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Validation of F3ALLS Assessment in Older Adults
Pranav Y. Somasekhar, Nilson Wu, Benjamin Hung, John E. Morley, Theodore K. Malmstrom
Falls are one of the most common healthcare conditions that affect older adults today. The WHO estimates 28-35% of people ages 65 or older fall each year (1). There is compelling evidence from meta-analyses that exercise and individually tailored multifactorial interventions can reduce falls among community dwelling older adults (2). F3ALLS is a falls assessment and management guide for older adult patients that is quick, easy to administer and computerizable in a clinical setting. The aim of this prospective study is to evaluate the validity of the F3ALLS assessment. To do this, we investigate the association of F3ALLS scores with falls 6-months post assessment, and examine the ability of the F3ALLS to discriminate between persons at risk versus not at risk for falls using the gold standard Tinetti Gait and Balance Assessment (TGBA).
Older adult patients ages 65 to 90 were recruited from the SLU General Internal Medicine and Geriatrics clinics in June-November 2019. The Tinetti Gait and Balance Assessment and F3ALLS surveys were administered at baseline. TGBA is a 16-item functional gait and balance assessment that scores 0-28. F3ALLS assessment scores 0-7 and includes 6 self-reported questions and measurement of orthostatic blood pressure. Participants reported any falls over a 6-month follow-up period in a falls diary, and investigators completed a chart review to identify falls over a 6-month follow-up period. Data were analyzed using SPSS version 19.0. Descriptive statistics are reported as means ± standard deviations or percentages. Logistic regression (odds ratios [OR], 95% Confidence Interval [CI]) is used to investigate the association of F3ALLS scores with falls (any vs. none) at 6-months adjusted for age, gender, and education. Receiver operator characteristic (ROC) curve (area under the curve [AUC], sensitivity, specificity) is used to examine how effectively the F3ALLS assessment discriminates between fall risk (any vs. none) on the TGBA.
Participants (N=97) were older adults ages 73.91±6.4, 68% (n=66) female, and 80% (n=78) had 12 or more years of education. Approximately one-third (n=30) of participants reported at least one fall at 6-months. F3ALLS scores were 3.23±1.5 and 2.35±1.7 for participants who reported 1 or more falls at 6-months versus those reported no falls at 6-months, respectively. Higher F3ALLS scores were associated with 6-month fall risk (OR=1.463, 95% CI=1.098-1.949). A F3ALLS score > 3 stratified patients as at risk of falling (AUC=0.77 P<.001; sensitivity=0.65, Specificity=0.71).
F3ALLS is a brief, valid measure to assess fall risk among older adults in the outpatient clinic. The F3ALLS questionnaire adequately classifies person at risk versus not at risk for falls, and higher (worse) F3ALLS scores are associated with falls over 6 months. Future studies should investigate the validity and utility of the F3ALLS falls management recommendations.
- World Health Organization. WHO global report on falls prevention in older age. 2007. http://www.who.int.ezp.slu.edu/ageing/publications/Falls_prevention7March.pdf.
- Stubbs, B., et al. (2015). “What Works to Prevent Falls in Community-Dwelling Older Adults? Umbrella Review of Meta-analyses of Randomized Controlled Trials.” Physical Therapy 95(8): 1095-1110
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