Assessing Risk of Falling: A Comparison of Three Different Methods

Purpose: Prevention of falls and fall-related consequences is crucial in elderly health care because older individuals are at a high risk of suffering falls. Various risk assessment methods have been developed to assess fall risk. Diagnostic accuracy of fall risk assessments is low and there is a scarcity of evidence regarding clinical effectiveness. The study’s aim was to evaluate the diagnostic accuracy and clinical effectiveness of a standardized fall risk assessment relative to clinical and self-report assessment.

Methods: A single-site, prospective, longitudinal study was performed in a group of geriatric patients. Participants were patients being admitted to a geriatric rehabilitation hospital. The St. Thomas’s risk assessment tool (STRATIFY), clinical assessment, and a self-report assessment (fear of falling) were used to assess fall risk at two time points (at baseline and 3-weeks follow-up). The primary outcome was fall events. Contingency tables were used to calculate sensitivity, specificity, positive predictive values, and negative predictive values. Fisher’s exact test was used to test the association between assessments and fall events.

Results: A total of 124 patients participated in the study. The self-report technique demonstrated the highest sensitivity and negative predictive validity. The STRATIFY tool showed the highest specificity but the lowest sensitivity. The self-report technique was associated with a decrease in the number of fall events.

Conclusions: Given the lack of diagnostic accuracy of all three assessment techniques and the lack of evidence regarding clinical effectiveness, the usefulness of these fall risk assessments can be challenged. It is questionable whether time-consuming assessments examined in this study are necessary. None of the three fall risk assessment techniques demonstrated adequate diagnostic accuracy, which emphasizes the current state of research. The self-report technique seemed to be associated with a decrease in fall events. Given the lack of diagnostic accuracy in all three assessment techniques the usefulness of these fall risk assessments can be challenged. Further studies are needed to examine the diagnostic accuracy and clinical effectiveness of fall risk assessments. At least in settings in which fall prevention programs are a part of standard care, additional time consuming assessments may not be required.