Comparing Sensitivity, Specificity, and Accuracy of Fall Risk Assessments in Community-Dwelling Older Adults

IF 3.6 3区医学

Clinical Interventions in Aging Pub Date : 2024-03-27 DOI:10.2147/cia.s453966

Kworweinski Lafontant, Amber Blount, Jethro Raphael M Suarez, David H Fukuda, Jeffrey R Stout, Evette M Trahan, Nichole R Lighthall, Joon-Hyuk Park, Rui Xie, Ladda Thiamwong

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Abstract

Purpose: The US Centers for Disease Control and Prevention (CDC) has implemented the Stopping Elderly Accidents, Deaths, and Injuries (STEADI) initiative. This initiative provides an algorithm for fall risk screening. However, the algorithm has the potential to overcategorize individuals as high risk for falling upon initial screening, which may burden clinicians with the task of recategorizing individuals after follow-up testing. Therefore, this study aimed to compare the accuracy, sensitivity, and specificity of fall risk appraisal between the STEADI, Short Fall-Efficacy Scale International (FES-I), and portable balance system (BTrackS) assessments in community-dwelling older adults.
Patients and Methods: This cross-sectional analysis included 122 community-dwelling older adults, comprising 94 women and 28 men. Center-of-pressure postural sway was assessed using the BTrackS, fear of falling was assessed using the Short FES-I questionnaire, and all participants completed the STEADI checklist. Each assessment categorized participants as either high or low fall risk and fall risk appraisal was compared between groups using McNemar tests.
Results: The STEADI checklist (high risk: n = 62; low risk: n = 60) significantly differed in fall risk appraisal compared to the BTrackS (high risk: n = 44; low risk: n = 78; p = 0.014) and the Short FES-I (high risk: n = 42; low risk: n = 80; p = 0.002). Compared to the BTrackS, the STEADI checklist had a specificity of 62.8%, sensitivity of 70.5%, and accuracy of 65.6%. Compared to the Short FES-I, the STEADI checklist had a specificity of 67.5%, sensitivity of 81.0%, and accuracy of 72.1%.
Conclusion: The STEADI checklist appears to overcategorize individuals as high fall risk more frequently than direct assessments of postural sway and fear of falling. Further research is needed to examine potential improvements in accuracy when combining the STEADI checklist with direct assessments of postural sway and/or fear of falling.

Plain Language Summary: Fall risk assessments are crucial for preventative care in older adults. However, the demands of clinical practice require an accurate and time-efficient method. The U.S Centers for Disease Control and Prevention (CDC) has implemented a fall risk checklist through the Stopping Elderly Accidents, Deaths, and Injuries (STEADI) initiative. However, the STEADI checklist might cost clinicians more time than expected, as some patients initially classified as high risk for falling may not actually be at high risk. This leads to unnecessary follow-up assessments. In this study, we compared the STEADI checklist to direct measures of postural sway (balance) using the BTrackS system and fear of falling using the Short FES-I survey to determine how they differed in classifying community-dwelling older adults as high versus low fall risk. Our results show that the STEADI checklist classifies older adults as high risk more frequently than the BTrackS and Short FES-I. Considering that the follow-up assessments for a high-risk classification by the STEADI checklist include a balance test, we suggest that combining a balance test such as the BTrackS with a questionnaire or checklist may yield better screening outcomes and accurately identify high-risk individuals in a timely manner. Further research is needed to determine the effectiveness of this combination and to establish a true gold standard method for fall risk appraisal.

Keywords: balance, postural sway, fall efficacy, clinical practice

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比较社区老年人跌倒风险评估的敏感性、特异性和准确性

目的：美国疾病控制和预防中心（CDC）实施了 "制止老年人事故、死亡和伤害（STEADI）"计划。该计划为跌倒风险筛查提供了一种算法。然而，该算法有可能在初次筛查时将个人过度归类为跌倒高风险人群，这可能会加重临床医生在后续测试后对个人进行重新分类的负担。因此，本研究旨在比较 STEADI、国际跌倒效能短量表（FES-I）和便携式平衡系统（BTrackS）评估对社区老年人跌倒风险评估的准确性、灵敏度和特异性：这项横断面分析包括 122 名居住在社区的老年人，其中有 94 名女性和 28 名男性。使用 BTrackS 对压力中心姿势摇摆进行评估，使用简短 FES-I 问卷对跌倒恐惧进行评估，所有参与者都填写了 STEADI 核对表。每项评估都将参与者划分为跌倒风险高或低的组别，并通过 McNemar 检验对不同组别之间的跌倒风险评估进行比较：与 BTrackS（高风险：n = 44；低风险：n = 78；p = 0.014）和 Short FES-I（高风险：n = 42；低风险：n = 80；p = 0.002）相比，STEADI 检查表（高风险：n = 62；低风险：n = 60）在跌倒风险评估方面存在显著差异。与 BTrackS 相比，STEADI 核对表的特异性为 62.8%，敏感性为 70.5%，准确性为 65.6%。与 Short FES-I 相比，STEADI 检查表的特异性为 67.5%，敏感性为 81.0%，准确性为 72.1%：结论：与直接评估姿势摇摆和跌倒恐惧相比，STEADI 检查表似乎更经常地将人过度归类为高跌倒风险。将 STEADI 核对表与体位摇摆和/或跌倒恐惧的直接评估相结合，可能会提高准确性，这还需要进一步研究：跌倒风险评估对于老年人的预防保健至关重要。然而，临床实践的要求需要一种准确、省时的方法。美国疾病控制和预防中心（CDC）通过 "制止老年人意外事故、死亡和伤害（STEADI）"计划实施了跌倒风险检查表。然而，STEADI 检查表可能会花费临床医生比预期更多的时间，因为一些最初被归类为跌倒高风险的患者实际上可能并不高危。这就导致了不必要的后续评估。在这项研究中，我们将 STEADI 核对表与使用 BTrackS 系统的姿势摇摆（平衡）直接测量法和使用 Short FES-I 调查的跌倒恐惧测量法进行了比较，以确定它们在将社区居住的老年人划分为高跌倒风险和低跌倒风险时有何不同。我们的结果表明，STEADI 检查表比 BTrackS 和 Short FES-I 更容易将老年人归类为高风险人群。考虑到 STEADI 核对表对高风险分类的后续评估包括平衡测试，我们建议将 BTrackS 等平衡测试与问卷或核对表相结合，可能会产生更好的筛查结果，并及时准确地识别出高风险人群。要确定这种组合的有效性，并为跌倒风险评估建立真正的金标准方法，还需要进一步的研究。关键词：平衡、姿势摇摆、跌倒疗效、临床实践

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来源期刊

Clinical Interventions in Aging GERIATRICS & GERONTOLOGY-

CiteScore

6.20

自引率

2.80%

发文量

193

期刊介绍： Clinical Interventions in Aging, is an online, peer reviewed, open access journal focusing on concise rapid reporting of original research and reviews in aging. Special attention will be given to papers reporting on actual or potential clinical applications leading to improved prevention or treatment of disease or a greater understanding of pathological processes that result from maladaptive changes in the body associated with aging. This journal is directed at a wide array of scientists, engineers, pharmacists, pharmacologists and clinical specialists wishing to maintain an up to date knowledge of this exciting and emerging field.