This study aimed to examine the predictive validity of two internationally well-known instruments, the Modified Home Falls and Accidents Screening Tool (Modified HOME FAST) and the Modified Home Falls and Accidents Screening Tool-Self Report (Modified HOME FAST-SR), and the newly developed Thai Home Falls Hazard Assessment Tool (Thai-HFHAT) (69 items) in predicting falls among older Thai adults. It also aimed to examine the predictive validity of the two abbreviated versions (44 and 27 items) of the Thai-HFHAT, which were developed post hoc to accommodate older adults’ limited literacy and poor vision and to facilitate the identification of high-impact home fall hazards that are prevalent in the Thailand context. A prospective cohort study was conducted among 450 participants aged 60 years and above who were assessed by the aforementioned tools at baseline, for which data on fall incidence were then collected during the one-year follow-up. The Cox proportional hazard model was applied to estimate hazard ratios (HRs); then, Harrell’s C-statistics and receiver operating characteristic (ROC) analyses were conducted to identify the best cutoff point, sensitivity and specificity for each instrument. The results showed that the fall hazard rate was 2.04 times per 1,000 person-days. Taking into account both the predictive validity and applicability, the Thai-HFHAT (44 items) was found to be the most suitable screening tool due to its highest sensitivity and specificity (93% and 72%) at the cutoff score of 18. In conclusion, our study showed that these internationally validated home fall hazard assessment tools were quite applicable for Thailand, but further tailoring the tools into a specific local context yielded even more highly valid tools in predicting fall risk among older Thai adults. Although these findings were well reproducible by inferring from the internal validation results, further external validation in the independent population is necessary.

Background: The 44-question Thai Home Fall Hazard Assessment Tool (Thai-HFHAT) was developed to assist healthcare professionals in identifying the risk of falls among community-dwelling older adults from their home environment. However, the reliability of this tool has not been studied. This study aimed to examine the reliability of the 44-question Thai-HFHAT and determine the demographic characteristics associated with home hazards. Methods: A descriptive cross-sectional study design was used to evaluate inter-rater reliability. The participants in this study were 51 older people from various types of Thai houses: a one-story elevated house, a one-story non-elevated house, and a house with two or more floors, 51 caregivers of older patients, and 5 village health volunteers (VHV). A prospective design was used to evaluate test-retest reliability with older people at different times in their homes. All participants answered 44 Thai-HFHAT questions to determine inter-rater and test-retest reliabilities. The reliabilities were analyzed using an intra-class correlation coefficient (ICC). Demographic characteristics including sex, occupation, and education were used to identify the factors affecting home hazards, and linear regression was used to analyze. Results: The ICC of inter-rater reliability of the 44-question Thai-HFHAT was 0.74 (95% CI: 0.57-0.84) and the test-retest reliability was 0.80 (95% CI: 0.64-0.88) for the older adults, 0.80 (95% CI: 0.65-0.89) for the caregivers and 0.70 (95% CI: 0.477-0.83) for the VHV. In demographic variables, personal business career and education level (grades 1-3) had significant relations with the total number of home hazards in the 44-questions Thai-HFHAT. Conclusions: The 44-question Thai-HFHAT is suitable for home hazard assessment among older adults in Thailand. Further studies are needed to investigate changes in the house environment after using the 44-question Thai-HFHAT to determine which changes can reduce fall risk.

The Thai-Home Fall Hazard Assessment Tool (Thai-HFHAT) was developed to identify the fall risk among the elderly arising from their home environment. However, it is more time consuming for large items. Therefore, this study developed a short-form of Thai-HFHAT (Thai-HFHAT-SF). In phase I, we developed the Thai-HFHAT-SF by performing a confirmatory factor analysis (CFA) of 450 rural elderly people. In phase II, a total of 105 participants; 50 elderly people, 50 caregivers, and 5 village health volunteers (VHV) were recruited to examine the reliability of the Thai-HFHAT-SF. Intra-class correlation coefficient (ICC) was used to analyze the inter-rater and test–retest reliability. Factor analysis selected 28 out of the 69 original Thai-HFHAT items in 4 components: indoor area, garage, outdoor areas, and risky spots/areas including pets. The factor loading was 0.67, 0.60, 0.32, and 0.31 in each component. The fitness index indicated that this model was fit (χ2/df = 1.38, goodness-of-fit Index (GFI) = 0.988, adjusted goodness-of-fit index (AGFI) = 0.970, standardized root mean square residual (SRMR) = 0.030, and root mean square error of approximation (RMSEA) = 0.029). The inter-rater reliability of the Thai-HFHAT-SF was 0.82 (95% CI: 0.71–0.89). The test–retest reliability was 0.77 (95% CI: 0.60–0.87) for the older person group, 0.85 (95% CI: 0.73–0.91) for the caregiver group, and 0.60 (95% CI: 0.29–0.77) for the VHV group. The new 28-item scale focused on home fall hazards and can be conducted in 10–15 min. Thai-HFHAT-SF is suitable for home hazards assessment among elderly in Thailand.

Background: The 44-question Thai Home Fall Hazard Assessment Tool (Thai-HFHAT) was developed to assist healthcare professionals in identifying the risk of falls among community-dwelling older adults from their home environment. However, the reliability of this tool has not been studied. This study aimed to examine the reliability of the 44-question Thai-HFHAT and determine the demographic characteristics associated with home hazards. Methods: A descriptive cross-sectional study design was used to evaluate inter-rater reliability. The participants in this study were 51 older people from various types of Thai houses: a one-story elevated house, a one-story non-elevated house, and a house with two or more floors, 51 caregivers of older patients, and 5 village health volunteers (VHV). A prospective design was used to evaluate test-retest reliability with older people at different times in their homes. All participants answered 44 Thai-HFHAT questions to determine inter-rater and test-retest reliabilities. The reliabilities were analyzed using an intra-class correlation coefficient (ICC). Demographic characteristics including sex, occupation, and education were used to identify the factors affecting home hazards, and linear regression was used to analyze. Results: The ICC of inter-rater reliability of the 44-question Thai-HFHAT was 0.74 (95% CI: 0.57-0.84) and the test-retest reliability was 0.80 (95% CI: 0.64-0.88) for the older adults, 0.80 (95% CI: 0.65-0.89) for the caregivers and 0.70 (95% CI: 0.477-0.83) for the VHV. In demographic variables, personal business career and education level (grades 1-3) had significant relations with the total number of home hazards in the 44-questions Thai-HFHAT. Conclusions: The 44-question Thai-HFHAT is suitable for home hazard assessment among older adults in Thailand. Further studies are needed to investigate changes in the house environment after using the 44-question Thai-HFHAT to determine which changes can reduce fall risk.

Background: The 44-question Thai Home Fall Hazard Assessment Tool (Thai-HFHAT) was developed to assist healthcare professionals in identifying the risk of falls among community-dwelling elderly from their home environment. However, the reliability of this tool has not been studied. This study aimed to examine the reliability of the 44-question Thai-HFHAT and determine the personal characteristics associated with home hazards. Methods: A descriptive cross-sectional study design was used to evaluate interrater reliability. The participants in this study were 51 elderly people from various types of Thai houses: a one-story elevated house, a one-story non-elevated house, and a house with two or more floors, 51 caregivers of elderly patients, and 5 village health volunteers (VHV). A prospective design was used to evaluate test-retest reliability with older people at different times in their homes. All participants answered 44 Thai-HFHAT questions to determine inter-rater and test-retest reliabilities. The reliabilities were analyzed using an intra-class correlation coefficient (ICC). Personal characteristics including sex, occupation, and education were used to identify the factors affecting home hazards, and linear regression was used to analyze. Results: The ICC of inter-rater reliability of the 44-question Thai-HFHAT was 0.74 (95% CI: 0.57-0.84) and the test-retest reliability was 0.80 (95% CI: 0.64-0.88) for the elderly, 0.80 (95% CI: 0.65-0.89) for the caregivers and 0.70 (95% CI: 0.477-0.83) for the VHV. Personal business career and education level grades 1-3 are less than 0.05, which showed these factors had a significant relationship with the 44-question Thai-HFHAT score as the dependent variable. Conclusions: The 44-question Thai-HFHAT is suitable for home hazard assessment among the elderly in Thailand. Further studies are needed to investigate changes in the house environment after using the 44-question Thai-HFHAT to determine which changes can reduce fall risk.