict the risk of fall for the next six months.

• The ESAY Care tool is used to identify the risk of fall for the older adults who live in the community.

The implications of this paper

• ESAY-Care can be incorporated into health providers and family caregivers’ measures, especially at primary prevention levels.

• Falling in older adults can be predicted in every community in the future.

• ESAY-Care will provide an efficient method to identify older people at the risk of fall during a routine community level assessment.

Keywords:

• Community-dwelling older adults
• EASY-Care tool
• fall
• prediction

Acknowledgments

This study is part of an MSc thesis approved by Tehran University of Medical Sciences. We declare our great thanks to the Older Adults Health Research Center, Endocrinology and Metabolism Population Sciences Research Institute to support this work. Hereby we offer our thanks to all the elderly population ≥60 who were residents of Tehran and who took part in the study.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work was supported by Tehran University of Medical Sciences (Grant number 2074).