How predictive is a home-safety checklist of indoor fall risk for the elderly living in the community?

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Abstract
Objectives: Development and evaluation of a homesafety checklist of indoor fall risk for the elderly living in the community. Methods: A checklist of indoor fall risk was developed in a Delphi procedure as part of a baseline assessment of fall risk. Based on the number of falls in the previous year, the 1238 responders to a postal questionnaire on occurrence, risk factors, and consequences of falls in community-living elderly of 70 years or over were divided into three groups: non fallers, one-time fallers and recurrent fallers (≥2 falls). Out of each group, 130 subjects were randomly selected and stratified on age and gender (n=392), 311 of whom (79%) were available for participation in a prospective study: a baseline assessment including home-safety assessment of indoor fall risk, and a subsequent 36-week follow-up procedure with telephone calls every six weeks. Outcome variables were indoor falls and the number of subjects with indoor falls during follow-up. Prevalences of potential risk factors were determined. In addition, associations between potential risk factors for indoor falls and indoor falls during follow-up were calculated by bivariate analysis. Results: Follow-up was completed by 293 subjects and data from 287 subjects were available for analysis. During follow-up, 198 falls were reported by 96 participants (32%). Two persons had a hip fracture (1%) and four had other fractures (2%). A total of 135 indoor falls were reported by 63 (21%) and 63 outdoor falls by 45 persons (15%). Potential risk factors for indoor falls belong equally to structural (immobile) and non-structural (immobile) risk factors. Stairs, bedrooms and bathrooms are the locations of the dwelling in which most potential risk factors are situated, but do not correspond with locations in which indoor falls actually occur. In bivariate analyses, high scores on the checklist do not have a predictive value for indoor falls with an exception for indoor falls in the entrance. Conclusions: A checklist on indoor fall risk is useful in the identification of potential risk factors for indoor falls, but does not have a predictive value for indoor falls in the community-dwelling elderly with an exception for indoor falls in the entrance.