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Development of a fall-risk assessment profile for community-dwelling older adults by using the National Health Interview Survey in Taiwan.

ABSTRACT: BACKGROUND:Falls represent a global health issue among older adults and cause a considerable burden on medical systems. In this study, a fall-risk assessment profile was developed for community-dwelling older adults. METHOD:The data of survey participants aged >?65?years were obtained from three rounds (2005, 2009, and 2013) of the National Health Interview Survey in Taiwan. In total, 8356 older participants were included in this study. Logistic regression analyses were used to determine potential predictors associated with falls. The regression coefficients of the predictors in the final model were translated into scores (by multiplying by 5) and then summed to obtain a total risk-score for falls. A receiver operating characteristic (ROC) curve was used to evaluate the discriminative performance of the risk assessment profile. RESULT:Self-reported falls within 1?year accounted for 19.1% of the total falls. The predictors that were included in the risk profile according to the logistic regression analysis results were as follows: female sex (adjusted odds ratio?=?1.57; risk-score?=?2), living alone (adjusted odds ratio?=?1.56; risk-score?=?2), urinary incontinence (adjusted odds ratio?=?1.36; risk-score?=?2), perceived unhealthiness (adjusted odds ratio?=?1.32; risk-score?=?1), perceived pain (adjusted odds ratio?=?1.51; risk-score?=?2), hospital admission in the past year (adjusted odds ratio?=?2.42; risk-score?=?4), low activity of daily living (ADL) scores (adjusted odds ratio?=?1.29; risk-score?=?1), and low mobility function scores (adjusted odds ratio?=?1.68; risk-score?=?3). At a total risk-score cutoff point of 6 (range 0-17), the model predicted falls with a sensitivity and specificity of 75.16 and 52.75%, respectively (area under the ROC curve?=?0.70). CONCLUSION:The fall-risk assessment profile comprising eight predictors-female sex, living alone, incontinence, perceived unhealthiness, perceived pain, hospital admission in the past year, low ADL scores, and low mobility function scores-may serve as an assessment tool for identification of older adults with a high risk of falling, and assessment results can be used to facilitate community-based intervention.

SUBMITTER: Chen PL

PROVIDER: S-EPMC7023681 | biostudies-literature | 2020 Feb

REPOSITORIES: biostudies-literature

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Development of a fall-risk assessment profile for community-dwelling older adults by using the National Health Interview Survey in Taiwan.

Chen Ping-Ling PL Lin Hsiao-Yu HY Ong Jiann Ruey JR Ma Hon-Ping HP

BMC public health 20200214 1

<h4>Background</h4>Falls represent a global health issue among older adults and cause a considerable burden on medical systems. In this study, a fall-risk assessment profile was developed for community-dwelling older adults.<h4>Method</h4>The data of survey participants aged > 65 years were obtained from three rounds (2005, 2009, and 2013) of the National Health Interview Survey in Taiwan. In total, 8356 older participants were included in this study. Logistic regression analyses were used to de ...[more]

PMID: 32059657

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Project description:BackgroundAn aging society incurs great losses due to fall-related injuries and mortalities. The foreseeable increased burden of fall-related injury among older people requires a regular nationwide study on the fall epidemic and prevention strategies.MethodsThe fall epidemic was examined using data from three consecutive waves of the National Health Interview Survey (2005, 2009, and 2013). Common explanatory variables across these surveys included sociodemographic factors (age, sex, and difficulty in performing activities of daily living (ADL) or instrumental ADL), biological factors (vision, comorbidities, urinary incontinence, and depressive symptoms), and behavioral risk factors (sleeping pill use, and frequency of exercise). After the univariate and bivariate analyses, the prevalence of falls was investigated using multiple linear regression models adjusted for age group, sex, and year of survey. A multivariate logistic regression model for falls with adjustments for these common explanatory variables was established across three waves of surveys. The effect of fall prevention programs was examined with the effect size in terms of age-specific and sex-specific prevalence of falls and fall-related hospitalization rates during 2005 and 2009.ResultsFor each survey, there were consecutively 2722; 2900; and 3200 respondents with a mean age of 75.1, 75.6, and 76.4?years, respectively. The multiple linear regression model yielded a negative association between the prevalence of falls and year of survey. Several sociodemographic and biological factors, including female sex, difficulty in performing one basic ADL, difficulty in performing two or more instrumental ADLs, unclear vision, comorbidities, urinary incontinence, and depressive symptoms, were significantly associated with falls. In contrast to the universal positive effect on the prevalence of falls among older adults, the effect size of fall-related hospitalization rates revealed a 2% relative risk reduction only for those aged 65-74?years, but deteriorated for those aged 75-84 (-?10.9%).ConclusionAlthough the decline in fall prevalence over time supports existing fall intervention strategies in Taiwan, the differential prevention effect and identification of risk factors in older people suggest the necessity of adjusting fall prevention programs.

Project description:IntroductionFall rates and fall-related injuries among community-dwelling older adults (≥65 years) are expected to increase rapidly, due to the aging population worldwide. Fall prevention programs (FPPs), consisting of strength and balance exercises, have been proven effective in reducing fall rates among older adults. However, these FPPs have not reached their full potential as most programs are under-enrolled. Therefore, this study aims to identify promising strategies that promote participation in FPPs among community-dwelling older adults.MethodsThis is an exploratory qualitative study. Previously, barriers and facilitators for participation in FPPs by older adults had been identified. Next, six strategies had been designed using the Intervention Mapping approach: (1) reframing; (2) informing about benefits; (3) raising awareness of risks; (4) involving social environment; (5) offering tailored intervention; (6) arranging practicalities. Strategies were validated during semi-structured interviews with community-dwelling older adults (n = 12) at risk of falling. Interviews were audio-recorded, transcribed, and analyzed following a qualitative thematic methodology, with a hybrid approach.ResultsAll strategies were considered important by at least some of the respondents. However, two strategies stood out: (1) reframing 'aging' and 'fall prevention': respondents preferred to be approached differently, taking a 'life course' perspective about falls, and avoiding confronting words; and (2) 'informing about benefits' (e.g., 'living independently for longer'); which was mentioned to improve the understanding of the relevance of participating in FPPs. Other strategies were considered important to take into account too, but opinions varied more strongly.DiscussionThis study provides insight into potential strategies to stimulate older adults to participate in FPPs. Results suggest that reframing 'aging' and 'fall prevention' may facilitate the dialogue about fall prevention, by communicating differently about the topic, for example 'staying fit and healthy', while focusing on the benefits of participating in FPPs. Gaining insight into the strategies' effectiveness and working mechanisms is an area for future research. This could lead to practical recommendations and help professionals to enhance older adults' participation in FPPs. Currently, the strategies are further developed to be applied and evaluated for effectiveness in multiple field labs in a central Dutch region (Utrecht).

Dataset Information

Development of a fall-risk assessment profile for community-dwelling older adults by using the National Health Interview Survey in Taiwan.

Publications

Development of a fall-risk assessment profile for community-dwelling older adults by using the National Health Interview Survey in Taiwan.

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