Cargando…

The use and predictive performance of the Peninsula Health Falls Risk Assessment Tool (PH-FRAT) in 25 residential aged care facilities: a retrospective cohort study using routinely collected data

BACKGROUND: The Peninsula Health Falls Risk Assessment Tool (PH-FRAT) is a validated and widely applied tool in residential aged care facilities (RACFs) in Australia. However, research regarding its use and predictive performance is limited. This study aimed to determine the use and performance of P...

Descripción completa

Detalles Bibliográficos
Autores principales: Wabe, Nasir, Siette, Joyce, Seaman, Karla L., Nguyen, Amy D., Raban, Magdalena Z., Close, Jacqueline C. T., Lord, Stephen R., Westbrook, Johanna I.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8973529/
https://www.ncbi.nlm.nih.gov/pubmed/35365078
http://dx.doi.org/10.1186/s12877-022-02973-0
_version_ 1784680057516589056
author Wabe, Nasir
Siette, Joyce
Seaman, Karla L.
Nguyen, Amy D.
Raban, Magdalena Z.
Close, Jacqueline C. T.
Lord, Stephen R.
Westbrook, Johanna I.
author_facet Wabe, Nasir
Siette, Joyce
Seaman, Karla L.
Nguyen, Amy D.
Raban, Magdalena Z.
Close, Jacqueline C. T.
Lord, Stephen R.
Westbrook, Johanna I.
author_sort Wabe, Nasir
collection PubMed
description BACKGROUND: The Peninsula Health Falls Risk Assessment Tool (PH-FRAT) is a validated and widely applied tool in residential aged care facilities (RACFs) in Australia. However, research regarding its use and predictive performance is limited. This study aimed to determine the use and performance of PH-FRAT in predicting falls in RACF residents. METHODS: A retrospective cohort study using routinely-collected data from 25 RACFs in metropolitan Sydney, Australia from Jul 2014-Dec 2019. A total of 5888 residents aged ≥65 years who were assessed at least once using the PH-FRAT were included in the study. The PH-FRAT risk score ranges from 5 to 20 with a score > 14 indicating fallers and ≤ 14 non-fallers. The predictive performance of PH-FRAT was determined using metrics including area under receiver operating characteristics curve (AUROC), sensitivity, specificity, sensitivity(Event Rate(ER)) and specificity(ER). RESULTS: A total of 27,696 falls were reported over 3,689,561 resident days (a crude incident rate of 7.5 falls /1000 resident days). A total of 38,931 PH-FRAT assessments were conducted with a median of 4 assessments per resident, a median of 43.8 days between assessments, and an overall median fall risk score of 14. Residents with multiple assessments had increased risk scores over time. The baseline PH-FRAT demonstrated a low AUROC of 0.57, sensitivity of 26.0% (sensitivity(ER) 33.6%) and specificity of 88.8% (specificity(ER) 82.0%). The follow-up PH-FRAT assessments increased sensitivity(ER) values although the specificity(ER) decreased. The performance of PH-FRAT improved using a lower risk score cut-off of 10 with AUROC of 0.61, sensitivity of 67.5% (sensitivity(ER) 74.4%) and specificity of 55.2% (specificity(ER) 45.6%). CONCLUSIONS: Although PH-FRAT is frequently used in RACFs, it demonstrated poor predictive performance raising concerns about its value. Introducing a lower PH-FRAT cut-off score of 10 marginally enhanced its predictive performance. Future research should focus on understanding the feasibility and accuracy of dynamic fall risk predictive tools, which may serve to better identify residents at risk of falls. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12877-022-02973-0.
format Online
Article
Text
id pubmed-8973529
institution National Center for Biotechnology Information
language English
publishDate 2022
publisher BioMed Central
record_format MEDLINE/PubMed
spelling pubmed-89735292022-04-02 The use and predictive performance of the Peninsula Health Falls Risk Assessment Tool (PH-FRAT) in 25 residential aged care facilities: a retrospective cohort study using routinely collected data Wabe, Nasir Siette, Joyce Seaman, Karla L. Nguyen, Amy D. Raban, Magdalena Z. Close, Jacqueline C. T. Lord, Stephen R. Westbrook, Johanna I. BMC Geriatr Research BACKGROUND: The Peninsula Health Falls Risk Assessment Tool (PH-FRAT) is a validated and widely applied tool in residential aged care facilities (RACFs) in Australia. However, research regarding its use and predictive performance is limited. This study aimed to determine the use and performance of PH-FRAT in predicting falls in RACF residents. METHODS: A retrospective cohort study using routinely-collected data from 25 RACFs in metropolitan Sydney, Australia from Jul 2014-Dec 2019. A total of 5888 residents aged ≥65 years who were assessed at least once using the PH-FRAT were included in the study. The PH-FRAT risk score ranges from 5 to 20 with a score > 14 indicating fallers and ≤ 14 non-fallers. The predictive performance of PH-FRAT was determined using metrics including area under receiver operating characteristics curve (AUROC), sensitivity, specificity, sensitivity(Event Rate(ER)) and specificity(ER). RESULTS: A total of 27,696 falls were reported over 3,689,561 resident days (a crude incident rate of 7.5 falls /1000 resident days). A total of 38,931 PH-FRAT assessments were conducted with a median of 4 assessments per resident, a median of 43.8 days between assessments, and an overall median fall risk score of 14. Residents with multiple assessments had increased risk scores over time. The baseline PH-FRAT demonstrated a low AUROC of 0.57, sensitivity of 26.0% (sensitivity(ER) 33.6%) and specificity of 88.8% (specificity(ER) 82.0%). The follow-up PH-FRAT assessments increased sensitivity(ER) values although the specificity(ER) decreased. The performance of PH-FRAT improved using a lower risk score cut-off of 10 with AUROC of 0.61, sensitivity of 67.5% (sensitivity(ER) 74.4%) and specificity of 55.2% (specificity(ER) 45.6%). CONCLUSIONS: Although PH-FRAT is frequently used in RACFs, it demonstrated poor predictive performance raising concerns about its value. Introducing a lower PH-FRAT cut-off score of 10 marginally enhanced its predictive performance. Future research should focus on understanding the feasibility and accuracy of dynamic fall risk predictive tools, which may serve to better identify residents at risk of falls. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12877-022-02973-0. BioMed Central 2022-04-01 /pmc/articles/PMC8973529/ /pubmed/35365078 http://dx.doi.org/10.1186/s12877-022-02973-0 Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Wabe, Nasir
Siette, Joyce
Seaman, Karla L.
Nguyen, Amy D.
Raban, Magdalena Z.
Close, Jacqueline C. T.
Lord, Stephen R.
Westbrook, Johanna I.
The use and predictive performance of the Peninsula Health Falls Risk Assessment Tool (PH-FRAT) in 25 residential aged care facilities: a retrospective cohort study using routinely collected data
title The use and predictive performance of the Peninsula Health Falls Risk Assessment Tool (PH-FRAT) in 25 residential aged care facilities: a retrospective cohort study using routinely collected data
title_full The use and predictive performance of the Peninsula Health Falls Risk Assessment Tool (PH-FRAT) in 25 residential aged care facilities: a retrospective cohort study using routinely collected data
title_fullStr The use and predictive performance of the Peninsula Health Falls Risk Assessment Tool (PH-FRAT) in 25 residential aged care facilities: a retrospective cohort study using routinely collected data
title_full_unstemmed The use and predictive performance of the Peninsula Health Falls Risk Assessment Tool (PH-FRAT) in 25 residential aged care facilities: a retrospective cohort study using routinely collected data
title_short The use and predictive performance of the Peninsula Health Falls Risk Assessment Tool (PH-FRAT) in 25 residential aged care facilities: a retrospective cohort study using routinely collected data
title_sort use and predictive performance of the peninsula health falls risk assessment tool (ph-frat) in 25 residential aged care facilities: a retrospective cohort study using routinely collected data
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8973529/
https://www.ncbi.nlm.nih.gov/pubmed/35365078
http://dx.doi.org/10.1186/s12877-022-02973-0
work_keys_str_mv AT wabenasir theuseandpredictiveperformanceofthepeninsulahealthfallsriskassessmenttoolphfratin25residentialagedcarefacilitiesaretrospectivecohortstudyusingroutinelycollecteddata
AT siettejoyce theuseandpredictiveperformanceofthepeninsulahealthfallsriskassessmenttoolphfratin25residentialagedcarefacilitiesaretrospectivecohortstudyusingroutinelycollecteddata
AT seamankarlal theuseandpredictiveperformanceofthepeninsulahealthfallsriskassessmenttoolphfratin25residentialagedcarefacilitiesaretrospectivecohortstudyusingroutinelycollecteddata
AT nguyenamyd theuseandpredictiveperformanceofthepeninsulahealthfallsriskassessmenttoolphfratin25residentialagedcarefacilitiesaretrospectivecohortstudyusingroutinelycollecteddata
AT rabanmagdalenaz theuseandpredictiveperformanceofthepeninsulahealthfallsriskassessmenttoolphfratin25residentialagedcarefacilitiesaretrospectivecohortstudyusingroutinelycollecteddata
AT closejacquelinect theuseandpredictiveperformanceofthepeninsulahealthfallsriskassessmenttoolphfratin25residentialagedcarefacilitiesaretrospectivecohortstudyusingroutinelycollecteddata
AT lordstephenr theuseandpredictiveperformanceofthepeninsulahealthfallsriskassessmenttoolphfratin25residentialagedcarefacilitiesaretrospectivecohortstudyusingroutinelycollecteddata
AT westbrookjohannai theuseandpredictiveperformanceofthepeninsulahealthfallsriskassessmenttoolphfratin25residentialagedcarefacilitiesaretrospectivecohortstudyusingroutinelycollecteddata
AT wabenasir useandpredictiveperformanceofthepeninsulahealthfallsriskassessmenttoolphfratin25residentialagedcarefacilitiesaretrospectivecohortstudyusingroutinelycollecteddata
AT siettejoyce useandpredictiveperformanceofthepeninsulahealthfallsriskassessmenttoolphfratin25residentialagedcarefacilitiesaretrospectivecohortstudyusingroutinelycollecteddata
AT seamankarlal useandpredictiveperformanceofthepeninsulahealthfallsriskassessmenttoolphfratin25residentialagedcarefacilitiesaretrospectivecohortstudyusingroutinelycollecteddata
AT nguyenamyd useandpredictiveperformanceofthepeninsulahealthfallsriskassessmenttoolphfratin25residentialagedcarefacilitiesaretrospectivecohortstudyusingroutinelycollecteddata
AT rabanmagdalenaz useandpredictiveperformanceofthepeninsulahealthfallsriskassessmenttoolphfratin25residentialagedcarefacilitiesaretrospectivecohortstudyusingroutinelycollecteddata
AT closejacquelinect useandpredictiveperformanceofthepeninsulahealthfallsriskassessmenttoolphfratin25residentialagedcarefacilitiesaretrospectivecohortstudyusingroutinelycollecteddata
AT lordstephenr useandpredictiveperformanceofthepeninsulahealthfallsriskassessmenttoolphfratin25residentialagedcarefacilitiesaretrospectivecohortstudyusingroutinelycollecteddata
AT westbrookjohannai useandpredictiveperformanceofthepeninsulahealthfallsriskassessmenttoolphfratin25residentialagedcarefacilitiesaretrospectivecohortstudyusingroutinelycollecteddata