Predictive validity of three home fall hazard assessment tools for older adults in Thailand

Abstract

This study aimed to examine the predictive validity of two internationally well-known instruments, the Modified Home Falls and Accidents Screening Tool (Modified HOME FAST) and the Modified Home Falls and Accidents Screening Tool-Self Report (Modified HOME FAST-SR), and the newly developed Thai Home Falls Hazard Assessment Tool (Thai-HFHAT) (69 items) in predicting falls among older Thai adults. It also aimed to examine the predictive validity of the two abbreviated versions (44 and 27 items) of the Thai-HFHAT, which were developed post hoc to accommodate older adults’ limited literacy and poor vision and to facilitate the identification of high-impact home fall hazards that are prevalent in the Thailand context. A prospective cohort study was conducted among 450 participants aged 60 years and above who were assessed by the aforementioned tools at baseline, for which data on fall incidence were then collected during the one-year follow-up. The Cox proportional hazard model was applied to estimate hazard ratios (HRs); then, Harrell’s C-statistics and receiver operating characteristic (ROC) analyses were conducted to identify the best cutoff point, sensitivity and specificity for each instrument. The results showed that the fall hazard rate was 2.04 times per 1,000 person-days. Taking into account both the predictive validity and applicability, the Thai-HFHAT (44 items) was found to be the most suitable screening tool due to its highest sensitivity and specificity (93% and 72%) at the cutoff score of 18. In conclusion, our study showed that these internationally validated home fall hazard assessment tools were quite applicable for Thailand, but further tailoring the tools into a specific local context yielded even more highly valid tools in predicting fall risk among older Thai adults. Although these findings were well reproducible by inferring from the internal validation results, further external validation in the independent population is necessary.

Reliability of the 44-question Home Fall Hazard Assessment Tool and personal characteristics associated with home hazards among the Thai elderly

“…11 There was a report of psychometric properties of 44-question Thai-HFHAT as the adjusted hazards ratio (HR) was 1.26 (95% CI: 1.20-1.33), a cut-off was 18 points, the sensitivity and specificity were 0.93 and 0.72, and the area under the receiver operating characteristic curve (AuROC) was 0.90. 12 In addition, the study also found that the 44-question Thai-HFHAT requires only 30 minutes for elderly users to complete all the questions. Occasionally, due to the inability to answer all the elders' questions in practice, the remaining questions were answered by a caregiver or a village health volunteer for the elders.…”

“…The inter-rater reliability of the 44-question version was higher than the Modified HOME FAST-SR (Thai version) (ICC = 0.64). 12 This is probably because the Thai-HFHAT was designed to have questions listed in an organized manner with drawings to help illustrate each room in a house, allowing subjects to identify home hazards at ease. However, the text in the HOME FAST-SR may have been confusing.…”

Construction of the Short-Form Thai-Home Fall Hazard Assessment Tool (Thai-HFHAT-SF) and Testing Its Validity and Reliability in the Elderly

“…It has been designed in such a way that the elderly can fill it out with or without help from Thai village health volunteers (VHV). The ICC of inter-rater reliability and test-retest reliability for the Thai-HFHAT was 0.87 (95% CI: 0.78-0.93) and 0.78 (95% CI: 0.58-0.89), respectively [9]. The cutoff point of the Thai-HFHAT was 18, which predicted the risk of falls due to home hazards in the elderly.…”

“…The survey method examined the achievement of fall risk screening data of 450 elderly [9] who were recruited to participate and fulfill the sample size conducted in phase I. Because the suitable samples were from 200 or more, the study used a confirmatory factor analysis (CFA) [10].…”

Stroke Rehabilitation for Falls and Risk of Falls in Southeast Asia: A Scoping Review With Stakeholders' Consultation

“…Thus, there is a need to select and validate a high-quality self-reporting screening tool to assess home hazards that can be utilized for the stroke population and their caregivers. The use of home hazards instruments sensitive to cultural settings may capture more valuable and meaningful hazards (168,169). With home hazards, healthcare professionals should focus on clutter, assistive devices (i.e., mobility aids, shoe), and the functional aspects of the person-environment fit, and in particular, attention should be given to the bathroom and stairs area as these were also found to be related to falls (170,171).…”