Einschätzung der Sturzgefährdung gebrechlicher, noch selbstständig lebender, älterer Menschen

Abstract

Mobility is one of the most important factors for well-being and autonomy in old age. Impairments in mobility, falls and fear of falling are, therefore, of prognostic value. Falls generally result from an interaction of multiple risk factors. However, older people are often not aware of the risks of falling. They neither recognize risk factors nor report these factors to their physicians. The aim of this study was to develop and to test a self-reported multidimensional screening instrument to evaluate risk factors of falling in community-dwelling older people. Therefore, we identified multiple risk factors of falls based on a systematic literature review and then developed a new questionnaire - the Senior Citizen Risk of Falling Check. Risk factors, i.e. cognitive disorders, that are closely associated with the demand of nursing care were not covered in this relatively healthy target group. We pretested this instrument and adapted it before its use in a pilot test in residents of a sheltered housing complex in Hamburg. A group of 117 residents (average age 82.9 years, range 68.2-98.2 years, 83.8% women), all without care needs (assessed by the German health and care insurance system) returned the Senior Citizen Risk of Falling Check. Within 2 weeks all 117 participants were interviewed by telephone to analyze the test-retest reliability of the instrument (Cohen's kappa). We administered 13 questions on visual and hearing deficits, neurological impairment, depressive mood, medication use, muscle weakness, gait and balance deficits, nutrition, and history of falls. On average, 6 risk factors were reported (range 0-12). Reductions in gait speed (64.1%) was most frequently mentioned. Of the participants, 30.8% fell at least once during the last year and 22.2% of these falls resulted in injuries (fractures, hematomas, laceration, pain). Cohen's kappa was good (2/13 questions) to excellent (10/13 questions) with one exception (balance question kappa=0.20). The study results confirm good test-retest reliability of the fall risk screening Senior Citizen Risk of Falling Check. At the moment we are working on the validation of this questionnaire to provide it to senior citizens throughout Hamburg in cooperation with the City of Hamburg.

Development and Evaluation of an Online Fall-Risk Questionnaire for Nonfrail Community-Dwelling Elderly Persons: A Pilot Study

“…We only assessed falls during six months; a longer follow-up would have increased the number of falls. The frequency of problems reported in the individual fall-risk questions was very low if compared to other studies on self-report fall-risk questionnaires [ 15 , 17 ]. This could be due to the good health state of our participants but it could also be due to how the questions were formulated (i.e., unclear wording or wording targets only serious problems).…”

“…Based on seven existing questionnaires for the self-assessment of fall-risk [ 13 – 17 , 44 , 45 ], we devised a set of questions that covered most of the fall-risks found in the previous step (review of reviews). The questions were written in German and translated into French and submitted to seven health professionals and two laypersons with the question about the understandability.…”

“…Current self-administered predictions tools do not cover all dimensions of fall-risk, such as dual tasks, medication, diseases like diabetes, pain, stroke, rheumatic disease, fear of falling, the frequency of toileting, gait problems, balance, muscle weakness, sensibility impairments, or hearing problems [ 13 – 17 ] (see also Table 1 for a comprehensive overview of existing tools).…”

Beweglich?

“…Anders et al 2006) erkannter und messbarer Sturzgefährdung oder zunehmender Gebrechlichkeit (»frailty«) sollten individuell angepasste Maßnahmen der Sekundär-oder Tertiärprävention erhalten ⊡ Abb. Noch selbstständig lebende Personen mit frühzeitig mittels eines Screenings (z.…”