Falls risk assessment outcomes and factors associated with falls for older Indigenous Australians

Abstract

Objective: To describe the prevalence of falls and associated risk factors in older Indigenous Australians, and compare the accuracy of validated falls risk screening and assessment tools in this population in classifying fall status. Method:Cross-sectional study of 289 Indigenous Australians aged ≥45 years from the Kimberley region of Western Australia who had a detailed assessment including self-reported falls in the past year (n=289), the adapted Elderly Falls Screening Tool (EFST; n=255), and the Falls Risk for Older People-Community (FROP-Com) screening tool (3 items, n=74) and FROPCom falls assessment tool (n=74).Results: 32% of participants had ≥1 fall in the preceding year, and 37.3% were classified high falls risk using the EFST (cut-off ≥2). In contrast, for the 74 participants assessed with the FROPCom, only 14.9% were rated high risk, 35.8% moderate risk, and 49.3% low risk. The FROP-Com screen and assessment tools had the highest classification accuracy for identifying fallers in the preceding year (area under curve >0.85), with sensitivity/specificity highest for the FROP-Com assessment (cut-off ≥12), sensitivity=0.84 and specificity=0.73. Conclusions:Falls are common in older Indigenous Australians. The FROP-Com falls risk assessment tool appears useful in this population, and this research suggests changes that may improve its utility further.

Risk factors for falls among older Aboriginal and Torres Strait Islander people in urban and regional communities

“…Examples include reduced mobility, cognitive impairment and the use of multiple medications. Previous work from the Kimberly Region in Western Australia (WA) found 32% of Aboriginal and Torres Strait Islander people aged 45 years and older had fallen at least once in the past year . This is similar to the proportion of falls reported by the general population aged 65 years and older, where approximately 30% of people experience at least one fall per year.…”

“…Within this study of Aboriginal people aged 60 years and older, 23% of participants experienced one or more falls within the year preceding data collection. The proportion of people reporting falls in this study is lower than the proportion previously reported by Aboriginal and Torres Strait Islander people aged 45 years and older in WA, where 32% of the study population experienced at least one fall within a one‐year period . Similar methods of participant recruitment and data collection were used in both studies.…”

“…Higher rates of comorbid conditions may cause activity levels to be lower among older Aboriginal and Torres Strait Islander people, providing fewer opportunities for a fall to occur. Additionally, past falls may have been underreported by study participants due to falls data being collected retrospectively through both this study and the closest comparable study conducted in WA . This highlights the need for a large‐scale prospective study in this area.…”

Validity of the Falls Risk for Older People in the Community (FROP-Com) tool to predict falls and fall injuries for older people presenting to the emergency department after falling

“…The latest Cochrane Review on falls prevention in the community setting highlighted that multifactorial interventions (based on a risk assessment and targeted intervention delivery) are effective in reducing the rate of falls (Gillespie et al 2012). Given the positive results of previous research using the FROP-Com in other samples with high falls risk (e.g., stroke, arthritis, care recipients, older people presenting to EDs after a fall) (Hill et al 2016;Meyer et al 2012;Price and Choy 2018;Suttanon et al 2013a), there would be value in evaluating the use of the FROP-Com to tailor falls prevention interventions to individual risk profiles to reduce falls among this high risk population.…”

“…The FROP-Com has subsequently been reported as discriminating high levels of falls risk in people with Alzheimer's disease (Suttanon et al 2013a), and in older people receiving informal care at home (Meyer et al 2012). The FROP-Com has been shown to significantly correlate with the Functional Gait Assessment in stroke patients (Price and Choy 2018), has been used as a reference tool for other falls risk screening processes in the ED (Tiedemann et al 2013) and has been used to evaluate falls risk among Indigenous Australians (Hill et al 2016). The FROP-Com has also been shown to be responsive to falls prevention interventions (Suttanon et al 2013b;Williams et al 2010).…”