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Development and Validation of the ReTos Scale as a Support Tool for Fall Risk Assessment in a Large Sample of Older
Laura Rasero1, Paolo Iovino1, Angela Brandi2
1Department of Health Sciences, University of Florence, Florence, Italy.
Evaluation & the Health Professions
|August 11, 2026
Summary
The ReTos scale effectively identifies older inpatients at risk of falls, showing good reliability. While its discriminative performance is modest, it serves as a valuable adjunct to clinical judgment for fall prevention strategies.
Area of Science:
- Gerontology
- Clinical Nursing
- Health Services Research
Background:
- Falls are a significant risk for older inpatients, leading to adverse outcomes.
- Accurate identification of high-risk individuals is crucial for effective fall prevention.
- Existing fall risk assessment tools require validation and refinement for diverse clinical settings.
Purpose of the Study:
- To develop and evaluate the validity and reliability of the ReTos (Regione Toscana) scale for fall risk identification in older inpatients.
- To assess the psychometric properties of the ReTos scale, including content validity, dimensionality, internal consistency, and criterion-related validity.
- To determine the discriminative performance of the ReTos scale in predicting falls among hospitalized older adults.
Main Methods:
- A large-scale study involving 15,159 inpatients aged ≥65 years across 41 Italian hospitals with a six-month follow-up.
- Development of scale items through literature review and expert consensus, followed by content validity assessment.
- Exploratory factor analysis (EFA) for dimensionality, McDonald's Omega for internal consistency, and logistic regression with ROC curve analysis for criterion-related validity.
Main Results:
- EFA refined the ReTos scale to 11 items across five factors: motor disorders, mental state, diseases/medications, anamnesis, and sensory impairment.
- The scale demonstrated acceptable internal consistency (Ω = 0.79) and satisfactory psychometric properties.
- Modest discriminative performance was observed (AUC = 0.62), with sensitivity 0.70 and specificity 0.52 at a cut-off ≥7, indicating its utility as a supplementary tool.
Conclusions:
- The ReTos scale exhibits satisfactory psychometric properties for identifying fall risk in older inpatients.
- Its modest discriminative performance suggests it should be used as an adjunct to clinical judgment, not as a standalone assessment.
- The ReTos scale can contribute to targeted fall prevention interventions in geriatric care settings.
