Design and validation of the PRECAHI Scale to assess risk of falls in patientes over 65 years old
DOI:
https://doi.org/10.60108/ce.129Keywords:
hyponatremia; accidental falls; aged; safety management; risk assessmentAbstract
Falls mainly affect people over the age of 65 and, in hospitalized patients, are one of the most common side effects. Currently, the evidence describes the low sensitivity and specificity of the instruments used to measure the risk of falls. Hyponatremia has been recognized as a risk factor associated with falls that, however, is not included in the scales.
Aim. Validate the instrument PRECAHI Scale to identify the risk of falls in hospitalized patients over the age of 65.
Material and methods. This study consists of two phases: instrument design (Phase I) and clinimetric validation (Phase II). The study population in Phase II were patients over 65 years admitted to hospitalization units with higher incidence of falls. The risk of patient falls was assessed with the Downton and Stratify scales and with the new scale designed.
Data analysis. Descriptive analysis depending on the nature of the variables: bivariate for the study of the differences between scales and, for sensitivity and specificity, ROC curves.
Results. 322 patients with a mean age 81.6(7.73) and equal gender distribution participated. The performance assessment shows a sensitivity of 78.26%, higher than the Downton and Stratify scales. As for the specificity found, 29.64%, is higher than the Downton Scale and lower than the Stratify scale.
Conclusion. The PRECAHI Scale instrument has been validated, with a sensitivity higher than that provided by the Downton and Stratify scales and an specificity is greater than that obtained by the Downton scale. However, it is necessary to confirm its validity in surgical and critical care environments, and to re-evaluate its properties.
References
OMS (Organización Mundial de la Salud). Caídas [Internet]. 2018 [cited 2019 Aug 20]. Available from: https://www.who.int/es/news-room/fact-sheets/detail/falls
World Health Organization. Profundidad de la 6a edición: Prevención de caídas en entornos de pacientes internos y externos | Únete a la Comisión Internacional [Internet]. [cited 2020 Feb 3]. Available from: https://www.jointcommissioninternational.org/standards/hospital-standards-communication-center/6th-edition-in-depth-preventing-falls-in-inpatient-and-outpatient-settings/
WHO. World Patient Safety Day 2019 [Internet]. World Patient Safety Day. 2019 [cited 2020 Jan 13]. Available from: https://www.who.int/campaigns/world-patient-safety-day/2019
Lee SE, Vincent C, Dahinten VS, Scott LD, Park CG, Dunn Lopez K. Effects of Individual Nurse and Hospital Characteristics on Patient Adverse Events and Quality of Care: A Multilevel Analysis. J Nurs Scholarsh. 2018;50(4):432–40.
Quintar E, Giber F. Las caídas en el adulto mayor: factores de riesgo y consecuencias. Vol. 10, Actual. Osteol. 2014.
Olvera-Arreola SS, Hernandez-Cantoral A, Arroyo-Lucas S, Nava-Galan MG, Zapien-Vazquez M de los A, Perez-Lopez MT, et al. [Factors relating to falls in hospitalized patients]. Rev Invest Clin. 2013;65(1):88–93.
Gulka HJ, Patel V, Arora T, McArthur C, Iaboni A. Efficacy and Generalizability of Falls Prevention Interventions in Nursing Homes: A Systematic Review and Meta-analysis. J Am Med Dir Assoc. 2020 Jan 22;
Lee SE, Vincent C, Dahinten VS, Scott LD, Park CG, Dunn Lopez K. Effects of Individual Nurse and Hospital Characteristics on Patient Adverse Events and Quality of Care: A Multilevel Analysis. J Nurs Scholarsh an Off Publ Sigma Theta Tau Int Honor Soc Nurs. 2018;50(4):432–40.
Aranda-Gallardo M, Enriquez de Luna-Rodriguez M, Vazquez-Blanco MJ, Canca-Sanchez JC, Moya-Suarez AB, Morales-Asencio JM. Diagnostic validity of the STRATIFY and Downton instruments for evaluating the risk of falls by hospitalised acute-care patients: a multicentre longitudinal study. BMC Health Serv Res. 2017 Dec 17;17(1):277.
Corona G, Norello D, Parenti G, Sforza A, Maggi M, Peri A. Hyponatremia, falls and bone fractures: A systematic review and meta-analysis. Clin Endocrinol (Oxf). 2018;89(4):505–13.
Draper B, Berman K. Tolerability of selective serotonin reuptake inhibitors: issues relevant to the elderly. Drugs Aging. 2008;25(6):501–19.
Lobo-Rodriguez C, Garcia-Pozo AM, Gadea-Cedenilla C, Moro-Tejedor MN, Pedraz Marcos A, Tejedor-Jorge A. Prevalence of hyponatraemia in patients over the age of 65 who have an in-hospital fall. Nefrologia. 2016;36(3):292–8.
Harianto H, Anpalahan M. In-hospital Falls in Older Patients: The Risk Factors and The Role of Hyponatraemia. Curr Aging Sci. 2017;10(2):143–8.
Filippatos TD, Makri A, Elisaf MS, Liamis G. Hyponatremia in the elderly: Challenges and solutions. Vol. 12, Clinical Interventions in Aging. Dove Medical Press Ltd.; 2017. p. 1957–65.
Bhandari SK, Adams AL, Li BH, Rhee CM, Sundar S, Krasa H, et al. Sub‐Acute more than Chronic Hyponatremia is associated with Serious Falls and Hip Fractures. Intern Med J. 2019 Nov 10;imj.14684.
Boyer S, Gayot C, Bimou C, Mergans T, Kajeu P, Castelli M, et al. Prevalence of mild hyponatremia and its association with falls in older adults admitted to an emergency geriatric medicine unit (the MUPA unit). BMC Geriatr. 2019;19(1):265.
DeVellis RF. Scale Development Theory and Applications. 4a. 2016.
Merino Soto C, Livia Segovia J. Intervalos de confianza asimétricos para el índice la validez de contenido: un programa Visual Basic para la V de Aiken. An Psicol. 2009;25(1):159–61.
Cordon J. Analizando la V de Aiken Usando el Método Score con Hojas de Cálculo. [Internet]. 2015 [cited 2020 Feb 7]. Available from: https://www.researchgate.net/publication/277555967_Analizando_la_V_de_Aiken_Usando_el_Metodo_Score_con_Hojas_de_Calculo
Nunnally JC, Bernstein IH. Psychometric theory. 3rd ed. New York: McGraw-Hill; 1994. 752 p.
Linacre JM. Investigating rating scale category utility. J Outcome Meas. 1999;3(2):103–22.
Beavers GA, Iwata BA, Lerman DC. Thirty years of research on the functional analysis of problem behavior. J Appl Behav Anal. 2013;46(1):1–21.
Boyer S, Gayot C, Bimou C, Mergans T, Kajeu P, Castelli M, et al. Prevalence of mild hyponatremia and its association with falls in older adults admitted to an emergency geriatric medicine unit (the MUPA unit). Vol. 19, BMC Geriatrics. 2019. p. 265.
Hopewell S, Adedire O, Copsey BJ, Sherrington C, Clemson LM, Close JC, et al. Multifactorial and multiple component interventions for preventing falls in older people living in the community. Cochrane Database of Systematic Reviews. 2016.
Lovallo C, Rolandi S, Rossetti AM, Lusignani M. Accidental falls in hospital inpatients: evaluation of sensitivity and specificity of two risk assessment tools. J Adv Nurs. 2010 Mar;66(3):690–6.
Schwendimann R, Bühler H, De Geest S, Milisen K. Falls and consequent injuries in hospitalized patients: effects of an interdisciplinary falls prevention program. BMC Health Serv Res [Internet]. 2006 Dec 7;6(1):69. Available from: https://bmchealthservres.biomedcentral.com/articles/10.1186/1472-6963-6-69
Kim EAN, Mordiffi SZ, Bee WH, Devi K, Evans D. Evaluation of three fall-risk assessment tools in an acute care setting. J Adv Nurs. 2007 Nov;60(4):427–35.
Kiyoshi-Teo H, Northrup-Snyder K, Cohen DJ, Dieckmann N, Stoyles S, Winters-Stone K, et al. Older hospital inpatients’ fall risk factors, perceptions, and daily activities to prevent falling. Geriatr Nurs. 2019;40(3):290–5.
Bassett AM, Siu K-C, Honaker JA. Functional Measures for Fall Risk in the Acute Care Setting: A Review. West J Nurs Res. 2018;40(10):1469–88.
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