Validity and Practicality of Fall Risk Assessment Tools for Community-dwelling Older People

Abstract

Early identification of individuals with a higher risk of falling is important for effective fall prevention. Even though many fall risk assessment tools have been developed in the past two decades to evaluate fall risks and to screen out ‘at high risk’ older individuals, there are very few general guidelines on which tools are valid and suitable. This study aimed to compare seven widely used fall risk assessment tools (BBS, SPPB, TUG, FR, Mini-BESTest, SFES, SGDS) for the community-dwelling older people in terms of validity and practicality, and to provide the guideline on choosing the appropriate fall risk assessment tool for the general elderly. Sixty community-dwelling older Korean women (30 fallers and 30 matched nonfaller controls) were evaluated throughout the study. Performance measures of all tools were compared between the faller and nonfaller groups through t-test, receiver operating characteristic (ROC) curves were generated with odds ratios for discriminant analysis. Results showed that SPPB and SGDS were not sensitive to detect group differences between fallers and non-fallers, FR didn’t show significant discriminative power. Four remaining assessment tools (BBS, TUG, Mini-BESTest, SFES) showed significant discriminant validities, and SFES has the best and excellent discriminant validity (Area under ROC curve, i.e., AUC=0.852), followed by BBS of acceptable discriminant validity (AUC=0.754), but both TUG and Mini-BESTest have limited discriminant validities (AUC<0.7). In terms of practicality, SFES is also excellent. These findings suggested that SFES is the most suitable tool for assessing fall risks of community-dwelling older people, followed by BBS.