Predicting falls in residential care by a risk assessment tool, staff judgement, and history of falls

Background and aims: It is of great importance to consider whether a tool's predictive value is generalizable to similar samples in other locations. Numerous fall prediction systems have been developed, but very few are evaluated over a different time period in a different location. The purpose of this study was to validate the predictive accuracy of the Mobility Interaction Fall (MIF) chart, and to compare it to staff judgement of fall risk and history of falls. Methods: The MIF chart, staff judgement, and fall history were used to classify the risk of falling in 208 residents (mean age 83.2+/-6.8 years) living in four residential care facilities in northern Sweden. The MIF chart includes an observation of the ability to walk and simultaneously interact with a person or an object, a vision test. and a concentration rating. Staff rated each resident's risk as high or low and reported the resident's history of falls during the post 6 months. Falls were followed up for 6 months. Results: During the follow-up period, 104 residents (50%) fell at least once indoors. Many of the factors commonly associated with falls did not differ significantly between residents who fell at least once and residents who did not fall. In this validating sample the predictive accuracy of the MIF chart was notably lower than in the developmental sample. A combination of any two of the MIF chart, staff judgement, and history of falls was more accurate than any approach alone: more than half of the residents classified as 'high risk' by two approaches sustained a fall within 3 months. Conclusions: Residents classified as 'high risk' by any two of the MIF chart, staff judgement, and history of falls should be regarded as 9 particularly prone to falling and in urgent need of preventive measures.