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Two-Item Fall Screening Tool Identifies Older Adults at Increased Risk of Falling after Emergency Department Visit
Journal article   Open access   Peer reviewed

Two-Item Fall Screening Tool Identifies Older Adults at Increased Risk of Falling after Emergency Department Visit

Christopher J Solie, Morgan B Swanson, Kari Harland, Christopher Blum, Kevin Kin and Nicholas Mohr
The western journal of emergency medicine, Vol.21(5), pp.1275-1282
08/20/2020
DOI: 10.5811/westjem.2020.5.46991
PMCID: PMC7514384
PMID: 32970586
url
https://doi.org/10.5811/westjem.2020.5.46991View
Published (Version of record) Open Access

Abstract

Few emergency department (ED)-specific fall-risk screening tools exist. The goals of this study were to externally validate Tiedemann et al's two-item, ED-specific fall screening tool and test handgrip strength to determine their ability to predict future falls. We hypothesized that both the two-item fall screening and handgrip strength would identify older adults at increased risk of falling. A convenience sample of patients ages 65 and older presenting to a single-center academic ED were enrolled. Patients were asked screening questions and had their handgrip strength measured during their ED visit. Patients were given one point if they answered "yes" to "Are you taking six or more medications?" and two points for answering "yes" to "Have you had two or more falls in the past year?" to give a cumulative score from 0 to 3. Participants had monthly follow- ups, via postcard questionnaires, for six months after their ED visit. We performed sensitivity and specificity analyses, and used likelihood ratios and frequencies to assess the relationship between risk factors and falls, fall-related injury, and death. In this study, 247 participants were enrolled with 143 participants completing follow-up (58%). During the six-month follow-up period, 34% of participants had at least one fall and 30 patients died (12.1%). Fall rates for individual Tiedemann scores were 14.3%, 33.3%, 60.0% and 72.2% for scores of 0,1, 2 and 3, respectively. Low handgrip strength was associated with a higher proportion of falls (46.3%), but had poor sensitivity (52.1%). Handgrip strength was not sensitive in screening older adults for future falls. The Tiedemann rule differentiated older adults who were at high risk for future falls from low risk individuals, and can be considered by EDs wanting to screen older adults for future fall risk.
 Accidental Falls - prevention & control Aged Aged, 80 and over Emergency Service, Hospital - organization & administration Female Hand Strength Humans Male Mass Screening - methods Mass Screening - standards Predictive Value of Tests Risk Assessment - methods Risk Factors Surveys and Questionnaires

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