Assessment of fall risk in community-dwelling older persons
This three-study project was developed in collaboration with a local senior services agency to investigate fall risk in community-dwelling elders. The purpose of Study One was to investigate relationships among medication, dementia, and falls in community-dwelling elders with polypharmacy receiving home healthcare services from the agency. Medical information of 147 clients specifically their medication, diagnoses of dementia, and records of recent falls were obtained from clinical records. Chi-square tests were used to compare the use of psychotropic drugs between elders with and without dementia. A logistic regression was performed to test the hypothesis that psychotropic drugs and dementia predicted falls in this population. No significant differences were found in any type of psychotropic drug use between elders with and without dementia. Neither psychotropic drugs nor dementia predicted falls in this population. The purpose of Study Two was to determine the psychometric properties of the agency's Fall Risk Screening Form (FRSF). Content validity was evaluated on the basis of relevance, clarity and ease of use, and completeness of each item on the FRSF, as rated by 5 experts using a content response form. Rater consistency was evaluated by percentage agreement between two raters using the FRSF to assess 5 clients' fall risk. In a retrospective study of 100 clients' records, an ordinal coefficient alpha was used to assess the FRSF's internal consistency, and a Spearman's correlation was used to examine convergent validity between the FRSF and the Fall Risk Assessment Form (FRAF). Results showed that it was reasonable to use the FRSF for fall risk assessment, but there is room for improvement. The purpose of Study Three was to gather information on the procedures of fall risk screening, which involves collaboration between agency components and outreach workers. A semi-structured interview was used to gather feedback from geriatric care workers on what was needed for universal fall risk screening. Results indicate that integrating 8 fall-risk categories to a universal form improves the completeness of the form used in different agency components. However, to increase the utility of the fall risk screening, integrating service plans with each screening procedure needs to be developed.