Predicting First-Time Injurious Falls in Older Men and Women Living in the Community: Development of the First Injurious Fall Screening Tool

Objectives: The aim of this study was to create a screening tool to predict first-time injurious falls in community-living older men and women. Design: Longitudinal cohort study between 2001 and 2009. Setting: The Swedish National Study on Aging and Care in Kungsholmen (SNAC-K), Sweden. Participants: Community-living older adults (n = 2808; 1750 women and 1058 men) aged >= 60 years (mean age 73, standard deviation 10.3). Measurements: The outcome was injurious falls within 5 years from baseline survey. Data on the risk factors for falls were collected through interviews, clinical examinations, and tests at baseline. Several previously established fall risk factors were identified for the development of the screening tool. The tool was formulated based on the beta coefficients from sex-specific multivariate Cox proportional hazards models. The discriminative power was assessed using Harrell C statistic. Results: Old age, living alone, being dependent in instrumental activities of daily living, and impaired balance were the factors included in the final score of the First Injurious Fall (FIF) screening tool. The predictive values (Harrell C statistic) for the scores were 0.75 for women and 0.77 for men. The sensitivity and specificity at the Youden cut-off points were 0.69 and 0.70 for women, and 0.72 and 0.71 for men. Conclusions and Implications: The FIF screening tool for first injurious fall in older persons consists of 3 questions and a physical test (5-second 1-leg standing balance with eyes open). Quick and easy to administer, it could be ideal for use in primary care or public health to identify older men and women at high fall risk, who may benefit from primary preventive interventions. (C) 2019 The Author(s). Published by Elsevier Inc. on behalf of AMDA - The Society for Post-Acute and Long-Term Care Medicine. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).