The development of the fall risk assessment tool in the institutionalized elderly

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The purpose of this three-year research project was to develop the fall risk assessment tool in the institutionalized elderly. In the first year, we reviewed research articles dealing with risk factors of falls in the elderly. We measured the isometric maximal knee-extension strength of the institutionalized elderly every year using a hand-held dynamometer, ultrasound bone densitometry of calcaneus, and postural sways. Then, we compared these data with community-residing elderly. In the second year, we surveyed nurses who encountered falls in the nursing home and extended care facility and asked if the nurse predicted the fall of the patient and risk factors identified by the nurse. The result of the qualitative study was integrated in the assessment tool. In addition, we analyzed elderly who had fallen. In the last year, we conducted a prospective study to evaluate the assessment tool in the eleven institutions. The paper and pencil tool consisted of eight elements including, mobility, vision, cognitive function, nurses' prediction to predict falls, trigger events, etc.The sensitivity of the tool was 68.2%, and the specificity was 74.0% using the cutoff point of 5 excluding trigger events. The highest relative risk of falls was nurses' prediction (RR : 6.5), followed by the history of falls (RR : 5.6), the assistance of elimination (RR : 3.0), and lowed cognitive function (RR : 2.6). The results are consistent with previous studies, the assessment tool was effective in identifying high risk elderly.