Departamento de Desporto e Saúde, Escola de Saúde e Desenvolvimento Humano, Universidade de Évora, Largo dos Colegiais 2, Évora, Portugal.
Comprehensive Health Research Centre (CHRC), Universidade de Évora, Largo dos Colegiais 2, Évora, Portugal.
BMC Public Health. 2021 Nov 10;21(Suppl 2):808. doi: 10.1186/s12889-021-10813-w.
Fall risk assessment in older people is of major importance for providing adequate preventive measures. Current predictive models are mainly focused on intrinsic risk factors and do not adjust for contextual exposure. The validity and utility of continuous risk scores have already been demonstrated in clinical practice in several diseases. In this study, we aimed to develop and validate an intrinsic-exposure continuous fall risk score (cFRs) for community-dwelling older people through standardized residuals.
Self-reported falls in the last year were recorded from 504 older persons (391 women: age 73.1 ± 6.5 years; 113 men: age 74.0 ± 6.1 years). Participants were categorized as occasional fallers (falls ≤1) or recurrent fallers (≥ 2 falls). The cFRs was derived for each participant by summing the standardized residuals (Z-scores) of the intrinsic fall risk factors and exposure factors. Receiver operating characteristic (ROC) analysis was used to determine the accuracy of the cFRs for identifying recurrent fallers.
The cFRs varied according to the number of reported falls; it was lowest in the group with no falls (- 1.66 ± 2.59), higher in the group with one fall (0.05 ± 3.13, p < 0.001), and highest in the group with recurrent fallers (2.82 ± 3.94, p < 0.001). The cFRs cutoff level yielding the maximal sensitivity and specificity for identifying recurrent fallers was 1.14, with an area under the ROC curve of 0.790 (95% confidence interval: 0.746-0.833; p < 0.001).
The cFRs was shown to be a valid dynamic multifactorial fall risk assessment tool for epidemiological analyses and clinical practice. Moreover, the potential for the cFRs to become a widely used approach regarding fall prevention in community-dwelling older people was demonstrated, since it involves a holistic intrinsic-exposure approach to the phenomena. Further investigation is required to validate the cFRs with other samples since it is a sample-specific tool.
老年人的跌倒风险评估对于提供充分的预防措施非常重要。目前的预测模型主要关注内在风险因素，而不调整环境暴露因素。在许多疾病的临床实践中，连续风险评分的有效性和实用性已经得到了证明。本研究旨在通过标准化残差为社区居住的老年人开发和验证内在-暴露连续跌倒风险评分（cFRs）。
从 504 名老年人（391 名女性：年龄 73.1 ± 6.5 岁；113 名男性：年龄 74.0 ± 6.1 岁）中记录了过去一年的自我报告跌倒事件。参与者被分为偶发性跌倒者（跌倒次数≤1）或复发性跌倒者（≥2 次跌倒）。为每个参与者推导 cFRs，方法是将内在跌倒风险因素和暴露因素的标准化残差（Z 分数）相加。使用接收者操作特征（ROC）分析确定 cFRs 识别复发性跌倒者的准确性。
cFRs 随报告跌倒次数而变化；无跌倒者的 cFRs 最低（-1.66 ± 2.59），有一次跌倒者的 cFRs 较高（0.05 ± 3.13，p < 0.001），有复发性跌倒者的 cFRs 最高（2.82 ± 3.94，p < 0.001）。用于识别复发性跌倒者的 cFRs 截断值为 1.14，ROC 曲线下面积为 0.790（95%置信区间：0.746-0.833；p < 0.001）。
cFRs 是一种有效的、动态的多因素跌倒风险评估工具，可用于流行病学分析和临床实践。此外，cFRs 有潜力成为社区居住老年人跌倒预防的一种广泛应用的方法，因为它涉及到对现象的整体内在-暴露方法。需要进一步的研究来验证 cFRs 在其他样本中的有效性，因为它是一种针对特定样本的工具。
