The Risk of Falling in the Elderly

Abstract

Accidental injury resulting from falling is the leading cause of death in the elderly population. In fact, 11 % of the nation's annual injury deaths occur in this age group. A significant number of accidental deaths occur in resident institutions. A short-term risk index was constructed and validated for the purpose of predicting the risk of a fall in an elderly institutionalized population. The risk index was developed from expert insights, using Bayesian inference. A group of experts identified major risk factors that influence the chance of a fall and provided estimates of the impacts of the identified risk factors. Identification of risk factors, elicitation of experts' insights, construction of the subjective risk index, and validation of the index are discussed. Key words: Bayesian inference; risk index; falling; elderly. (Med Decis Making 1990;10:195-200)

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References

Albarede JL , Lemieux A. , Vellas B. , Groulx B. Psychological factors in falls in elderly patients. Can J Psychiat. 1989;34(2):94-6.

Jaeger R. Falls prevention and management in the institutional setting. Clin Geriatr Med. 1988;4:3:613-22.

Tideiksaar R. Geriatric falls: assessing the cause, preventing recurrence. Geriatrics. 1989;44:7:57-64.

Tinetti ME Instability and falling in elderly patients. Semin Neurol . 1989;9:1:39-45.

Alemi F. , Gustafson DL , Johnson M. How to construct a subjective index. Eval Health Prof. 1986;9:1:42-52.

Gustafson DL , Kestley JJ Griest JH , Jenson N. Initial evaluation of a subjective Bayesian diagnostic system. Health Serv Res J. 1983 ;6:204-10.

Hogarth RM Cognitive processes and the assessment of subjective probability distributions . J Am Stat Assoc. 1975;70:271-89.

Slovic P. , Lichenstein S. Comparison of Bayesian and regression approach to the study of information processing in judgment. Org Behav Human Perf. 1971;6:6-11.

Gustafson DL , Shukla RK , Walster GW A comparative study of differences in subjective likelihood estimates made by individual, interacting groups and nominal groups . Org Behav Human Perf. 1973;9:280-91.

10.

Lichtenstein S. , Fischoff B. , Phillips LD Calibration of probabilities : the state of the art. In: Jungerman, Zeeuw, eds. Decision making and change in human affairs. Dordrecht, Netherlands, Reidel Publishing, 1977;123-31.

11.

Adams J. , Adams P. Realism of confidence judgments. Psychol Rev. 1961;68:33-45.

12.

Pitz G. Subjective probability distributions for imperfecting known quantitiesIn: Gregg LW, ed. Knowledge and cognition. New York , John Wiley and Sons, 1974;201-10.

13.

Murphy AH , Winkler RL

Probability forecasters: a survey of national weather service forecasters

Bull Meterol Soc. 1974;55:1449-53.

14.

Fleiss JL Statistical methods for rates and proportions. New York , John Wiley and Sons, 1974;88-97.

15.

McClish DK Analyzing a portion of the ROC curve. Med Decis Making. 1989;9:190-5.

16.

Erdreich LS , Lee ET Use of relative operating characteristic analysis in epidemiology: a method for dealing with subjective judgments. Am J Epidemiol. 1981;114:649-61.

17.

Beck JR , Schultz EK The use of relative operating characteristic (ROC) curves in test performance evaluation. Arch Pathol Lab Med. 1986;110:13-20.

18.

Swets JA ROC analysis applied to the evaluation of medical imaging techniques. Invest Radiol. 1979;14:109-21.

19.

Swets JA Indices of discrimination or diagnostic accuracy. Their ROC curves and implied models. Psychol Bull. 1986;6:100-17.

20.

McNeil BJ , Hanley JA Statistical approaches to the analysis of receiver operating characteristic (ROC) curves. Med Decis Making. 1984;4:137-50.

21.

McNeil BJ , Keeler E. , Adelstein SJ Primer in certain elements of medical decision making. N Engl J Med. 1975;293:216-21.

22.

Weinstein MC , Fineberg HV , Elstein AS, et al. Clinical decision analysis. Philadelphia, W. B. Saunders, 1980.

23.

Campbell AJ , Borrie MJ , Spears GF Risk factors for falls in a community-based prospective study of people 70 years and older. J Gerontol . 1989;44(4):112-7.

24.

Tinetti ME , Speechley M. , Ginter SF Risk factors for falls among elderly persons living in the community. N Engl J Med. 1988;319:26:1701-7.