AHP and risk management : a case study for assessing risk factors for falls in community-dwelling older patients (original) (raw)
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International Journal of the Analytic Hierarchy Process, 2010
Falls occur frequently among older people and represent the most common cause of injury-related morbidity and mortality in later life. Preventing falls is an important way to reduce injuries, hospitalizations, and injury-related morbidity and mortality among older people. The research literature has identified hundreds of risk factors for falls among elderly people. Prioritizing risk factors for falls is useful for designing effective and efficacious prevention programs.
Methods of Information in Medicine, 2010
Summary Background: A gap exists between evidence-based medicine and clinical-practice. Every day, healthcare professionals (HCPs) combine empirical evidence and subjective experience in order to maximize the effectiveness of interventions. Consequently, it is important to understand how HCPs interpret the research evidence and apply it in everyday practice. We focused on the prevention of falls, a common cause of injury-related morbidity and mortality in later life, for which there is a wide range of known risk factors. Objectives: To use the Analytic Hierarchy Process (AHP) to investigate the opinions of HCPs in prioritizing risk factors for preventing falls. Methods: We used the AHP to develop a hierarchy of risk factors for falls based on the knowledge and experience of experts. We submitted electronic questionnaires via the web, in order to reach a wider number of respondents. With a web service, we pooled the results and weighted the coherence and the experience of respondents...
Multifactorial risk assessment for falls and injuries in the elderly within the community
Paripex Indian Journal Of Research, 2019
Falls are a leading cause of mortality and injury to the elderly. The aim of study is evaluation the risk of falls in individuals 65 years and older. A cross-sectional study was conducted on the sample of 200 respondents. The research instrument were used: Falls Risk for Older People-Community setting (FROP-COM) questionnaire and the questionnaire on the sociodemographic variables. The interdependent variables, statistically significant for the falls were: gender (p = 0.0001), age (p = 0.0001), financial status of the elderly (p = 0.003), adaptation of urban transport to the elderly and persons with disabilities (p = 0.047), giving up walking and moving for fear of falling (p = 0.0001) and a nurse's home visit for the purpose of assessing the risk factor for falling (p = 0.024). Risk factors identified as most influential in most elderly people are: medications, medical conditions, sensory loss, nutritional status, physical activity, function and history of falls.
The development of a validated falls risk assessment for use in clinical practice
Falls risk factor assessment is the first step in the development of appropriate intervention strategies for the prevention of falls. However, few multifactorial, validated falls risk assessments exist which are suitable for use in busy clinical settings. This project aimed to develop a reliable and valid falls risk assessment that was feasible for use in various clinical settings. The QuickScreen Clinical Falls Risk Assessment was developed and evaluated via four methods; a) the test-retest reliability of the measures was assessed with 30 community-dwelling older people, b) the concurrent validity of the measures was assessed by comparison with performance in the Physiological Profile Assessment, c) the predictive validity of the measures was assessed by comparison of performance with prospective falls in two studies involving large samples of community dwelling older people and d) the feasibility of the assessment was evaluated with 40 clinicians who trialled the assessment with their patients. The QuickScreen clinical falls risk assessment consists of eight measures, including previous falls, total medications, psychoactive medications, visual acuity, touch sensation, the sit to stand test, the near tandem stand test and the alternate step test. The test-retest reliability of the assessment measures was acceptable (intraclass correlation coefficients ranged from 0.56 to 0.89) and the assessment measures discriminated between multiple fallers and non-multiple fallers with relative risk values ranging from 1.4 to 2.5. The clinicians that trialled the assessment reported that it was quick and easy to administer and that it assisted in the management of their elderly patients. These results show that the QuickScreen Clinical Falls Risk Assessment has proven validity, test-retest reliability and is practical for use in a variety of clinical settings.
2019
Aims: 1) To determine fall risk assessment using subjective and objective measures; 2) To understand older adults' perception on fall risk assessment. Methodology: An explanatory sequential mixed methods design was used and consisted of two phases. Phase 1, the quantitative data was collected from nineteen older adults at an independent living facility in Orlando, Florida. Phase 2, the qualitative data was collected from three participants of Phase 1. After obtaining Institutional Review Board approval, the study was conducted at Lutheran Towers an independent living facility located in the downtown area of Orlando, Florida. Three measurement tools were used: demographic data sheet, an objective tool: BTrackS™ Balance Test (BBT), and Short Falls Efficacy Scale-International (FES-I). Results: In phase 1, 37% of participants had a high risk for falls assessed by the objective measure (BBT), and about 11% had high concern of fall risk assessed by the subjective measure (Short FES-I). Approximately 32% had congruent results between subjective and objective measures and 68 % presented incongruent results between subjective and objective measures. In phase 2, three themes were generated from the qualitative data :1) Perception and experience on fall risk assessment; 2) Perception of the subjective measure (Short FES-I) and 3) Perception of the objective measure (BBT). Conclusion: Those who have incongruent perceptions of their fall risk and physical abilities are most at risk. Performing fall risk assessment using both subjective and objective measures is critical for developing fall prevention plans, to identify those most at risk.
Background : Incidence of falls is 32% to 40% in people aged 65 or more. There is evidence that falls can be reduced. It is important to identify high risk patients for intervention. The objectives of this study were to compare the validity of the three fall risk assessment scales and to recommend the most appropriate fall risk assessment scale for Geriatric patients in Indian subcontinent. Materials and Methods : One hundred geriatric patients were assessed using three fall risk assessment tools : Morse scale , Schmid score , STRATIFY scale. The statistical analysis included calculation of sensitivity , specificity , positive predictive value and negative predictive value of each scale. Results : The fall risk assessment tools currently used for elderly did not show sufficiently high predictive validity for risk stratification. STRATIFY score had highest sensitivity but low specificity .Schmid score showed opposite findings. Conclusion : Rather than using a single measure, two assessment tools used together will maximize the advantage of each other in predicting occurrence of falls .
The perspectives of healthcare practitioners on fall risk factors in older adults
Health SA Gesondheid
Background: Accidental falls could have severe and far-reaching consequences for older adults, their families and society at large. Healthcare practitioners' (HCPs) perspectives on fall risk factors in older adults could assist in reducing and even preventing falls. Currently, no universal tool exists for this purpose. The World Health Organization's globally accepted International Classification of Functioning, Disability and Health (ICF) was used. Aim: This study aimed to (1) describe the perspectives of HCPs on fall risk factors in older adults in South Africa and (2) link these factors to the ICF. Setting: Eighteen HCPs participated in two focus groups. Methods: Using a qualitative research design, an inductive thematic analysis allowed for the identification of important themes, which were linked to the ICF. Results: The factors mentioned by participants were categorised into 38 themes, which were linked to 142 ICF codes, of which 43% (n = 61) were linked to the Body Function category, 23% (n = 32) to the Environmental Factors category, 18% (n = 26) to the Body Structure category and 16% (n = 23) to the Activities and Participation category. HCPs revealed two relevant factors that were not captured in existing fall risk assessment tools (FRATs), namely 'muscle-power functions' and 'mobility-of-joint functions', which directly relate to the ability to execute mobility activities. Combining HCPs' perspectives with other stakeholders and with literature provides a holistic picture of fall risk factors in older adults.