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Predictive validity of three home fall hazard assessment tools for older adults in Thailand.

ABSTRACT: This study aimed to examine the predictive validity of two internationally well-known instruments, the Modified Home Falls and Accidents Screening Tool (Modified HOME FAST) and the Modified Home Falls and Accidents Screening Tool-Self Report (Modified HOME FAST-SR), and the newly developed Thai Home Falls Hazard Assessment Tool (Thai-HFHAT) (69 items) in predicting falls among older Thai adults. It also aimed to examine the predictive validity of the two abbreviated versions (44 and 27 items) of the Thai-HFHAT, which were developed post hoc to accommodate older adults' limited literacy and poor vision and to facilitate the identification of high-impact home fall hazards that are prevalent in the Thailand context. A prospective cohort study was conducted among 450 participants aged 60 years and above who were assessed by the aforementioned tools at baseline, for which data on fall incidence were then collected during the one-year follow-up. The Cox proportional hazard model was applied to estimate hazard ratios (HRs); then, Harrell's C-statistics and receiver operating characteristic (ROC) analyses were conducted to identify the best cutoff point, sensitivity and specificity for each instrument. The results showed that the fall hazard rate was 2.04 times per 1,000 person-days. Taking into account both the predictive validity and applicability, the Thai-HFHAT (44 items) was found to be the most suitable screening tool due to its highest sensitivity and specificity (93% and 72%) at the cutoff score of 18. In conclusion, our study showed that these internationally validated home fall hazard assessment tools were quite applicable for Thailand, but further tailoring the tools into a specific local context yielded even more highly valid tools in predicting fall risk among older Thai adults. Although these findings were well reproducible by inferring from the internal validation results, further external validation in the independent population is necessary.

SUBMITTER: Lektip C

PROVIDER: S-EPMC7774965 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

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Predictive validity of three home fall hazard assessment tools for older adults in Thailand.

Lektip Charupa C Lapmanee Sarawut S Rattananupong Thanapoom T Lohsoonthorn Vitool V Vorayingyong Arnond A Woratanarat Thira T Sirisuk Kitti-On KO Suttanon Plaiwan P Petsirasan Rewwadee R Kitidumrongsuk Parinya P Jiamjarasrangsi Wiroj W

PloS one 20201231 12

This study aimed to examine the predictive validity of two internationally well-known instruments, the Modified Home Falls and Accidents Screening Tool (Modified HOME FAST) and the Modified Home Falls and Accidents Screening Tool-Self Report (Modified HOME FAST-SR), and the newly developed Thai Home Falls Hazard Assessment Tool (Thai-HFHAT) (69 items) in predicting falls among older Thai adults. It also aimed to examine the predictive validity of the two abbreviated versions (44 and 27 items) of ...[more]

PMID: 33382812

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Project description:BackgroundFalls are a common and serious public health issue among older adults, contributing to the loss of independence, psychological distress, and incapability to engage in meaningful occupations, etc. However, there is a lack of abundant information about the fall risk self-evaluation scale for community-dwelling older people. Therefore, this study aimed to evaluate the preliminary reliability and validity of the fall risk self-assessment scale (FRSAS) among community-dwelling older adults.MethodsA cross-sectional study was conducted. A total of 230 individuals aged 65 years and over were recruited by a convenience sampling between October and December 2020 from three communities in Haidian district, Beijing. Eligible participants were required to fill in the general condition questionnaire and the fall risk self-assessment scale. The reliability and validity were analyzed by using SPSS 20.0.ResultsTwo hundred twenty-two participants completed the assessment as required (the completion rate was 96.52%). The most items of FRSAS were understood by older adults, which was completed in 10 min. Cronbach's α and intraclass correlation coefficient ICC (2,1) of the scale were 0.757 and 0.967 respectively, suggesting good internal consistency and test-retest reliability. Exploratory factor analysis yielded 14 factors that explained 61.744% of the variance. Five items failed to be categorized into any factors because the factor loading of these items was less than 0.4. A future large-sample study needs to be conducted to explore its construct validity. The total scores and dimensional scores except for C-dimension showed significant differences between participants who had experienced a fall in the previous 6 months and those who had not (P < 0.05), indicating good discriminant validity.ConclusionsThe fall risk self-assessment scale including 41 items demonstrated relatively high feasibility as well as satisfactory results in the internal consistency, test-retest reliability, and discriminant validity.Trial registrationRegistration number: ChiCTR2000038856 ; Date of registration: 7 Oct 2020.

Project description:ImportanceThe ability of present-day etiologic stroke classification systems to generate subtypes with discrete stroke characteristics is not known.ObjectiveTo test the hypothesis that etiologic stroke subtyping identifies different disease processes that can be recognized through their different clinical courses.Design, setting, and participantsWe performed a head-to-head evaluation of the ability of the Causative Classification of Stroke (CCS), Trial of Org 10172 in Acute Stroke Treatment (TOAST), and ASCO (A for atherosclerosis, S for small-vessel disease, C for cardiac source, and O for other cause) classification systems to generate etiologic subtypes with different clinical, imaging, and prognostic characteristics in 1816 patients with ischemic stroke. This study included 2 cohorts recruited at separate periods; the first cohort was recruited between April 2003 and June 2006 and the second between June 2009 and December 2011. Data analysis was performed between June 2014 and May 2016.Main outcomes and measuresSeparate teams of stroke-trained neurologists performed CCS, TOAST, and ASCO classifications based on information available at the time of hospital discharge. We assessed the association between etiologic subtypes and stroke characteristics by computing receiver operating characteristic curves for binary variables (90-day stroke recurrence and 90-day mortality) and by calculating the ratio of between-category to within-category variability from the analysis of variance for continuous variables (admission National Institutes of Health Stroke Scale score and acute infarct volume).ResultsAmong the 1816 patients included, the median age was 70 years (interquartile range, 58-80 years) (830 women [46%]). The classification systems differed in their ability to assign stroke etiologies into known subtypes; the size of the undetermined category was 33% by CCS, 53% by TOAST, and 42% by ASCO (P < .001 for all binary comparisons). All systems provided significant discrimination for the validation variables tested. For the primary validation variable (90-day recurrence), the area under the receiver operating characteristic curve was 0.71 (95% CI, 0.66-0.75) for CCS, 0.61 (95% CI, 0.56-0.67) for TOAST, and 0.66 (95% CI, 0.60-0.71) for ASCO (P = .01 for CCS vs ASCO; P < .001 for CCS vs TOAST; P = .13 for ASCO vs TOAST). The classification systems exhibited similar discrimination for 90-day mortality. For admission National Institutes of Health Stroke Scale score and acute infarct volume, CCS generated more distinct subtypes with higher between-category to within-category variability than TOAST and ASCO.Conclusions and relevanceOur findings suggest that the major etiologic stroke subtypes are distinct categories with different stroke characteristics irrespective of the classification system used to identify them. We further show that CCS generates discrete etiologic categories with more diverse clinical, imaging, and prognostic characteristics than either TOAST or ASCO.

Project description:ImportanceFalls are the leading preventable cause of morbidity, mortality, and premature institutionalization for community-dwelling older adults.ObjectiveTo test the effectiveness of a behavioral intervention on fall risk among older adults receiving services from an Area Agency on Aging.Design, setting, and participantsThis randomized clinical trial examined a home hazard removal intervention in the community using a race- and sex-stratified randomization design. Older adults receiving services from the Area Agency on Aging in urban St Louis, Missouri, were assigned to a home hazard removal intervention delivered over 2 weeks with a 6-month booster or usual care control. Eligible participants were adults aged 65 years or older who did not have dementia, were at high risk for falling, and resided in the community. Enrollment occurred from January 2015 to September 2016; 12-month follow-up occurred from February 2016 to October 2017. Data were analyzed from February 2019 to July 2021.InterventionsThe intervention was a home hazard removal program delivered by an occupational therapist in the home that included a comprehensive clinical assessment and a tailored hazard removal plan. Usual care control consisted of annual assessments and community referral.Main outcomes and measuresThe primary outcome was the hazard of a fall over 12 months. Prespecified secondary outcomes included the rate of falls over 12 months, daily activity performance, falls self-efficacy, and self-reported quality of life.ResultsA total of 310 participants (mean [SD] age, 75 [7.4] years; 229 [74%] women; 161 Black participants [52%]) were randomized, with 155 participants assigned to the intervention and 155 participants assigned to usual care. Retention was 127 participants (82%) in the intervention group and 126 participants (81%) in the control group. There was no difference for our primary outcome of fall hazard (hazard ratio, 0.90; 95% CI, 0.66-1.27). There was a 38% reduction in the rate of falling in the intervention group compared with the control group (relative risk, 0.62; 95% CI, 0.40-0.95; P = .03). At 12 months, the rate of falls per person-year was 1.5 (95% CI, 1.32-1.75) in the intervention group and 2.3 (95% CI, 2.08-2.60) in the control group. There was no difference in daily activity performance (adjusted difference, -0.20; 95% CI, -0.95 to 0.55; P = .60), falls self-efficacy (adjusted difference, -0.12; 95% CI, -1.25 to 1.01; P = .84), or quality of life (adjusted difference, 0.84; 95% CI, -0.95 to 2.64; P = .35).Conclusions and relevanceThis randomized clinical trial found that a brief home hazard removal program did not reduce the hazard of falls among community-dwelling older adults at high risk for falling. The intervention was effective in achieving a reduced rate of falls, a prespecified secondary outcome. This effectiveness study has the potential for delivery through the national aging services network.Trial registrationClinicalTrials.gov Identifier: NCT02392013.

Dataset Information

Predictive validity of three home fall hazard assessment tools for older adults in Thailand.

Publications

Predictive validity of three home fall hazard assessment tools for older adults in Thailand.

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