Delilah S. Moore

Measurement of fall-related psychological constructs among independent-living older adults: a review of the research literature.

Objectives: Falls and the fall-related psychological concerns associated with these events pose a serious public health problem among aging adults. The measurement of fall-related psychological concerns can serve as important endpoints for fall prevention programs, yet there is some confusion regarding the best method of defining and measuring fall-related psychological constructs. Consequently, greater attention should be devoted to investigating fall-related psychological constructs and their measurement. Therefore, the purpose of this paper was to review the published research literature on the measurement of fall-related psychological constructs among independent-living older adults. Method: Electronic searches of PubMed, EBSCO, Academic Search Premier, PsycINFO, CINAHL and online library catalogs were conducted using search terms including but not limited to ‘fear of falling’, ‘falls efficacy’, ‘fall-related self-efficacy’, ‘balance confidence’, ‘fall-related psychological outcome(s)’ and ‘independent-living’. Results: Each of these constructs is unique, yet instruments are often employed to measure constructs other than those the instruments were designed to assess. Inconsistencies were also revealed both within and across studies in terms of providing evidence of validity for these instruments. Conclusion: Fall-related psychological constructs, although similar in nature, are unique constructs and should be measured as such.

Comparison of the Validity of Four Fall-Related Psychological Measures in a Community-Based Falls Risk Screening

Abstract We examined the measurement properties of fall-related psychological instruments with a sample of 133 older adults (M age = 74.4 years, SD = 9.4). Measures included the Comprehensive Falls Risk Screening Instrument, Falls-efficacy Scale-International (FES-I), Activities-specific Balance Confidence (ABC), modified Survey of Activities and Fear of Falling in the Elderly (mSAFFE), Consequences of Falling (CoF), Physical Activity Scale for the Elderly (PASE), and 36-Item Short-Form Health Survey (SF-36). The FES-I, ABC, mSAFFE, and CoF were significantly correlated with each other, with SF-36, and with mobility. The ABC and mSAFFE were significantly correlated with PASE. The ABC differentiated between fallers and nonfallers and predicted total falls risk. Findings can assist with the selection of psychological instruments in a falls risk screening context.

Construct Validation of Physical Activity Surveys in Culturally Diverse Older Adults: A Comparison of Four Commonly Used Questionnaires

The purpose of this study was to establish validity evidence of four physical activity (PA) questionnaires in culturally diverse older adults by comparing self-report PA with performance-based physical function. Participants were 54 older adults who completed the Continuous Scale Physical Functional Performance 10-item Test (CS-PFP10), Physical Activity Scale for the Elderly (PASE), CHAMPS Physical Activity Questionnaire for Older Adults, Yale Physical Activity Survey (YPAS), and modified Baecke questionnaire. The total PASE score, three outcome scores for the CHAMPS, and three summary indices for the YPAS were significantly correlated with total CS-PFP10 score. The modified Baecke exhibited no correlations with CS-PFP10 scores. The PASE, CHAMPS, and YPAS appear to be the most valid PA self-report questionnaires for culturally diverse older adults.

Development and Validation of the Comprehensive Falls Risk Screening Instrument

ABSTRACT Annually, one in three older adults experiences a fall. Falls can lead to death, disability, and/or decreased health-related quality of life (HRQL). Objectives: To validate the Comprehensive Falls Risk Screening Instrument (CFRSI). Methods: Data were collected on 286 older adults (M age in years = 74.2 ± 10.0). The CFRSI total falls risk score was compared to subscale scores, the Physical Activity Scale for the Elderly (PASE), the Functional Status Index (FSI), and HRQL (SF-36, PCS, and Mental Component Summary (MCS)) scores. Results: The total CFRSI falls risk score was associated with all subscales (r = 0.25, p < 0.01 to r = 0.69, p < 0.01), PASE (r = −0.30, p < 0.01), FSI (r = 0.30, p < 0.01), and SF-36 PCS and MCS scores (r = −0.44, p < 0.01 to r = −0.24, p = 0.03, respectively). Fallers (n = 90) had a higher total falls risk score (M = 41.03 ± 9.38) than nonfallers (n = 188, M = 34.06 ± 10.05, t [276] = 5.53, p < 0.001). The most important predictor of falling status was only the history risk score (r = 0.96). Strong association of variables supports the construct validation of the CFRSI. The CFRSI is a valid comprehensive measure of falls risk that allows for identification of older adults who are at risk for falls and the specific areas that should be targeted for falls prevention.

Proximal Determinants of Falls Risk Among Independent-Living Older Adults

The purpose of this investigation was to determine associations among race, education, and income and falls risk scores from the Comprehensive Falls Risk Screening Instrument (CFRSI). Participants (N = 626) were Black (n = 318) and White (n = 308) older adults (M age = 72.62, SD = 9.31). The CFRSI assessed history, physical functioning, medication, vision, and home environment, and produced an average total falls risk score. A 3 (Income) × 3 (Education) × 2 (Race) MANCOVA showed main effects for income and race. Univariate tests revealed that low-income participants had greater scores for history, physical functioning, and total falls risk than high income participants. Similarly, Black participants had greater scores on history, physical functioning, medication, and total falls risk than White participants. Low income and Black race were associated with greater falls risk, and professionals should consider these disparities when designing community-based falls prevention programs.