Background
Methods and results
Phase 1: developing the HFPK
Constructing items
Delphi method experts
Delphi method round 1
Delphi method round 2
Evaluation index
Extracting items
Dimension | English items | Chinese items | R | Factor | t-value |
---|---|---|---|---|---|
Physiology & disease | 1. Aging increases the risk of falls | 1.年龄的增长会增加跌倒的风险 | 0.367* | 0.556 | -4.841* |
5. Decreased balance increases the risk of falls | 5.平衡能力下降会增加跌倒的风险 | 0.392* | 0.685 | -5.618* | |
6. Reduced muscle strength in the lower extremities increases the risk of falls | 6.下肢肌力减退会增加跌倒的风险 | 0.421* | 0.667 | -5.027* | |
7. Syncope increases the risk of falls | 7.晕厥会增加跌倒的风险 | 0.315* | 0.648 | -4.266* | |
10. Epilepsy can increase the risk of falls | 10.癫痫会增加跌倒的风险 | 0.430* | 0.507 | -7.218* | |
11. Parkinson's disease can increase the risk of falls | 11.帕金森病会增加跌倒的风险 | 0.550* | 0.500 | -9.966* | |
12. Alzheimer's increases the risk of falls | 12.老年痴呆会增加跌倒的风险 | 0.499* | 0.455 | -10.097* | |
13. Stroke increases the risk of falls | 13.脑卒中会增加跌倒的风险 | 0.447* | 0.510 | -6.495* | |
14. Hypotension increases the risk of falls | 14.低血压会增加跌倒的风险 | 0.490* | 0.484 | -8.782* | |
15. Hypertension can increase the risk of falls | 15.高血压会增加跌倒的风险 | 0.533* | 0.618 | -9.872* | |
16. Arrhythmias increase the risk of falls | 16.心律失常会增加跌倒的风险 | 0.522* | 0.459 | -11.493* | |
Drug use | 20. The use of psychotropic drugs increases the risk of falls | 20.使用精神类药会增加跌倒的风险 | 0.580* | 0.566 | -15.461* |
21. The use of sedative pills increases the risk of falls | 21.使用镇静安眠类药会增加跌倒的风险 | 0.604* | 0.520 | -16.757* | |
22. The use of cardiovascular drugs increases the risk of falls | 22.使用心血管药会增加跌倒的风险 | 0.494* | 0.850 | -9.770* | |
23. The use of antiarrhythmic drugs increases the risk of falls | 23.使用抗心律失常药会增加跌倒的风险 | 0.582* | 0.850 | -11.960* | |
24. The use of antiepileptic drugs increases the risk of falls | 24.使用抗癫痫药会增加跌倒的风险 | 0.537* | 0.734 | -11.859* | |
25. Anti-dizziness drugs increase the risk of falls | 25.抗晕动病药会增加跌倒的风险 | 0.454* | 0.674 | -9.190* | |
26. The use of hypoglycemic drugs increases the risk of falls | 26.使用降糖药会增加跌倒的风险 | 0.417* | 0.597 | -7.615* | |
27. The use of central analgesics increases the risk of falls | 27.使用中枢性镇痛药会增加跌倒的风险 | 0.524* | 0.672 | -9.633* | |
Mental, cognitive & spiritual well-being | 28. Depression can increase the risk of falls | 28.抑郁症会增加跌倒的风险 | 0.592* | 0.580 | -15.497* |
29. Anxiety can increase the risk of falls | 29.焦虑症会增加跌倒的风险 | 0.637* | 0.776 | -20.653* | |
30. Mania can increase the risk of falls | 30.狂躁症会增加跌倒的风险 | 0.641* | 0.907 | -22.871* | |
31. Phobias can increase the risk of falls | 31.恐惧症会增加跌倒的风险 | 0.571* | 0.909 | -15.111* | |
32. Obsession can increase the risk of falls | 32.强迫症会增加跌倒的风险 | 0.588* | 0.776 | -17.210* | |
33. Schizophrenia increases the risk of falls | 33.精神分裂症会增加跌倒的风险 | 0.541* | 0.692 | -13.698* | |
34. Low or impaired cognition can increase the risk of falls | 34.认知低下或障碍会增加跌倒的风险 | 0.542* | 0.540 | -13.663* | |
Lifestyle & home environment | 46. Getting up frequently at night increases the risk of falls | 46.夜间频繁起夜会增加跌倒的风险 | 0.539* | 0.483 | -11.898* |
52. Cluttered indoor objects can increase the risk of falls | 52.室内物品摆放杂乱会增加跌倒的风险 | 0.463* | 0.607 | -7.977* | |
53. Lacking handrails in indoor activity venues can increase the risk of falls | 53.室内活动场所缺乏扶手会增加跌倒的风险 | 0.528* | 0.675 | -10.203* | |
54. High indoor stairs can increase the risk of falls | 54.室内楼梯阶层过高会增加跌倒的风险 | 0.556* | 0.484 | -9.320* | |
55. The lack of fall prevention signs on indoor stair steps can increase the risk of falls | 55.室内楼梯台阶缺乏防跌标识会增加跌倒的风险 | 0.529* | 0.635 | -11.457* | |
56. The turning corner of indoor stairs increases the risk of falls | 56.室内楼梯转角过大会增加跌倒的风险 | 0.515* | 0.458 | -11.091* | |
57. Lack of right-angle protectors at the edges or corners of indoor furniture can increase the risk of falls | 57.室内家具边缘或转角处缺乏直角保护器会增加跌倒的风险 | 0.573* | 0.527 | -15.747* | |
58. Uneven indoor floors can increase the risk of falls | 58.室内地面不平整会增加跌倒的风险 | 0.401* | 0.548 | -4.641* | |
59. High interior door thresholds increase the risk of falls | 59.室内门槛过高会增加跌倒的风险 | 0.509* | 0.612 | -7.884* | |
60. The height of the bed, seat, and sofa is too low or too high will increase the risk of falling | 60.床铺、座椅、沙发高度过低或过高会增加跌倒的风险 | 0.540* | 0.646 | -13.128* | |
61. Kitchen without non-slip tiles or non-slip mats will increase the risk of falls | 61.厨房未铺防滑砖或防滑垫会增加跌倒的风险 | 0.546* | 0.552 | -10.010* | |
62. Too much debris on the balcony can increase the risk of falls | 62.阳台杂物过多会增加跌倒的风险 | 0.630* | 0.621 | -15.572* | |
63. The lack of non-slip mats on the bathroom floor increases the risk of falls | 63.卫生间地面缺乏防滑垫会增加跌倒的风险 | 0.473* | 0.606 | -6.349* | |
64. Lack of handrails next to the bathroom or toilet increases the risk of falls | 64.浴室或马桶旁缺乏扶手会增加跌倒的风险 | 0.542* | 0.575 | -12.601* | |
66. Lack of seats or weak seats in the shower increases the risk of falls | 66.淋浴间缺乏座椅或座椅不牢固会增加跌倒的风险 | 0.491* | 0.625 | -10.728* | |
67. Not wearing slippers during shower increases the risk of falling | 67.淋浴时未穿防滑拖鞋会增加跌倒的风险 | 0.350* | 0.641 | -4.991* | |
68. Dry and wet toilet without separation can increase the risk of falls | 68.卫生间干湿未分离会增加跌倒的风险 | 0.500* | 0.668 | -10.046* | |
Deleted items | 2. Vision loss increases the risk of falls | 2.视力减退会增加跌倒的风险 | - | ||
3. Hearing loss can increase the risk of falls | 3.听觉减退会增加跌倒的风险 | - | |||
4. Decreased sense of touch can increase the risk of falls | 4.触觉减退会增加跌倒的风险 | - | |||
8. Pain episodes can increase the risk of falls | 8.疼痛发作会增加跌倒的风险 | - | |||
9. Poor sleep quality can increase the risk of falls | 9.睡眠质量不好会增加跌倒的风险 | - | |||
17. Osteoarthritis can increase the risk of falls | 17.骨关节炎会增加跌倒的风险 | - | |||
18. Osteoporosis can increase the risk of falls | 18.骨质疏松会增加跌倒风险 | - | |||
19. Cervical spondylosis increases the risk of falls | 19.颈椎病会增加跌倒风险 | - | |||
35. Overestimation of your condition increases the risk of falls | 35.对自身状况的高估会增加跌倒的风险 | - | |||
36. Insufficient awareness of fall risk increases the risk of falls | 36.对跌倒风险认识不足会增加跌倒的风险 | - | |||
37. Decreased responsiveness increases the risk of falls | 37.反应敏捷度下降会增加跌倒的风险 | - | |||
38. Fear of falling increases the risk of falling | 38.害怕跌倒会增加跌倒的风险 | - | |||
39. A history of falls within 6 months increases the risk of falls | 39.6个月内有跌倒史会增加跌倒的风险 | - | |||
40. Long clothes and pants can increase the risk of falls | 40.衣服裤子过长会增加跌倒的风险 | - | |||
41. Improperly sized or non-slip shoes can increase the risk of falls | 41.鞋子大小不合适或不防滑会增加跌倒的风险 | - | |||
42. Wearing too much clothing can increase the risk of falls | 42.衣物穿着过多会增加跌倒的风险 | - | |||
43. A sudden change of position increases the risk of falls | 43.突然改变体位会增加跌倒的风险 | - | |||
44. Climbing for objects can increase the risk of falling | 44.登高取物会增加跌倒的风险 | - | |||
45. Lifting heavy objects increases the risk of falling | 45.提重物会增加跌倒的风险 | - | |||
47. Exercise increases the risk of falls | 47.运动锻炼会增加跌倒的风险 | - | |||
48. Poor indoor lighting can increase the risk of falls | 48.室内光线不良会增加跌倒的风险 | - | |||
49. Poor indoor ventilation can increase the risk of falls | 49.室内通风不良会增加跌倒的风险 | - | |||
50. A slippery indoor floor increases the risk of falls | 50.室内地面湿滑会增加跌倒的风险 | - | |||
51. Small indoor spaces can increase the risk of falls | 51.室内空间狭小会增加跌倒的风险 | - | |||
65. Using a bathtub increases the risk of falls | 65.使用浴缸会增加跌倒的风险 | - |
Phase 2: testing the psychometric properties of the HFPK
Participants
Measures
Data collection
Data analysis
Results
Demographic characteristics of participants
Variable | Categories | n | % |
---|---|---|---|
Age, year | 60 ~ 69 | 182 | 48.66 |
70 ~ 79 | 128 | 34.22 | |
≥ 80 | 64 | 17.11 | |
Gender | Male | 188 | 50.27 |
Female | 186 | 49.73 | |
Education | Illiteracy | 35 | 9.36 |
Primary school | 64 | 17.11 | |
Junior high school | 81 | 21.66 | |
High school or technical secondary school | 95 | 25.40 | |
Junior college | 38 | 10.16 | |
Undergraduate and above | 61 | 16.31 | |
Marital status | Married | 348 | 93.04 |
Single | 1 | 0.27 | |
Widowed | 24 | 6.42 | |
Divorced | 1 | 0.27 | |
Monthly personal income (RMB) | < 1000 | 53 | 14.17 |
1000 ~ 2000 | 42 | 11.23 | |
2000 ~ 4000 | 131 | 35.03 | |
≥ 4000 | 148 | 39.57 | |
Number of chronic diseases | None | 154 | 41.18 |
1 | 139 | 37.17 | |
2 | 60 | 16.04 | |
≥ 3 | 21 | 5.61 | |
Self-care | cannot take care of themselves | 3 | 0.80 |
Partly self-care | 18 | 4.81 | |
Completely self-care | 353 | 94.39 | |
Children number | 0 | 3 | 0.80 |
1 | 164 | 43.85 | |
2 | 134 | 35.83 | |
≥ 3 | 73 | 19.52 | |
Whether the children live together | Live in the same city but not together | 133 | 35.56 |
do not live in the same city | 35 | 9.36 | |
living together | 206 | 55.08 | |
Primary caregiver | Spouse | 59 | 15.78 |
Nanny | 9 | 2.41 | |
Child | 25 | 6.68 | |
Self-care | 281 | 75.13 | |
Occupation before retirement | Worker | 109 | 29.14 |
farmer | 65 | 17.38 | |
teacher | 22 | 5.88 | |
civil servant | 56 | 14.97 | |
medical staff | 10 | 2.67 | |
Self-employed and others | 112 | 29.95 | |
Smoking frequency | never | 333 | 89.04 |
1–2 days a week | 6 | 1.60 | |
3–4 days a week | 7 | 1.87 | |
Almost every day | 28 | 7.49 | |
Drinking frequency | never | 302 | 80.75 |
1–2 days a week | 41 | 10.96 | |
3–4 days a week | 11 | 2.94 | |
Almost every day | 20 | 5.35 | |
Exercise frequency | never | 35 | 9.36 |
1–2 days a week | 43 | 11.50 | |
3–4 days a week | 45 | 12.03 | |
Almost every day | 251 | 67.11 |
Content validity
Construct validity
Exploratory factor analysis
Component | Eigenvalue | Explained Variance (%) | Cumulative Explained Variance (%) |
---|---|---|---|
1 | 16.588 | 24.394 | 24.394 |
2 | 4.213 | 6.196 | 30.590 |
3 | 3.100 | 4.559 | 35.149 |
4 | 2.090 | 3.074 | 38.223 |
Confirmatory factor analysis
Inspected Fit Indices | Acceptable Fit | Confirmatory Factor Analysis Fit Indices | Degree of Fit |
---|---|---|---|
χ2/df (χ2 = 1820.868, df = 854) | < 3.0 | 2.132 | Well |
SRMR | < 0.08 | 0.062 | Well |
RMSEA | < 0.08 | 0.055 | Well |
GFI | > 0.80 | 0.805 | Well |
AGFI | > 0.80 | 0.784 | General |
CFI | > 0.90 | 0.850 | General |
TLI | > 0.90 | 0.841 | General |
NFI | > 0.90 | 0.752 | General |
Phase 3: understanding HFPK among urban older adults
Measures
Data analysis
Results
Item analysis
Reliability
Descriptive statistics and multiple linear regression analysis results
Dimension | Score (‾x ± s) | Correct rate (%) |
---|---|---|
Physiology & disease (range of scores: 0 ~ 11) | 8.99 ± 2.56 | 81.77 |
Drug use (range of scores: 0 ~ 8) | 2.36 ± 2.64 | 29.51 |
Mental, cognitive & spiritual well-being (range of scores: 0 ~ 7) | 3.20 ± 2.65 | 45.76 |
Lifestyle & home environment (range of scores: 0 ~ 17) | 12.65 ± 4.41 | 74.39 |
Total score (range of scores: 0 ~ 43) | 27.21 ± 9.49 | 63.27 |
Model | R | R2 | Adjusted R2 | Standard Error of the Estimate | ANOVA | ||
F | Sig. F | ||||||
1 | 0.195 | 0.038 | 0.035 | 9.320 | 14.656 | < 0.001 | |
Model 1 | Unstandardised Coefficients | Standardised Coefficients | 95% Confidence Interval for B | ||||
B | Std. Error | Beta | t | p | Lower Bound | Upper Bound | |
(Constant) | 22.867 | 1.232 | - | 18.567 | < 0.001 | 20.445 | 25.289 |
Education | 1.209 | 0.316 | 0.195 | 3.828 | < 0.001 | 0.588 | 1.830 |
Model | R | R2 | Adjusted R2 | Standard Error of the Estimate | ANOVA | ||
F | Sig. F | ||||||
1 | 0.226a | 0.051 | 0.049 | 2.494 | 20.013 | < 0.001 | |
2 | 0.271b | 0.073 | 0.068 | 2.468 | 14.709 | < 0.001 | |
3 | 0.300c | 0.090 | 0.083 | 2.449 | 12.193 | < 0.001 | |
Model 3 | Unstandardised Coefficients | Standardised Coefficients | 95% Confidence Interval for B | ||||
B | Std. Error | Beta | t | p | Lower Bound | Upper Bound | |
(Constant) | 9.523 | 0.651 | 14.631 | < 0.001 | 8.243 | 10.802 | |
Education | 0.344 | 0.089 | 0.206 | 3.883 | < 0.001 | 0.170 | 0.518 |
Children's number | -0.520 | 0.170 | -0.159 | -3.054 | 0.002 | -0.854 | -0.185 |
Gender | -0.670 | 0.259 | -0.131 | -2.590 | 0.010 | -1.179 | -0.161 |
Model | R | R2 | Adjusted R2 | Standard Error of the Estimate | ANOVA | ||
F | Sig. F | ||||||
1 | 0.130 | 0.017 | 0.014 | 2.621 | 6.394 | 0.012 | |
Model 1 | Unstandardised Coefficients | Standardised Coefficients | 95% Confidence Interval for B | ||||
B | Std. Error | Beta | t | p | Lower Bound | Upper Bound | |
(Constant) | 1.555 | 0.346 | - | 4.488 | < 0.001 | 0.874 | 2.236 |
Education | 0.225 | 0.089 | 0.130 | 2.529 | 0.012 | 0.050 | 0.399 |
Model | R | R2 | Adjusted R2 | Standard Error of the Estimate | ANOVA | ||
F | Sig. F | ||||||
1 | 0.174 | 0.030 | 0.028 | 2.612 | 11.649 | 0.001 | |
Model 1 | Unstandardised Coefficients | Standardised Coefficients | 95% Confidence Interval for B | ||||
B | Std. Error | Beta | t | p | Lower Bound | Upper Bound | |
(Constant) | 2.948 | 0.154 | - | 19.087 | < 0.001 | 2.644 | 3.251 |
Occupation before retirement | 1.087 | 0.318 | 0.174 | 3.413 | 0.001 | 0.461 | 1.713 |
Model | R | R2 | Adjusted R2 | Standard Error of the Estimate | ANOVA | ||
F | Sig. F | ||||||
1 | 0.157 | 0.024 | 0.022 | 4.357 | 9.341 | 0.002 | |
Model 1 | Unstandardised Coefficients | Standardised Coefficients | 95% Confidence Interval for B | ||||
B | Std. Error | Beta | t | p | Lower Bound | Upper Bound | |
(Constant) | 10.655 | 0.690 | - | 15.447 | < 0.001 | 9.298 | 12.011 |
Monthly personal income | 0.664 | 0.217 | 0.157 | 3.056 | 0.002 | 0.237 | 1.091 |