Older adult fall injuries and the usage of fall screener tools

Abstract

Introduction: Older adult (≥65 years) falls are common and may result in severe injuries. There is limited knowledge about what proportion of older adults who fall sustain injuries that need medical attention. Screening is the first step in helping older adults reduce their risk of falls. However, there is limited research on how well current fall screeners can predict fall injuries. Methods: Previously collected data from community-dwelling older adults enrolled in a 13-month long study, from the AmeriSpeak Panel, were analyzed. Baseline survey included questions related to demographics, falls risk factors, and falls risk screeners (CDC’s 3 Key Questions (3KQ) and Stay Independent). Weighted percentages and 95% confidence intervals (CI) of older adults reporting one or more falls, fall-related injuries, falls needing any medical attention, falls resulting in doctor visits, and falls resulting in Emergency Department (ED) visits and/or hospitalization by demographics and fall risk factors were calculated. Risk ratios, sensitivity, specificity, and positive and negative predictive values were calculated to compare the two screeners’ ability to predict fall injury outcomes. Results: Among older adults who fell, 24.8% had an injury resulting in any medical attention, 14.5% sought treatment at a doctor’s office, and 14.3% sought treatment at an ED/hospital. Sensitivity estimates for baseline 3KQ and Stay Independent screeners for falls resulting in an ED/hospital visit were 87.3% and 75.0%, respectively. Specificity estimates were 47.4% and 63.6%. Conclusion: At least one in four older adults who fell needed medical attention. The 3KQ or Stay Independent screeners identified a large proportion of older adults who sought treatment at an ED/hospital for falls. However, using them may result in a large number of false positives. Practical Application: Clinicians may use these screeners to identify older adults at high fall injury risk, assess them for specific risk factors, and intervene accordingly.