Objective: To determine if self-reported data recalling at least one fall over a sixmonth recall period could be used as a reliable measure of falls by comparing retrospective self-report with a ‘gold standard' method of reporting these events using a prospective calendar-reported method.
Design: Prospective study.
Setting: Community-dwelling older people living in New South Wales (NSW) and Queensland in Australia.
Subjects: A stratified sample of 264 randomly selected participants from a concurrent randomized controlled trial (RCT) of preventive health assessment for people over the age of 70 years.
Interventions: Intervention and control group participants in the RCT kept a calendar of fall events for a six-month validation substudy. At the end of six months, participants were asked to retrospectively report their falls over the six-month period.
Main results: Results indicated that percentage agreement between retrospective self-report and the calendar report of falls was 84%, however, sensitivity was 56% (95% confidence interval (CI) 44.1−67.5). Ten participants (4%) gave false positive self-reports of falls, and 33 (13%) participants gave false negative self-reports of falls. Therefore, retrospective self-reported fall rates were likely to involve under-reporting of falls. Significant differences were found in the sensitivity of retrospectively selfreported falls reported by the intervention group participants (sensitivity=71%; 95% CI 56.6−85.5) compared with the control group (sensitivity=40.5%; 95% CI 24.7−56.4, P =0.008). Validity of self-reported injuries as a result of a fall was less accurate (71% agreement; sensitivity 24% (95% CI 16.0−33.6).
Conclusions: As recall of falls was more accurate in the intervention group than in the control group, it could appear that the intervention had the effect of increasing falls compared to the control group. Using these results, a method was devised to weight self-reported retrospective data to compensate for the poorer recall demonstrated in the control group, so that a more accurate estimate of falls could be derived from the self-reported data.
Get full access to this article
View all access options for this article.
References
1.
1 Cumming R, Kelsey J, Nevitt M. Methodologic issues in the study of frequent and recurrent health problems: Falls in the elderly. Ann Epidemiol1990; 1:49–56.
2.
2 Cumming R. Intervention strategies and risk-factor modification for falls prevention: A review of recent intervention studies. Top Geriatr Med2002; 18: 175–189.
3.
3 Streiner D, Norman G. Health measurement scales – a practical guide to their development and use. Oxford University Press, 1991.
4.
4 Means D. Autobiographical memory for health-related events. In Means D, ed. Vital health statistics. National Center for Health Statistics, 1989: 20–21.
5.
5 Fabacher D, Josephson K, Pietruszka F et al. An in-home preventative assessment program for independent older adults: A randomized controlled trial. J Am Geriatr Soc1994; 42: 630–638.
6.
6 Plautz B, Beck D, Selmar C et al. Modifying the environment: a community based injury reduction program for elderly residents. Am J Prevent Med1996; 12:33–38.
7.
7 Hornbrook M, Stevens V, Wingfield D et al. Preventing falls among community-dwelling older persons: results from a randomized trial. The Gerontologist1994; 34:6–23.
8.
8 Campbell A, Robertson C, Gardner M et al. Randomised controlled trial of a general practice programme of home based exercise to prevent falls in elderly women. BMJ1997; 315: 1065–1069.
9.
9 Close J, Ellis M, Hooper R et al. Prevention of falls in the elderly trial (PROFET): a randomised controlled trial. Lancet1999; 353:93–97.
10.
10 Cumming R, Thomas M, Szongi G et al. Home visits by an occupational therapist for assessment and modification of environmental hazards: a randomized trial of falls prevention. J Am Geriatr Soc1999; 47: 1397–1402.
11.
11 Peel N, Cartwright C, Steinberg M. Monitoring slips, trips and falls in the older community: preliminary results. Health Promot J Aust1998; 8: 148–150.
12.
12 Koski K, Luukinen H, Laippala P et al. Risk factors for major injurious falls among home-dwelling elderly by functional abilities. Gerontology1998; 44: 232–238.
13.
13 Province M, Hadley E, Hornbrook M et al. The effects of exercise on falls in elderly patients. A preplanned meta-analysis of the FICSIT trials. JAMA1995; 273: 1341–1347.
14.
14 van Schoor N, Smit J, Pluijm S et al. Different cognitive functions in relation to falls among older persons immediate memory as an independent risk factor for falls. J Clin Epidemiol2002; 55: 855–862.
15.
15 Stel V, Smit J, Pluijm S et al. Balance and mobility performance as treatable risk factors for recurrent falling in older persons. J Clin Epidemiol2003; 56: 659–668.
16.
16 Cumming R, Klineberg R. Fall frequency and characteristics and the risk of hip fractures. JAm Geriatr Soc1994; 42: 774–778.
17.
17 Reinsch S, MacRae P, Lachenbruch P et al. Attempts to prevent falls and injury: A prospective community study. The Gerontologist1992; 32: 450–456.
18.
18 Means K, Rodell D, O'Sullivan P et al. Rehabilitation of elderly fallers: pilot study of a low to moderate intensity exercise program. Arch Phys Med Rehabil1996; 77: 1030–1036.
19.
19 Centre for Clinical Epidemiology and Biostatistics. Preventive care trial establishment report June 1997. Centre for Clinical Epidemiology and Biostatistics, University of Newcastle, 1997.
20.
20 Byles J, Tavener M, Nair B et al. A randomized controlled trial of health assessments for older Australian veterans and war widows. Med J Aust2004; 181: 186–190.
21.
21 Freedman L, Parmar M, Baker S. The design of observer agreement studies with binary assessments. Stat Med1993; 12: 165–179.
22.
22 Fletcher R, Fletcher S, Wagner E. Clinical epidemiology – the essentials. Williams & Wilkins, 1988.
23.
23 Rothman K, Greenland S. Modern epidemiology. Lippincott-Raven, 1998.
24.
24 Kelsey J, Thompson W, Evans A. Methods in observational epidemiology. Oxford University Press, 1986.
25.
25 Boyle C, Dobson A. Morbidity from cardiovascular disease in Australia. Australian Institute of Health and Welfare, 1995.
26.
26 Cummings S, Nevitt M, Kidd S. Forgetting falls – the limited accuracy of recall of falls in the elderly. J Am Geriatr Soc1988; 36: 613-613.
27.
27 Peel N. Validating recall of falls by older people. Accident Analysis Prev2000; 32: 371–372.
28.
28 Lachenbruch P, Reinsch S, MacRae P et al. Adjusting for recall bias with the proportional hazards model. Methods Inf Med1991; 30: 108–110.
29.
29 Nevitt M. Ascertainment and description of falls among older persons by self-report. In Weindruch R, Hadley E, Ory, M eds. Reducing frailty and falls in older persons. Charles C Thomas, 1991.
