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Assessing the cutoffs of four commonly used fall risk assessment tools for old Chinese community-dwellers: A
Weiqiang Li1, Yanhong Fu1, Youyou Wu1
1Department of Epidemiology and Health Statistics, Hunan Provincial Key Laboratory of Clinical Epidemiology, Xiangya School of Public Health, Central South University, Changsha, Hunan Province, China.
Introduction:
To compare predictive performances of existing cutoffs developed outside China for four commonly-used fall risk assessment tools and new cutoffs based on a Chinese sample.
Method:
A 12-month prospective study was conducted between April 2023 and June 2024 in Changsha, China. The Stay Independent Brochure Questionnaire (SIB), Fall Efficacy Scale International (FES-I), Home Falls and Accidents Screening Tool (HOME FAST), and Time Up and Go Test (TUGT) were included. New cutoffs were developed by plotting receiver operating characteristic (ROC) curves and calculating the largest Youden index. Chi-square test was used to compare predictive performances of new and old cutoffs for the same assessment tools.
Results:
The study was completed by 1,237 older adults. The new cutoffs for SIB, FES-I, HOME FAST, and TUGT in predicting falls were 3 points, 18 points, 5 points, and 10.6s, respectively, with AUC values ranging from 0.513 (95% CI: 0.485-0.542) for HOME FAST to 0.631 (95% CI: 0.604-0.658) for SIB. For predicting fall-related injuries, the new cutoffs were 3 points for SIB, 26 points for FES-I, 5 points for HOME FAST, and 11.7s for TUGT, with AUC values ranging from 0.530 (95% CI: 0.502-0.558) for HOME FAST to 0.628 (95% CI: 0.601-0.655) for SIB. Compared with the existing cutoffs, the new cutoff values for all tools generally showed significantly improved sensitivities but reduced specificities.
Conclusions:
The newly-determined cutoffs showed somewhat improved predictive performance over the existing cutoffs in sensitivity, but neither set of cutoffs achieved good predictive performance among older Chinese community-dwellers when the fall risk assessment results were used solely, without supplemental information.
Practical Applications:
Considering the poor predictive performances of the four commonly-used fall risk assessment tools with either set of cutoffs, we recommend use of the tools along with supplemental information to predict future fall risk among older adults in China.
