FRAT-up, a Fall-Risk Assessment Tool for Elderly People Living in the Community

Abstract

BackgroundAbout 30% of people over 65 are subject to at least one unintentional fall a year. Fall prevention protocols and interventions can decrease the number of falls. To be effective, a prevention strategy requires a prior step to evaluate the fall risk of the subjects. Despite extensive research, existing assessment tools for fall risk have been insufficient for predicting falls.ObjectiveThe goal of this study is to present a novel web-based fall-risk assessment tool (FRAT-up) and to evaluate its accuracy in predicting falls, within a context of community-dwelling persons aged 65 and up.MethodsFRAT-up is based on the assumption that a subject’s fall risk is given by the contribution of their exposure to each of the known fall-risk factors. Many scientific studies have investigated the relationship between falls and risk factors. The majority of these studies adopted statistical approaches, usually providing quantitative information such as odds ratios. FRAT-up exploits these numerical results to compute how each single factor contributes to the overall fall risk. FRAT-up is based on a formal ontology that enlists a number of known risk factors, together with quantitative findings in terms of odds ratios. From such information, an automatic algorithm generates a rule-based probabilistic logic program, that is, a set of rules for each risk factor. The rule-based program takes the health profile of the subject (in terms of exposure to the risk factors) and computes the fall risk. A Web-based interface allows users to input health profiles and to visualize the risk assessment for the given subject. FRAT-up has been evaluated on the InCHIANTI Study dataset, a representative population-based study of older persons living in the Chianti area (Tuscany, Italy). We compared reported falls with predicted ones and computed performance indicators.ResultsThe obtained area under curve of the receiver operating characteristic was 0.642 (95% CI 0.614-0.669), while the Brier score was 0.174. The Hosmer-Lemeshow test indicated statistical significance of miscalibration.ConclusionsFRAT-up is a web-based tool for evaluating the fall risk of people aged 65 or up living in the community. Validation results of fall risks computed by FRAT-up show that its performance is comparable to externally validated state-of-the-art tools. A prototype is freely available through a web-based interface.Trial RegistrationClinicalTrials.gov NCT01331512 (The InChianti Follow-Up Study); http://clinicaltrials.gov/show/NCT01331512 (Archived by WebCite at http://www.webcitation.org/6UDrrRuaR).

Sociotechnical probabilistic risk modeling to predict injurious falls in community living centers

“…Serious falls (requiring transfer to a hospital) were associated with increasing age, being female, less restricted functional status, walking (rather than transfers), and morning hours (specifically 6-8 a.m.) [26]. The Web-based Fall-Risk Assessment Tool is an ontology that is based upon a risk assessment algorithm and probability contributions for individual risk factors [27]. Probabilities may be extrapolated from odds ratios, and rules are developed for each risk factor.…”

Technologies for fall risk assessment and conceptual design in personal health record system

“…Timed Up and Go test (TUG) assesses functional ability [17,18], and the Short Physical Performance Battery (SPPB) physical performance [19]. FRAT-up is a recently proposed predictive tool which issues the probability of falling at least once within the time span of one year [20].…”

A falls case summary: Application of the public health nursing intervention wheel

“…Case finding is essential to identify individuals at risk of falls. Screening for falls focuses on risk assessment and is undertaken using a validated screening tool, for example, fall risk assessment tool (FRAT-up) (Cattelani et al, 2015) to support a case finding process. (Stubbs, Brefka, & Denkinger, 2015).…”