Objective: This study identifies fall risk factors in an understudied population of older people who receive community-based care services. Method: Data were collected from enrollees of Ohio’s Medicaid home- and community-based waiver program (preadmission screening system providing options and resources today [PASSPORT]). A total of 23,182 participants receiving PASSPORT services in 2005/2006 was classified as fallers and nonfallers, and a variety of risk factors for falling was analyzed using logistic regressions. Results: The following factors were identified as risk factors for falling: previous fall history, older age, White race, incontinence, higher number of medications, fewer numbers of activity of daily living limitations, unsteady gait, tremor, grasping strength, and absence of supervision. Discussion: Identifying risk factors for the participants of a Medicaid home- and community-based waiver program are useful for a fall risk assessment, but it would be most helpful if the community-based care service programs incorporate measurements of known fall risk factors into their regular data collection, if not already included.
Ahmed, N., Mandel, R., & Fain, M.J. ( 2007). Frailty: An emerging geriatric syndrome. American Journal of Medicine, 120, 748-753.
2.
American Association of Retired Persons. ( 1992). Understanding senior housing for the 1990s. Washington, DC: Author.
3.
Baker, S.P. ( 1992). The injury fact book. New York, NY : Oxford University Press.
4.
Barrett-Connor, E., Weiss, T., McHorney, C., Miller, P., & Siris, E. ( 2009). Predictors of falls among postmenopausal women: Results from the National Osteoporosis Risk Assessment (NORA). Osteoporosis International, 20, 715-722.
5.
Baxter, P., & Markle-Reid, M. (2009). An interprofessional team approach to fall prevention for older home care clients "at risk" of falling: Health care providers share their experiences. International Journal of Integrated Care , 9, 1-12.
6.
Berg, W.P., Alessio, H.M., Mills, E.M., & Tong, C. ( 1997). Circumstances and consequences of falls in independent community-dwelling older adults. Age and Ageing, 26, 261-268.
7.
Bleijlevens, M., Diederiks, J., Hendriks, M., van Haastregt, J., Crebolder, H., & van Eijk, J. ( 2010). Relationship between location and activity in injurious falls: An exploratory study. BMC Geriatrics, 10(10), 1-9.
8.
Bohannon, R. ( 2001). Dynamometer measurements of hand-grip strength predict multiple outcomes. Perceptual and Motor Skills, 93, 323-328.
9.
Brown, J.S., Vittinghoff, E., Wyman, J.F., Stone, K.L., Nevitt, M.C., Ensrud, K., & Grady, D. ( 2000). Urinary incontinence: Does it increase risk for falls and fractures? Study of Osteoporotic Fractures Research Group. Journal of the American Geriatrics Society, 48, 721-725.
10.
Campbell, A., & Robertson, M. ( 2007). Rethinking individual and community fall prevention strategies: A meta-regression comparing single and multifactorial interventions. Age and Ageing, 36, 656-662.
11.
Clemson, L., Mackenzie, L., Ballinger, C., Close, J.C.T., & Cumming, R.G. ( 2008). Environmental interventions to prevent falls in community-dwelling older people: A meta-analysis of randomized trials. Journal of Aging and Health, 20, 954-971.
12.
DeMaris, A. ( 2004). Regression with social data: Modeling continuous and limited response variables. Hoboken, NJ: Wiley-Interscience.
13.
Dunn, J.E., Furner, S.E., & Miles, T.P. ( 1993). Do falls predict institutionalization in older persons?: An analysis of data from the longitudinal study of aging. Journal of Aging and Health, 5, 194-207.
Filiatrault, J., Parisien, M., Laforest, S., Genest, C., Gauvin, L., Fournier, M., . . . Robitaille, Y. (2007). Implementing a community-based falls-prevention program: From drawing board to reality. Canadian Journal on Aging, 26, 213-225.
16.
Flacker, J.M. ( 2003). What is a geriatric syndrome anyway? Geriatrics, 51, 574-576.
17.
Gardner, M.M., Buchner, D.M., Robertson, M.C., & Campbell, A.J. (2001). Practical implementation of an exercise-based falls prevention programme. Age and Ageing , 30, 77-83.
18.
Gilliland, F., Mahler, R., & Davis, S. ( 1998). Health-related quality of life for rural American Indians in New Mexico. Ethnicity & health, 3, 223-229.
19.
Haines, T.P., Hill, K., Walsh, W., & Osborne, R. ( 2007). Design-related bias in hospital fall risk screening tool predictive accuracy evaluations: Systematic review and meta-analysis. Journals of Gerontology Series A: Biological Sciences and Medical Sciences , 62, 664-672.
20.
Haines, T.P., Kuys, S., Morrison, G., Clarke, J., & Bew, P. ( 2009). Cost-effectiveness analysis of screening for risk of in-hospital falls using physiotherapist clinical judgement. Medical Care, 47, 448-456.
21.
Hausdorff, J.M., Rios, D.A., & Edelberg, H.K. (2001). Gait variability and fall risk in community-living older adults: A 1-year prospective study. Archives of Physical Medicine and Rehabilitation, 82, 1050-1056.
22.
Hosmer, D.W., & Lemeshow, S. ( 2004). Applied logistic regression. New York, NY: Wiley-Interscience.
23.
Iinattiniemi, S., Jokelainen, J., & Luukinen, H. ( 2009). Falls risk among a very old home-dwelling population . Scandinavian Journal of Primary Health Care, 27, 25-30.
24.
Inouye, S.K., Studenski, S., Tinetti, M.E., & Kuchel, G.A. ( 2007). Geriatric syndromes: Clinical, research and policy implications of a core geriatric concept. Journal of the American Geriatrics Society, 55, 780-791.
25.
Kannus, P., Parkkari, J., Koskinen, S., Niemi, S., Palvanen, M., Järvinen, M., & Vuori, I. ( 1999). Fall-induced injuries and deaths among older adults. Journal of the American Medical Association, 281, 1895-1899.
26.
Kannus, P., Sieven, H., Palvanen, M., Javinen, T., & Parkkari, J. ( 2005). Prevention of falls and consequent injuries in elderly people. Lancet, 366, 1885-1893.
27.
Laforest, S., Pelletier, A., Gauvin, L., Robitaille, Y., Fournier, M., Corriveau, H., & Filiatrault, J. (2009). Impact of a community-based falls prevention program on maintenance of physical activity among older adults . Journal of Aging and Health, 21, 480-500.
28.
La Grow, S.J., Robertson, M.C., Campbell, A.J., Clarke, G.A., & Kerse, N.M. ( 2006). Reducing hazard related falls in people 75 years and older with significant visual impairment: How did a successful program work?Injury Prevention, 12, 296-301.
29.
Leung, A., Chi, I., Lou, V., & Chan, K. ( 2010). Psychosocial risk factors associated with falls among Chinese community-dwelling older adults in Hong Kong. Health & Social Care in the Community, 18, 272-281.
30.
Lord, S.R., & Fitzpatrick, R.C. (2001). Choice stepping reaction time: A composite measure of falls risk in older people. Journals of Gerontology Series A: Biological Sciences and Medical Sciences , 56, 627-632.
31.
Lord, S.R., Menz, H.B., & Tiedemann, A. ( 2003). A physiological profile approach to falls risk assessment and prevention. Physical Therapy, 83, 237-252.
32.
Mann, W.C. ( 2005). A comparison of fallers and non-fallers in the frail elderly. Technology and Disability, 17, 25-32.
33.
Markle-Reid, M., Browne, G., Gafni, A., Roberts, J., Weir, R., Thabane, L., . . . Henderson, S. ( 2010a). A cross-sectional study of the prevalence, correlates, and costs of falls in older home care clients "at risk" for falling. Canadian Journal on Aging/Revue canadienne du vieillissement, 29, 119-137.
34.
Markle-Reid, M., Browne, G., Gafni, A., Roberts, J., Weir, R., Thabane, L., . . . Henderson, S. ( 2010b). The effects and costs of a multifactorial and interdisciplinary team approach to falls prevention for older home care clients "at risk" for falling: A randomized controlled trial. Canadian Journal on Aging/Revue canadienne du vieillissement, 29, 139-161.
Mehdizadeh, S., Nelson, I.M., & Thieman, L. ( 2007). Do PASSPORT consumers meet eligibility requirements for participation in the Medicaid home and community-based waiver program?Oxford, OH: Scripps Gerontology Center.
37.
Nevitt, M.C., Cummings, S.R., Kidd, S., & Black, D. ( 1989). Risk factors for recurrent nonsyncopal falls. A prospective study. Journal of the American Medical Association, 261, 2663-2668.
38.
Nordin, E., Lindelof, N., Rosendahl, E., Jensen, J., & Lundin-olsson, L. (2008). Prognostic validity of the Timed Up-and-Go Test, a modified Get-Up-and-Go Test, staff’s global judgement and fall history in evaluating fall risk in residential care facilities . Age and Ageing, 37, 442-448.
39.
Oliver, D., Connelly, J.B., Victor, C.R., Shaw, F.E., Whitehead, A., Genc, Y., . . . Gosney, M.A. ( 2007). Strategies to prevent falls and fractures in hospitals and care homes and effect of cognitive impairment: Systematic review and meta-analyses . British Medical Journal, 334, 82.
40.
Perell, K., Nelson, A., Goldman, R., Luther, S., Prieto-Lewis, N., & Rubenstein, L. (2001). Fall risk assessment measures: An analytic review. Journals of Gerontology Series A: Biological and Medical Sciences, 56, 761-766.
41.
Petridou, E., Manti, E., Ntinapogias, A., Negri, E., & Szczerbińska, K. (2009). What works better for community-dwelling older people at risk to fall?Journal of Aging and Health, 21, 713-729.
42.
Pillemer, K., Czaja, S., Schulz, R., & Stahl, S.M. ( 2003). Finding the best ways to help: Opportunities and challenges of intervention research on aging. Gerontologist, 43(Suppl. 1), 5-8.
43.
Pluijm, S.M., Smit, J.H., Tromp, E.A., Stel, V.S., Deeg, D.J., Bouter, L.M., & Lips, P. ( 2006). A risk profile for identifying community-dwelling elderly with a high risk of recurrent falling: Results of a 3-year prospective study . Osteoporosis International, 17, 417-425.
44.
Rizzo, J.A., Friedkin, R., Williams, C.S., Nabors, J., Acampora, D., & Tinetti, M.E. ( 1998). Health care utilization and costs in a Medicare population by fall status. Medical Care, 36, 1174-1188.
45.
Robitaille, Y., Laforest, S., Fournier, M., Gauvin, L., Parisien, M., Corriveau, H., . . . Damestoy, N. ( 2005). Moving forward in fall prevention: An intervention to improve balance among older adults in real-world settings. American Journal of Public Health, 95, 2049-2056.
46.
Rubenstein, L.Z. ( 2006). Falls in older people: Epidemiology, risk factors and strategies for prevention. Age and Ageing, 35(2), ii37-ii41.
47.
Rubenstein, L.Z., & Josephson, K.R. (2002). Risk factors for falls: A central role in prevention. Generations, 26(4), 15-21.
48.
Russell, M.A., Hill, K.D., Blackberry, I., Day, L.M., & Dharmage, S.C. (2008). The reliability and predictive accuracy of the falls risk for older people in the community assessment (FROP-Com) tool. Age and Ageing, 37, 634-639.
49.
Ryan, A., McCann, S., & McKenna, H. ( 2009). Impact of community care in enabling older people with complex needs to remain at home. International Journal of Older People Nursing, 4, 22-32.
50.
SAS Institute. (2002). SAS software 9.1.3 of the SAS system for the Windows [Computer software]. Cary, NC: Author.
51.
Shumway-Cook, A., Brauer, S., & Woollacott, M. (2000). Predicting the probability for falls in community-dwelling older adults using the Timed Up & Go Test . Physical Therapy, 80, 896-903.
52.
Shumway-Cook, A., Ciol, M.A., Hoffman, J., Dudgeon, B.J., Yorkston, K., & Chan, L. ( 2009). Falls in the medicare population: Incidence, associated factors, and impact on health care. Physical Therapy, 89, 324-332.
53.
Steinman, B.A., Pynoos, J., & Nguyen, A. Q. D. (2009). Fall risk in older adults: Roles of self-rated vision, home modifications, and limb function. Journal of Aging and Health, 21, 655-676.
54.
Stevens, J.A., Corso, P.S., Finkelstein, E.A., & Miller, T.R. ( 2006). The costs of fatal and non-fatal falls among older adults . Injury Prevention, 12, 290-295.
55.
Stevens, J., Mack, K., Paulozzi, L., & Ballesteros, M. (2008). Self-reported falls and fall-related injuries among persons aged ≥65 years-United States, 2006 . Journal of Safety Research, 39, 345-349.
56.
Stolee, P., Poss, J., Cook, R.J., Byrne, K., & Hirdes, J.P. ( 2009). Fall-related hip fractures. Journal of Gerontology Series A: Biological Sciences and Medical Sciences, 64A, 1199.
57.
Swets, J.A. ( 1988). Measuring the accuracy of diagnostic systems. Science, 240, 1285-1293.
58.
Tinetti, M.E., Inouye, S.K., Gill, T.M., & Doucette, J.T. (1995). Shared risk factors for falls, incontinence, and functional dependence. Unifying the approach to geriatric syndromes. Journal of the American Medical Assocaition, 273, 1348-1353.
59.
Todd, C., & Skelton, D. ( 2004). What are the main risk factors for falls among older people and what are the most effective interventions to prevent these falls?Copenhagen, Denmark: WHO Regional Office for Europe.
60.
Tromp, A.M., Pluijm, S.M.F., Smit, J.H., Deeg, D.J.H., Bouter, L.M., & Lips, P. ( 2001). Fall-risk screening test: A prospective study on predictors for falls in community-dwelling elderly. Journal of clinical epidemiology, 54, 837-844.
61.
Wallace, C., Reiber, G.E., LeMaster, J., Smith, D.G., Sullivan, K., Hayes, S., & Vath, C. ( 2002). Incidence of falls, risk factors for falls, and fall-related fractures in individuals with diabetes and a prior foot ulcer. Diabetes Care, 25, 1983-1986.
