Identification and Assessment of Fall Risks in Community-Dwelling Korean Older Women

Abstract

The world is facing a major challenge of population aging and falls in the elderly present a major health problem due to their high incidence, the involvement of multiple risk factors, and the fall related injuries and psychosocial consequences. Many studies have been conducted to investigate the potential fall risk factors and develop corresponding fall risk assessment tools for proactive fall prevention. Simple fall risk assessment tools including questionnaires and performance measures are widely used because these tools are easy to administer and cost-effective.

This thesis was aimed to identify Korean elderly women’s fall risk profile and to provide a guideline on choosing appropriate simple fall risk assessment tools for the Korean general elderly population through a comparison study with various previously reported fall risk assessment tools since Korea is also one of the countries facing population aging. Thereafter, a new fall risk assessment tool was developed and its effectiveness was evaluated through a follow-up experimental study. To identify the fall risk profile in Korean older people, characteristics of Korean older people’s fall (fall history, circumstances of falls, and consequences of falls etc) were investigated by face to face interviews. To evaluate the effectiveness of the fall risk assessment tools, existing fall risk assessment tools were compared in terms of validity and practicality through an experimental study. Limitations of existing fall risk assessment tools were investigated afterwards, and a new tool was developed based on four design criteria: inclusion of various fall risk factors, utilization of objective test items, systematic structure, and determination of weights for each fall risk factor. A follow-up experiment to prove the new tool is effective to detect fall risks was conducted.

The results of the first experiment suggested that among seven widely used simple fall risk assessment tools, short version of Falls Efficacy Scale (SFES) is the most suitable tool for assessing fall risks of community-dwelling Korean older women, followed by Berg Balance Scale (BBS). SFES had high classification accuracy and discriminant validity (AUC= 0.821) and BBS had moderate accuracy (AUC= 0.726). Results of the second experiment on a new sample demonstrated that the newly developed tool is appropriate to assess fall risks in Korean community-dwelling older women. Logistic regression model in the new tool, which is one of the methods for determining the weighting of each risk factor, showed significantly higher accuracy (AUC=0.808) than existing fall risk assessment tools (AUC ranged from 0.502 to 0.683) in assessing fall risks of the Korean older women. The findings of this study could contribute to not only discovering fall risk characteristics of Korean older people and effective tools to assess their fall risks, but also developing a new systematic fall risk assessment tool for Korean older people.