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Volume 45 Number 8, 2008
   Pages 1105 — 1116

Abstract - Systematic review of accuracy of screening instruments for predicting fall risk among independently living older adults

Simon Gates, PhD;1* Lesley A. Smith, PhD;2 Joanne D. Fisher, PhD;3 Sarah E. Lamb, DPhil1,4

1Warwick Medical School Clinical Trials Unit, University of Warwick, Coventry, UK; 2Oxford Brookes University, School of Health and Social Care, Oxford, UK; 3Warwick Medical School, Gibbet Hill Campus, University of Warwick, Coventry, UK; 4Kadoorie Critical Care Research Centre, University of Oxford, Oxford, UK

Abstract — The objective of this study was to summarize the evidence on the accuracy of screening tools for predicting falling risk in community-living older adults. This study was designed as a systematic review. Prospective studies of clinical fall risk prediction tools that provided data on the number of participants who sustained falls during follow-up were included. We searched six electronic databases and reference lists of studies and review articles. Data were extracted by two reviewers independently, and methodological quality assessment was performed with a modified version of the Quality Assessment of Diagnostic Accuracy Studies checklist. Twenty-five studies were included. These studies evaluated 29 different screening tools, but only 6 of the tools were evaluated by more than one study. Methodological quality was variable, and many studies were small. No meta-analyses were performed because of heterogeneity. Most tools discriminated poorly between fallers and nonfallers. We found that existing studies are methodologically variable and the results are inconsistent. Insufficient evidence exists that any screening instrument is adequate for predicting falls.

Key words: accidental falls, assessment tool, clinical screening, fall risk, older adults, rehabilitation, risk assessment, screening, sensitivity, specificity, systematic review.

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