title: The predictive value of fall assessment tools for patients admitted to hospice care.
abstract: OBJECTIVE
  Fall assessment tools are commonly used to evaluate the likelihood of fall. For patients found to be at high risk, patient-specific fall prevention interventions are implemented. The purposes of this study were to describe the population, evaluate and compare the efficacy of fall assessment tools, and suggest the best use for these tools in hospice.
  
  
  METHODS
  Data were downloaded from the electronic medical record for all patients who were admitted to and died in hospice care in 2013. Variables included demographic, clinical and initial fall assessment scores that had been computed on admission to hospice care, using our standard fall assessment tool. To facilitate comparison among three tools, additional fall assessment calculations were made for each patient using the Morse Fall Scale and MACH-10, two tools commonly used in a variety of healthcare settings.
  
  
  RESULTS
  Data were available for 3446 hospice patients. Female patients were less likely to fall than males; Fallers lived longer than Nonfallers; and patients with a primary dementia diagnosis fell 10 days sooner than those with a primary non-dementia diagnosis. A comparison of three fall assessment tools revealed that no tool had a good positive predictive value, but each demonstrated a good negative predictive value.
  
  
  CONCLUSIONS
  Fall assessment scores should not be used as the sole predictor of likelihood of fall, and are best used as a supplement to clinical judgement. Patients with a primary dementia diagnosis are likely to fall earlier in their hospice care than those with other primary diagnoses.
authors.affiliation: Department of Quality, Hospice of the Western Reserve, Cleveland, Ohio, USA.
authors.forename: Rebecca J
authors.initials: RJ
authors.lastname: Patrick
authors.affiliation: Department of Quality, Hospice of the Western Reserve, Cleveland, Ohio, USA.
authors.forename: Dana
authors.initials: D
authors.lastname: Slobodian
authors.affiliation: Department of Epidemiology and Biostatistics, Case Western University School of Medicine, Cleveland, Ohio, USA.
authors.forename: Sara
authors.initials: S
authors.lastname: Debanne
authors.affiliation: Department of Epidemiology and Biostatistics, Case Western University School of Medicine, Cleveland, Ohio, USA.
authors.forename: Ying
authors.initials: Y
authors.lastname: Huang
authors.affiliation: Department of Quality, Hospice of the Western Reserve, Cleveland, Ohio, USA.
authors.forename: Charles
authors.initials: C
authors.lastname: Wellman
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control*; D000368:Aged; D057286:Electronic Health Records; D005260:Female; D017051:Hospice Care; D006801:Humans; D008297:Male; D011237:Predictive Value of Tests; D018570:Risk Assessment; D019452:Terminally Ill
keywords: Fall assessment tools; Falls; Hospice care