title: Application of a fall screening algorithm stratified fall risk but missed preventive opportunities in community-dwelling older adults: a prospective study.
abstract: OBJECTIVE
  Evaluate the ability of the American and British Geriatrics Society fall prevention guideline's screening algorithm to identify and stratify future fall risk in community-dwelling older adults.
  
  
  METHODS
  Prospective cohort of community-dwelling older adults (n = 117) aged 65 to 90 years. Fall history, balance, and gait measured during a comprehensive geriatric assessment at baseline. Falls data were collected monthly for 1 year. The outcomes of any fall and any injurious fall were evaluated.
  
  
  RESULTS
  The algorithm stratified participants into 4 hierarchal risk categories. Fall risk was 33% and 68% for the "no intervention" and "comprehensive fall evaluation required" groups respectively. The relative risk estimate for falling comparing participants in the 2 intervention groups was 2.08 (95% CI 1.42-3.05) for any fall and 2.60 (95% Cl 1.53-4.42) for any injurious fall. Prognostic accuracy values were: sensitivity of 0.50 (95% Cl 0.36-0.64) and specificity of 0.82 (95% CI 0.70-0.90) for any fall; and sensitivity of 0.56 (95% CI 0.38-0.72) and specificity of 0.78 (95% Cl 0.67-0.86) for any injurious fall.
  
  
  CONCLUSIONS
  The algorithm was able to identify and stratify fall risk for each fall outcome, though the values of prognostic accuracy demonstrate moderate clinical utility. The recommendations of fall evaluation for individuals in the highest risk groups appear supported though the recommendation of no intervention in the lowest risk groups may not address their needs for fall prevention interventions. Further evaluation of the algorithm is recommended to refine the identification of fall risk in community-dwelling older adults.
authors: Department of Epidemiology & Biostatistics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada. susanw.muir@uwo.ca
authors: Susan W
authors: SW
authors: Muir
authors: Katherine
authors: K
authors: Berg
authors: Bert
authors: B
authors: Chesworth
authors: Neil
authors: N
authors: Klar
authors: Mark
authors: M
authors: Speechley
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control*; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D005260:Female; D005684:Gait; D015577:Geriatric Assessment; D006801:Humans; D008297:Male; D008403:Mass Screening; D009864:Ontario; D004856:Postural Balance; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity