Factors included in adult fall risk assessment tools (FRATs): a systematic review

Abstract

Falls often have severe financial and environmental consequences, not only for those who fall, but also for their families and society at large. Identifying fall risk in older adults can be of great use in preventing or reducing falls and fall risk, and preventative measures that are then introduced can help reduce the incidence and severity of falls in older adults. The overall aim of our systematic review was to provide an analysis of existing mechanisms and measures for evaluating fall risk in older adults. The 43 included FRATs produced a total of 493 FRAT items which, when linked to the ICF, resulted in a total of 952 ICF codes. The ICF domain with the most used codes was body function, with 381 of the 952 codes used (40%), followed by activities and participation with 273 codes (28%), body structure with 238 codes (25%) and, lastly, environmental and personal factors with only 60 codes (7%). This review highlights the fact that current FRATs focus on the body, neglecting environmental and personal factors and, to a lesser extent, activities and participation. This over-reliance on the body as the point of failure in fall risk assessment clearly highlights the need for gathering qualitative data, such as from focus group discussions with older adults, to capture the perspectives and views of the older adults themselves about the factors that increase their risk of falling and comparing these perspectives to the data gathered from published FRATs as described in this review.

The perspectives of healthcare practitioners on fall risk factors in older adults

“…The ICF also offers a common terminology for the improvement of clinical and patient-orientated assessment instruments (Bickenbach et al 2012 ; World Health Organization 2012). A comparison between the perspectives of HCPs and a recent systematic review of FRATs (De Clercq et al 2020 ) indicated that the majority of perspectives of both the FRATS and the HCPs focussed on Body Function. It also showed that the knowledge of HCPs was in line with contemporary knowledge in the field.…”

“…A comparison between the clinical perspectives of HCPs on fall risk factors in older adults and the systematic review of FRATs (De Clercq et al 2020 ) revealed that the HCPs mentioned two relevant factors that were not captured in existing FRATs, namely ‘muscle-power functions’ and ‘mobility-of-joint functions’. Both of these ICF codes are important to consider for fall risk in older adults, as they relate directly to the ability to execute mobility activities.…”

“…Practitioners have an important role to play in identifying fall risk (Liddle et al 2018 ), yet their perspectives are not routinely included in research on the topic (Burgon et al 2019 ). Currently, no universal tool exists for HCPs to comprehensively document fall risk factors in older adults, and this possibly contributes to the ineffective management of the problem (De Clercq, Naude & Bornman 2020 ). One strategy towards creating an early identification documentation system is to develop a holistic, universal classification of fall risk in older adults.…”

Use of Standardized and Non-Standardized Tools for Measuring the Risk of Falls and Independence in Clinical Practice

“…Continuous nursing assessments enables monitoring mobility issues that are frequently related to independence problems, falls, pressure sores, incontinence, and spasticity [ 10 , 11 ]. Standardized tools, such as the Conley Scale [ 12 ], the Morse Fall Scale [ 13 ], or the Tinetti Test [ 14 ], can be used to assess fall risk. The Barthel Test, a test of Activities of Daily Living (ADL) and the Instrumental Activities of Daily Living (IADL) test can be used to assess independence [ 15 ].…”

Older Adults’ Perspectives on Fall Risk: Linking Results to the ICF

“…A framework such as the International Statistical Classification of Diseases and Related Health Problems (ICD), in contrast, focuses on classifying diseases and other health problems associated mainly with bodily disfunctions (World Health Organization [WHO], 2004). The ICF views functioning and disability as outcomes of interactions between the health condition (in this case, falls) and the contextual factors (in this case, fall risk factors), which include physical environmental risk factors such as natural or man-made products or environments (de Clercq et al, 2020). This framework has allowed us to code the older adult’s perception of fall risk factors into three categories, namely, (a) Body Function and Structure, (b) Activities and Participation, and (c) Environmental Factors.…”