Objective: To assess the predictive validity of the Elderly Mobility Scale (EMS), Functional Reach (FR) and the Barthel Index (BI) in identifying recurrent fallers following discharge from a geriatric day hospital (GDH).
Subjects: Seventy-six GDH patients with identified mobility problems.
Methods: Each patient was assessed by an independent physiotherapist before and after a programme of physiotherapy using the EMS, FR and BI and a ‘falls follow-up’ assessment was performed after four months.
Results: Fifty-four per cent (29 out of 54) of patients had reduced mobility at follow-up. Twenty-five per cent (18 out of 71) of patients had two or more falls post discharge. Using logistic regression analysis for EMS, FR and BI at discharge, each of these variables individually was significantly associated with the risk of having two or more falls (p = 0.008, 0.017 and 0.031 respectively). A prognostic tree was developed for GDH patients identifying high-risk and low-risk groups.
Conclusion: EMS, FR and BI were all significantly associated with GDH patients with mobility problems having two or more falls. A prognostic tree identified high and low-risk groups of GDH patients and should now be tested prospectively. Introduction
Get full access to this article
View all access options for this article.
References
1.
Prudham D, Evans JG. Factors associated with falls in the elderly: a community study. Age Ageing1981; 10: 141–146.
2.
Campbell AJ, Reinken J, Allan BC, Martinez GS. Falls in old age: a study of frequency and related clinical factors. Age Ageing1981; 10: 264–270.
3.
Nevitt MC. Falls in older persons: risk factors and prevention. In: Berg RL, Cassells JS, eds. The second fifty years: promoting health and preventing disability. Washington, DC: National Academy Press, 1990: 263–290.
4.
Tinetti ME, Speechley M, Ginter SF. Risk factors for falls among elderly persons living in the community. N Engl J Med1988; 319: 1701–1707.
5.
Nevitt MC, Cummings SR, Kidd S, Black D. Risk factors for recurrent nonsyncopal falls: a prospective study. JAMA1989; 261: 2663–2668.
6.
Scottish Health Statistics 1997. Information and Statistics Division, Common Services Agency, Scotland.
7.
Scottish Needs Assessment Programme: Hip Fracture. Glasgow: Scottish Forum for Public Health Medicine, 1997.
8.
Folstein MF, Folstein SE, McHugh PR. ‘Mini Mental State’: a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res1975; 12: 189–198.
9.
Tinetti ME, Doucette J, Claus E, Marottoli R. Risk factors for serious injury during falls by older persons in the community. J Am Geriatr Soc1995; 43: 1214–1221.
10.
Smith R. Validation and reliability of the Elderly Mobility Scale. Physiotherapy1994; 80: 744–747.
11.
Spilg EG, Mitchell S, Martin BJ, Aitchison TC. A comparison of mobility assessments in a geriatric day hospital. Clin Rehabil2001; 15: 296–300.
12.
Prosser L, Canby A. Further validation of the elderly mobility scale for measurement of mobility of hospitalized elderly people. Clin Rehabil1997; 11: 338–343.
13.
Holden MK, Gill KM, Magliozzi MR, Nathan J, Piehl-Baker L. Clinical gait assessment in the neurologically impaired: reliability and meaningfulness. Phys Ther1984; 64: 35–40.
14.
Mahoney FI, Barthel DW. Functional evaluation: the Barthel Index. Md State Med J1965; 14: 61–65.
15.
Royal College of Physicians and British Geriatrics Society. Standardised assessment scales for elderly people. London: RCP and BGS, 1992.
16.
Duncan PW, Weiner DK, Chandler J, Studenski S. Functional Reach: a new clinical measure of balance. J Gerontol1990; 45: M192–M97.
17.
Duncan PW, Studenski S, Chandler J, Prescott B. Functional Reach: predictive validity in a sample of elderly male veterans. J Gerontol1992; 47: M93–M98.
18.
Hodkinson HM. Evaluation of a mental test score for the assessment of mental impairment in the elderly. Age Ageing1972; 1: 233–238.
19.
Breiman L, Friedman JH, Olshen RA, Stone CJ. Classification and regression trees. Belmont, CA: Wadsworth International, 1984.
