Background
Methods
Step 1: Searching the literature for risk factors for falling
Step 2: First consultation of experts: suitability of factors
Step 3: Final selection of risk factors
Step 4: Second consultation of experts: practical use of the tool
Results
Searching the literature for risk factors for falling
high age [13,14,16,17,32,37] female gender [14,32,44] weight (e.g. low BMI) [38] previous falls [13-17,19,26-29,33-35,38,44,51] dependency in activities of daily life [14,17,19,26,31,35-38,51] acute disease(s) [2,38] chronic disease(s) [43] neurological diseases [19,32,44] cardiopathy (e.g. heart failure) [20,42,44,45] hart rate (e.g. arrhythmia) [2] high blood pressure [2,26] orthostatic hypotension [12,19] medication (e.g. psychotropic, sedative, neuroleptic, antidepressive) [13,15,16,17,19,21,23,26-29,32,34,35,38,44,45,51] polypharmacy [32,35] alcohol abuse [37] pain [2] dizziness [19,37] diabetes mellitus [13] | urine incontinence [38,41] cognitive problems [13,19,35,40,45,51] confusion [30,42,44,45] depression [33] fear of falling [34] behavioural problems [15,17] disturbed vision [20,38,39,42,44] hearing problems [42,44] independency of transfers [14,16] disturbed balance [13,14,17,19-22] bad quality of co-ordination [6,38] mobility impairments [13,14,17-29,32,33,35-37,39,41,44,51] muscle weakness [20] arthrosis [32] gait disorders [2,26-29,50] wandering [14] foot defects [35] inappropriate footwear [46] environmental factors [2,6,26,33,47-49,51] assistive devices [14,30,31] protective devices [2,47] |
First consultation of experts: suitability of factors
Final selection of risk factors
Risk factors for falls | 1 | 2 | 3 | 4 | 5 | 6 | All |
---|---|---|---|---|---|---|---|
Previous falls | + | + | + | + | + | + | + |
Chronic disease(s) | + | - | +/- | +/- | +/- | - | - |
Medication | + | + | + | + | + | + | + |
Disturbed vision | + | + | +/- | +/- | +/- | + | - |
Independency of transfers | + | + | + | + | + | + | + |
Disturbed balance | + | + | + | + | + | + | + |
Bad quality of co-ordination | + | + | + | + | + | - | - |
Mobility impairments | + | + | + | + | + | + | + |
Muscle weakness | + | + | + | + | + | + | + |
Foot defects | + | + | + | + | + | - | - |
Assistive devices | + | + | + | + | + | + | + |
Protective devices | + | + | + | + | + | + | + |
Second consultation of experts: practical use of the tool
WHAT? | HOW? | WHO? | WHEN? |
---|---|---|---|
Previous falls | data from GP (hetero) anamnesis fall registration [52] | nursing home physician nurses/carers | |
Medication | medication list | nursing home physician | At admission After a fall incident At request ward Periodical repetition (2 × per year) |
Locomotor functions | Barthel index [30] Tinetti (POMA) [55] | nurses/carers occupational therapist physiotherapist | |
Assistive and protective devices | Check-list concerning - choice - use | nurses/carers occupational therapist physiotherapist |