title: Systematic review of fall risk screening tools for older patients in acute hospitals.
abstract: OBJECTIVE
  To determine the most accurate fall risk screening tools for predicting falls among patients aged 65 years or older admitted to acute care hospitals.
  
  
  BACKGROUND
  Falls represent a serious problem in older inpatients due to the potential physical, social, psychological and economic consequences. Older inpatients present with risk factors associated with age-related physiological and psychological changes as well as multiple morbidities. Thus, fall risk screening tools for older adults should include these specific risk factors. There are no published recommendations addressing what tools are appropriate for older hospitalized adults.
  
  
  METHODS
  Systematic review.
  
  
  METHODS
  MEDLINE, CINAHL and Cochrane electronic databases were searched between January 1981-April 2013. Only prospective validation studies reporting sensitivity and specificity values were included.
  
  
  METHODS
  Recommendations of the Cochrane Handbook of Diagnostic Test Accuracy Reviews have been followed.
  
  
  RESULTS
  Three fall risk assessment tools were evaluated in seven articles. Due to the limited number of studies, meta-analysis was carried out only for the STRATIFY and Hendrich Fall Risk Model II. In the combined analysis, the Hendrich Fall Risk Model II demonstrated higher sensitivity than STRATIFY, while the STRATIFY showed higher specificity. In both tools, the Youden index showed low prognostic accuracy.
  
  
  CONCLUSIONS
  The identified tools do not demonstrate predictive values as high as needed for identifying older inpatients at risk for falls. For this reason, no tool can be recommended for fall detection. More research is needed to evaluate fall risk screening tools for older inpatients.
authors.affiliation: School of Nursing, Campus Bio-medico of Rome University, Rome, Italy.
authors.forename: Maria
authors.initials: M
authors.lastname: Matarese
authors.affiliation: Medical-surgical Unit, Campus Bio-medico of Rome University Hospital, Rome, Italy.
authors.forename: Dhurata
authors.initials: D
authors.lastname: Ivziku
authors.affiliation: Marco Polo Hospital, Rome, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Bartolozzi
authors.affiliation: School of Nursing, Campus Bio-medico of Rome University, Rome, Italy.
authors.forename: Michela
authors.initials: M
authors.lastname: Piredda
authors.affiliation: School of Nursing, Campus Bio-medico of Rome University, Rome, Italy.
authors.forename: Maria Grazia
authors.initials: MG
authors.lastname: De Marinis
mesh_terms: D000058:Accidental Falls; D000368:Aged; D006779:Hospitals, Public; D006801:Humans; D007297:Inpatients; D007558:Italy; D018570:Risk Assessment
keywords: accidental falls; aged; hospital; nursing; patients; risk assessment; systematic review