Predictive Performance of a Fall Risk Assessment Tool for Community-Dwelling Older People (FRAT-up) in 4 European Cohorts.
The fall risk assessment tool (FRAT-up) is a tool for predicting falls in community-dwelling older people based on a meta-analysis of fall risk factors. Based on the fall risk factor profile, this tool calculates the individual risk of falling over the next year. The objective of this study is to evaluate the performance of FRAT-up in predicting future falls in multiple cohorts.



Information about fall risk factors in 4 European cohorts of older people [Activity and Function in the Elderly (ActiFE), Germany; English Longitudinal Study of Aging (ELSA), England; Invecchiare nel Chianti (InCHIANTI), Italy; Irish Longitudinal Study on Aging (TILDA), Ireland] was used to calculate the FRAT-up risk score in individual participants. Information about falls that occurred after the assessment of the risk factors was collected from subsequent longitudinal follow-ups. We compared the performance of FRAT-up against those of other prediction models specifically fitted in each cohort by calculation of the area under the receiver operating characteristic curve (AUC).



The AUC attained by FRAT-up is 0.562 [95% confidence interval (CI) 0.530-0.594] for ActiFE, 0.699 (95% CI 0.680-0.718) for ELSA, 0.636 (95% CI 0.594-0.681) for InCHIANTI, and 0.685 (95% CI 0.660-0.709) for TILDA. Mean FRAT-up AUC as estimated from meta-analysis is 0.646 (95% CI 0.584-0.708), with substantial heterogeneity between studies. In each cohort, FRAT-up discriminant ability is surpassed, at most, by the cohort-specific risk model fitted on that same cohort.



We conclude that FRAT-up is a valid approach to estimate risk of falls in populations of community-dwelling older people. However, further studies should be performed to better understand the reasons for the observed heterogeneity across studies and to refine a tool that performs homogeneously with higher accuracy measures across different populations.
Department of Electrical, Electronic, and Information Engineering "Guglielmo Marconi"-DEI, University of Bologna, Bologna, Italy. Electronic address: pierpaolo.palumbo@unibo.it.
Pierpaolo
P
Palumbo
Department of Geriatrics and Clinic of Geriatric Rehabilitation, Robert-Bosch-Hospital, Stuttgart, Germany; Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany.
Jochen
J
Klenk
Department of Computer Science and Engineering-DISI, University of Bologna, Bologna, Italy.
Luca
L
Cattelani
Local Health Unit Tuscany Center, Florence, Italy.
Stefania
S
Bandinelli
Clinical Research Branch, National Institute on Aging, Baltimore, MD.
Luigi
L
Ferrucci
Department of Geriatrics and Clinic of Geriatric Rehabilitation, Robert-Bosch-Hospital, Stuttgart, Germany.
Kilian
K
Rapp
Department of Electrical, Electronic, and Information Engineering "Guglielmo Marconi"-DEI, University of Bologna, Bologna, Italy; Health Sciences and Technologies Interdepartmental Center for Industrial Research, University of Bologna, Bologna, Italy.
Lorenzo
L
Chiari
Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany.
Dietrich
D
Rothenbacher
D000058:Accidental Falls / Q000706:statistics & numerical data; D000368:Aged; D000369:Aged, 80 and over; D057189:Checklist / Q000592:standards*; D015331:Cohort Studies; D005260:Female; D005544:Forecasting; D006801:Humans; D008297:Male; D016017:Odds Ratio; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors
FRAT-up; Older people; falls; prediction model; validation