Age and Ageing Advance Access originally published online on December 6, 2006
Age and Ageing 2007 36(1):111-112; doi:10.1093/ageing/afl138
Re: ‘Falls Definition Validation’
SIR—As older people may be the only witnesses of their fall event self-report, remains a crucial source of information about falls. Dickens et al. [1] made a valid point, that for clinical use, a standardised full definition of a fall [2] may not be necessary for patients' understanding of ‘what is a fall’. However, for effective meta-analyses of data from different researchers, it is vital. For example, Tai Chi hit the United Kingdom with gusto after the publication by Wolf showing that older people taking part in Tai Chi halved their risk of falls [3]. Yet, on closer analysis, Wolf was considering trips and falls and so despite seeming to be more effective than previously published fall-prevention exercise, it could not be usefully compared. Without standardisation of falls definitions, we will not be able to extract useful data for clinical guidelines on fall prevention interventions [4]. Self-report of falls is notoriously inaccurate, a recent trial looking at the use of diaries to record falls for 6 months followed by a retrospective self-report of falls [5], found that falls were generally under-reported on questioning compared to a falls diary. A significant difference in falls self-report was seen between those in the intervention and those in the control group, suggesting that self-report varies depending on access to care. The assumption that an injury will assist in the recall of fall was not confirmed in this study as the self-reporting of injuries was worse than the self-reporting of falls [5]. However, these were falls over the last 6 months, whether or not a fall had precipitated a visit to an Accident and Emergency Department. The use of different methods of self-report of falls must be tailored to the setting and the use of the data. While we agree with Dickens that simplicity is optimal in the clinical setting, the limitations of these approaches need to be recognised. For research purposes we urge readers to adopt high quality standardised definitions, such as those developed by the ProFaNE consensus statement of outcome definitions [6].On behalf of ProFaNE (Prevention of Falls Network Europe) www.profane.eu.org.
1 School of Nursing, Midwifery and Social Work, University of Manchester, UK
2 Robert-Bosch Krankenhaus/Robert Bosch Stiftung, Stuttgart, Germany & Bethanien-Krankenhaus/Geriatrisches Zentrum a.d. Universität Heidelberg, Heidelberg, Germany
3 Warwick Emergency Care and Rehabilitation, Centre for Primary Health Care Studies, University of Warwick Medical School, University of Warwick, UK & Kadoorie Critical Care Research Centre, John Radcliffe Hospital, Oxford, UK
* To whom correspondence should be addressed Email: dawn.skelton{at}manchester.ac.uk
References
- Dickens J, Jones M, Johansen A. (2006) Falls definition—reliability of patients' own reports. Age Ageing 35 450–51.
[Free Full Text] - Hauer K, Lamb SE, Jørstad EC, Todd C, Becker C. ProFaNE Group. (2006) Systematic review of definitions and methods of measuring falls in randomised controlled fall prevention trials. Age Ageing 35 5–10.
[Abstract/Free Full Text] - Wolf SL, Barnhart HX, Kutner NG}, et al. (1996) Reducing frailty and falls in older persons: an investigation of Tai Chi and computerized balance training. Atlanta FICSIT Group. J Am Geriatr Soc 44 489–97.[Web of Science][Medline]
- National Institute of Clinical Excellence. (2004) Clinical practice guideline for the assessment and prevention of falls in older people www.nice.org.uk/page.aspx?o=20116.
- Mackenzie L, Byles J, D'Este C. (2006) Validation of self-reported fall events in intervention studies. Clin Rehabil 20 331–39.
[Abstract/Free Full Text] - Lamb S, Jørstad-Stein EC, Hauer K, Becker C. (2005) On behalf of the Prevention of Falls Network Europe and Outcomes Consensus Group. J Am Geriatr Soc 53 1618–23.[CrossRef][Web of Science][Medline]
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