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Test Predictability of Falls Screening Tools

Unknown old man doing his morning walk with a walker on a beautiful sunny day
NORC identified a set of questions to predict falls in older adults, beyond falls risk factors.
  • Client
    Centers for Disease Control and Prevention
  • Dates
    August 2016 - August 2019

Problem

Falls are the leading cause of injuries among older adults in the United States.

Falls are preventable and clinicians are advised to screen for fall risk yearly. However, though a number of screening tools exist for the identification of risk factors for older adult falls, these tools have never been tested to determine how well they predict future falls.

Given this, the purpose of the Test Predictability of Falls Screening Tools project was to identify a set of questions that will predict falls themselves, rather than identifying the risk factors for falls, in community-dwelling adults aged 65 and older. The study:

  • Tested the ability of existing falls screening tools to predict falls and falls requiring medical attention over the course of one year;

  • Assessed how well questions predicted falls for specific groups (e.g., gender, race, and disability status); and

  • Assessed how responses to questions change over time. 

Solution

NORC conducted a longitudinal survey that followed over 1,900 older adults over the course of approximately 15 months.

Each participant completed a baseline survey that included questions from several screening tools. After completing the baseline, he or she received a monthly survey that asked about falls and associated medical treatment in the previous month. ​The screening tools evaluated in this study were the CDC Stay Independent Checklist, the American Geriatric Society (AGS) Fall Prevention Guidelines and Recommended Questions, and Falls Risk for Older People - Community Setting (FROP-Com). Participants were randomly selected and surveyed using NORC’s AmeriSpeak panel, which is a probability-based, representative sample of the U.S. population. Panelists participated via either internet or phone interviews.

Result

NORC found that the 3-item subset of the STEADI tool for falls screening in the age 65+ U.S. population was the best predictor of future falls risk.

This was true when compared to the other standard tools in the survey and new models built using a wide range of socio-demographic, health and medical, and falls history variables.

NORC also found that reported incidence of falls was significantly higher in the monthly surveys than the incidence of falls reported at baseline, when panelists were asked to remember falls in the previous year. This suggests that panelists may have had difficulty remembering falls over time, and future screenings may be more effective if they are designed to improve recall. 

Based on these findings and recommendations, CDC will conduct additional research to determine whether screening guidance should change to use new tools that will predict falls in community-dwelling adults aged 65 and older.

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Centers for Disease Control and Prevention (CDC)

Countermeasures to Reduce Drowsy Driving

A literature review and expert discussions to identify ways to combat drowsy driving

Client:

AAA Foundation for Traffic Safety

Family Resilience Program Evaluation

Evaluating a parenting intervention for English, Spanish, and Amharic-speaking participants

Client:

Parent Encouragement Program

HRSA Strategy to Address Intimate Partner Violence

Updating the federal government’s strategy for addressing and responding to intimate partner violence

Client:

Health Resources and Services Administration

Effective Traffic Safety Messaging

Developing an evaluation framework for traffic safety campaigns

Client:

Traffic Research Board of the National Academies of Science, Engineering & Medicine

Evaluation of the ACO REACH Model

Evaluating the ACO REACH model that is transitioning Medicare from fee-for-service to value-based care

Client:

Center for Medicare & Medicaid Innovation within the Centers for Medicare & Medicaid Services

Expanding Hearing Loss Education & Awareness

The nation’s first ever state- and county-level hearing loss prevalence estimates

Client:

Centers for Disease Control and Prevention

National Immunization Surveys (NIS)

One of the nation’s largest phone surveys and the gold standard for data on U.S. immunization rates

Client:

Centers for Disease Control and Prevention’s National Center for Immunization and Respiratory Diseases

Understanding CRNA Contributions to OB Care in Rural & Underserved Areas

Using mixed-methods evaluation and data linkage to study the experiences of certified registered nurse anesthetists (CRNAs)

Client:

American Association of Nurse Anesthetists Foundation

Using Innovative Machine Learning to Detect Support and Opposition to E-Cigarette Use Prevention Messaging on Twitter and TikTok

First study to examine the content, sources, and patterns of diffusion of E-cigarette prevention campaigns

Client:

National Cancer Institute

Workforce Challenges & Technology Adoption for Health Information Professionals

Examining the current state of the health information workforce and the use of artificial intelligence

Client:

American Health Information Management Association

Improve Firearms Data Infrastructure

A Blueprint for Collecting National Firearms Data

Reliable data hold the key to better policymaking

Client:

Arnold Ventures LLC

Expert Panel Recommendations to Improve Firearms Data Infrastructure

NORC addresses a deficit in the gathering of data on gun use and injuries

Client:

Arnold Ventures LLC

Supporting a Workforce to Treat Substance Use Disorders

Examining the effects HRSA’s Bureau of Health Workforce NHSC and behavioral health grant programs

Client:

HRSA Bureau of Health Workforce

California Communities Mental Health Services Survey

Informing efforts to make mental health services more accessible for diverse populations

Client:

California Department of Public Health, Office of Health Equity

Binational Bus Travel: An Innovation for Public Health Action

Improving disease prevention via public health management of cross-border bus travel

Client:

Centers for Disease Control and Prevention

Understanding Historically Marginalized & Minoritized Communities in the Forgotten Middle

A deep dive into disparities among middle-income older adults’ finances, housing, and health status

Client:

The SCAN Foundation

Medicaid Section 1115 Demonstration Management and Evaluation

Ensuring states’ evaluations are scientifically valid and inform progress in meeting CMS goals

Client:

Center for Medicaid and CHIP Services, Centers for Medicare and Medicaid Services (CMS)

Support for CDC’s 6|18 Initiative

Engaging state health agencies to adopt 6|18 Initiatives that improve population health

Client:

Centers for Disease Control and Prevention

Healthcare Cost and Utilization Project (HCUP)

The nation’s most comprehensive source of hospital care data

Client:

Agency for Healthcare Research and Quality

Maternal Health Portfolio Evaluation and Capacity Building

A large-scale, mixed-methods evaluation of HRSA’s Maternal Health Portfolio

Client:

Health Resources Services Administration

Global Practices to Improve Maternal Mortality Outcomes in the U.S.

A comprehensive look at countries’ practices to address maternal mortality

Client:

Health Resources Services Administration

Smoke-Free Screens Initiative

Updating surveillance of on-screen tobacco imagery after pandemic-driven changes in video viewing

Client:

Truth Initiative

Community-Engaged Research on Gambling in Massachusetts

Understanding the impacts of gambling and sports betting on communities in Massachusetts

Client:

Massachussetts Gaming Commission

ND HOPES Suicide Prevention Initiative

Implementing a multi-tiered approach to suicide prevention in western North Dakota

Client:

Centers for Disease Control and Prevention