Author:
Bruce Julie,Hossain Anower,Ji Chen,Lall Ranjit,Arnold Susanne,Padfield Emma,Underwood Martin,Lamb Sarah E.
Abstract
Abstract
Background
Postal screening has not previously been validated as a method for identifying fall and fracture risk in community-dwelling populations. We examined prognostic performance of a postal risk screener used in the UK Prevention of Falls Injury Trial (PreFIT; ISRCTN71002650), to predict any fall, recurrent falls, and fractures over 12 months. We tested whether adding variables would improve screener performance.
Methods
Nine thousand eight hundred and eight community-dwelling participants, aged 70 years and older, and 63 general practices in the UK National Health Service (NHS) were included in a large, pragmatic cluster randomised trial comparing screen and treat fall prevention interventions. The short postal screener was sent to all participants in the trial intervention arms as an A4 sheet to be completed and returned to the GP (n = 6,580). The postal screener items were embedded in the baseline pre-randomisation postal questionnaire for all arms of the trial (n = 9,808). We assessed discrimination and calibration using area under the curve (AUC). We identified additional predictors using data from the control arm and applied these coefficients to internal validation models in the intervention arm participants. We used logistic regression to identify additional predictor variables.
Findings
A total of 10,743 falls and 307 fractures were reported over 12 months. Over one third of participants 3,349/8,136 (41%) fell at least once over 12 month follow up. Response to the postal screener was high (5,779/6,580; 88%). Prediction models showed similar discriminatory ability in both control and intervention arms, with discrimination values for any fall AUC 0.67 (95% CI 0.65 to 0.68), and recurrent falls (AUC 0.71; 95% CI 0.69, 0.72) but poorer discrimination for fractures (AUC 0.60; 95% CI 0.56, 0.64). Additional predictor variables improved prediction of falls but had modest effect on fracture, where AUC rose to 0.71 (95% CI 0.67 to 0.74). Calibration slopes were very close to 1.
Conclusion
A short fall risk postal screener was acceptable for use in primary care but fall prediction was limited, although consistent with other tools. Fracture and fall prediction were only partially reliant on fall risk although were improved with the additional variables.
Funder
Health Technology Assessment Programme
Publisher
Springer Science and Business Media LLC
Subject
Geriatrics and Gerontology
Reference42 articles.
1. Lord S, Sherrington C, Menz H. Falls in Older People. Cambridge: Cambridge University Press; 2001.
2. Royal College of Physicians (RCP). Falling Standards, Broken Promises: Report of the National Audit of Falls and Bone Health in Older People 2010. London: RCP; 2011.
3. National Institute for Health and Care Excellence (NICE). Falls: The Assessment and Prevention of Falls in Older People. London: NICE; 2013.
4. National Institute for Health and Care Excellence (NICE). Falls in older people. Quality standard [QS68]. Published 25 March 2015, Updated 31 January 2017. London: NICE; 2017.
5. Panel on Prevention of Falls in Older Persons, American Geriatrics Society and British Geriatrics Society. Summary of the updated American Geriatrics Society/British Geriatrics Society clinical practice guideline for prevention of falls in older persons. J Am Geriatr Soc. 2010;59:148–57. https://doi.org/10.1111/j.1532-5415.2010.03234.x.
Cited by
2 articles.
订阅此论文施引文献
订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献