Retrospective evaluation of the world falls guidelines-algorithm in older adults

Abstract

Background: The World Falls Guidelines (WFG) propose an algorithm that classifies patients as low-, intermediate-, and high-risk. We evaluated different operationalizations of the WFG algorithm and compared its predictive performance to other screening tools for falls, namely: the American Geriatrics Society and British Geriatrics Society (AGS/BGS) algorithm, the 3KQ on their own and fall history on its own.

Methods: We included data from 1509 adults aged ≥65 years from the population-based Longitudinal Aging Study Amsterdam. The outcome was ≥1 fall during 1-year follow-up, which was ascertained using fall calendars. The screening tools' items were retrospectively operationalized using baseline measures, using proxies where necessary.

Results: Sensitivity ranged between 30.9-48.0% and specificity ranged between 77.0-88.2%. Operationalizing the algorithm with the 3KQ instead of fall history yielded a higher sensitivity but lower specificity, whereas operationalization with the Clinical Frailty Scale (CFS) classification tree instead of Fried's frailty criteria did not affect predictive performance. Compared to the WFG algorithm, the AGS/BGS algorithm and fall history on its own yielded similar predictive performance, whereas the 3KQ on their own yielded a higher sensitivity but lower specificity.

Conclusion: The WFG algorithm can identify patients at risk of a fall, especially when the 3KQ are included in its operationalization. The CFS and Fried's frailty criteria may be used interchangeably in the algorithm's operationalization. The algorithm performed similarly compared to other screening tools, except for the 3KQ on their own, which have higher sensitivity but lower specificity and lack clinical recommendations per risk category.

Keywords: falls; older people; prediction; screening; stratification.

Figure 2

Operationalization of the American Geriatrics Society and British Geriatrics Society algorithm. LASA = Longitudinal Aging Study Amsterdam. Unless stated otherwise, proportions are calculated based on the number of participants with complete data in the preceding step. Proportions are provided as valid percentages, meaning missing data were not included in their calculations. A total of 13 participants (0.9%) could not be classified due to incomplete data.

Figure 1

Operationalization of the World Falls Guidelines algorithm using Three Key Questions and Fried’s frailty criteria. LASA = Longitudinal Aging Study Amsterdam. Unless stated otherwise, proportions are calculated based on the number of participants with complete data in the preceding step. Proportions are provided as valid percentages, meaning missing data were not included in their calculations. A total of 66 participants (4.4%) could not be classified due to incomplete data.