- Research article
- Open Access
- Open Peer Review
The development of a multidisciplinary fall risk evaluation tool for demented nursing home patients in the Netherlands
© Neyens et al; licensee BioMed Central Ltd. 2006
- Received: 30 June 2005
- Accepted: 21 March 2006
- Published: 21 March 2006
Demented nursing home patients are at high risk for falls. Falls and associated injuries can have a considerable influence on the autonomy and quality of life of patients. The prevention of falls among demented patients is therefore an important issue. In order to intervene in an efficient way in this group of patients, it is important to systematically evaluate the fall risk profile of each individual patient so that for each patient tailor-made preventive measures can be taken. Therefore, the objective of the present study is to develop a feasible and evidence based multidisciplinary fall risk evaluation tool to be used for tailoring preventive interventions to the needs of individual demented patients.
To develop this multidisciplinary fall risk evaluation tool we have chosen to combine scientific evidence on the one hand and experts' opinions on the other hand. Firstly, relevant risk factors for falling in elderly persons were gathered from the literature. Secondly, a group of Dutch experts in the field of falls and fall prevention in the elderly were consulted to judge the suitability of these risk factors for use in a multidisciplinary fall risk evaluation tool for demented nursing home patients. Thirdly, in order to generate a compact list of the most relevant risk factors for falling in demented elderly, all risk factors had to fulfill a set of criteria indicating their relevance for this specific target population. Lastly the final list of risk factors resulting from the above mentioned procedure was presented to the expert group. The members were also asked to give their opinion about the practical use of the tool.
The multidisciplinary fall risk evaluation tool we developed includes the following items: previous falls, use of medication, locomotor functions, and (correct) choice and use of assistive and protective devices. The tool is developed for the multidisciplinary teams of the nursing homes.
This evidence and practice based multidisciplinary fall risk evaluation tool targets the preventive interventions aimed to prevent falls and their negative consequences in demented nursing home patients.
- Nursing Home
- Fall Risk
- Protective Device
- Demented Patient
- Locomotor Function
Falls and fall related injuries are a major problem in community residing elderly persons and even more in frail elderly residing in institutions. Fall incidents occur frequently in nursing homes and may have considerable consequences for the health status and quality of life of the patients involved, especially if the fall results in a hip fracture. In the Netherlands the mean incidence of fractures for psychogeriatric patients in nursing homes is 26.3 to 28.8 per 1000 beds per year . Due to these fractures, not only the nursing care load increases, but also the mortality risk of patients.
Dementia is a major risk factor for falling [2–4]. Demented patients show a gradually deteriorating mobility and a diminishing ability to recognise, judge and avoid hazards. In Dutch nursing homes about 55% of the patients suffer from dementia but they are involved in 75% of the fall incidents . Therefore, it can be concluded that all demented patients in nursing homes are at high risk of falls. This stresses the importance of taking adequate preventive measures to prevent falls in this group of patients.
Research data indicate positive effects of multifactorial interventions targeted at the prevention of fall incidents . This evidence mostly concerns community dwelling people. Despite the magnitude of the problem of fall incidents in (demented) nursing home patients, only limited evidence is available for the effectiveness of fall prevention among these patients [6, 11]. Fall risk assessment tools and preventive interventions developed for the general population of elderly persons seem to be inappropriate for demented patients. The present study aims to contribute to the development of a specialised fall preventive intervention for demented nursing home patients, feasible for the nursing home staff. In order to intervene in an efficient way in the group of demented patients (who all can be considered to be at high risk for falls), it is important to systematically evaluate the fall risk profile of each individual patient so that for each patient tailor-made preventive measures can be taken. Therefore, the objective of the study presented in this article is to develop a feasible and evidence based multidisciplinary fall risk evaluation tool to be used for tailoring preventive interventions to the needs of individual demented patients.
The development of this multidisciplinary fall risk evaluation tool consisted of the following four steps:
1. Searching the literature for risk factors for falling;
2. First consultation of experts: suitability of factors;
3. Final selection of risk factors;
4. Second consultation of experts: practical use of the tool.
Below the methods used in each step are described.
Step 1: Searching the literature for risk factors for falling
A search in PubMed, Medline and Cinahl (from January 1986 until July 2002) was performed to collect scientific publications about risk factors for falling. The search strategy used was: [fall(s) AND elderly] AND [nursing home(s) OR long term care OR risk factor(s) OR assessment OR dementia]. The abstracts of the publications found were screened in order to make a first selection of potentially relevant papers. All papers that addressed risk factors for falling in the elderly were included in this first selection, irrelevant of whether they referred to elderly people residing in the community, hospitals or institutions for long term care. The full text of the publications included, were retrieved and the papers were screened for relevant information about risk factors for falling among elderly people (65+). Subsequently a list of risk factors for falls was made. A risk factor was included in the list if a relationship between the factor and falls in the elderly was reported.
Step 2: First consultation of experts: suitability of factors
A group of national experts (N = 11) in the field of falling, fall prevention, guideline development and implementation was assembled. The members of this group were researchers from the Free University Amsterdam (VU), Maastricht University (UM), the Dutch Organisation for Applied Scientific Research (TNO), representatives of different disciplines working in a nursing home (nursing home physician, nurse, physiotherapist and occupational therapist), a representative of the Dutch Branch Organisation for Nursing Homes (Arcares), and a representative of the Dutch Association of Nursing Home Physicians (NVVA).
In a plenary meeting the large list of risk factors resulting from step 1 was presented to the experts. Each expert was asked to judge for each risk factor whether it seemed relevant to include it in a multidisciplinary fall risk evaluation tool for demented nursing home patients. They were asked to take into account the daily care process in Dutch nursing homes. In the Netherlands it is common to perform a general comprehensive assessment shortly after admission of a patient to the nursing home. The multidisciplinary fall risk evaluation tool should not overlap with this assessment but should be complementary to it.
In order to generate a compact list of the most relevant risk factors for demented nursing home patients, we reduced the list of risk factors resulting from step 1 using the following criterion: during the expert meeting at least 75% of the experts present had to agree on the importance of this factor.
Step 3: Final selection of risk factors
Subsequently the members of the research team wanted to make a further selection of the factors resulting from step 2, in order to compose a feasible multidisciplinary fall risk evaluation tool. To do this, they developed the following list of criteria:
• the factor has been described as a risk factor for falling in at least one article addressing nursing home care;
• evaluation of the factor among demented nursing home patients has to be possible;
• the factor must be modifiable; and
• appropriate interventions to reduce or eliminate the risk factor among demented nursing home patients (applicable in daily nursing home routine) are or can be made available.
Next the research team assessed whether the factors resulting from the first selection matched these criteria. Because this did not lead to a substantial reduction of the number of factors, the following criterion was added to further reduce the number of factors:
• the reported Odds Ratio/Relative Risk Ratio of the factor has to be 1.5 or higher.
Step 4: Second consultation of experts: practical use of the tool
The list of factors resulting from step 3 was presented to the participating experts. By means of a structured (e-mail) questionnaire, we asked them to give their opinion regarding aspects of the practical use of the multidisciplinary fall risk evaluation tool. For every risk factor incorporated in the tool, the experts had to judge (yes or no) the proposals of the research team regarding how, by whom and at which moment in the care process it should be assessed. If the majority answered positive the tool became final.
Searching the literature for risk factors for falling
List of risk factors for falls derived from literature.
high age [13,14,16,17,32,37]
female gender [14,32,44]
weight (e.g. low BMI) 
previous falls [13-17,19,26-29,33-35,38,44,51]
dependency in activities of daily life [14,17,19,26,31,35-38,51]
acute disease(s) [2,38]
chronic disease(s) 
neurological diseases [19,32,44]
cardiopathy (e.g. heart failure) [20,42,44,45]
hart rate (e.g. arrhythmia) 
high blood pressure [2,26]
orthostatic hypotension [12,19]
medication (e.g. psychotropic, sedative, neuroleptic, antidepressive) [13,15,16,17,19,21,23,26-29,32,34,35,38,44,45,51]
alcohol abuse 
diabetes mellitus 
urine incontinence [38,41]
cognitive problems [13,19,35,40,45,51]
fear of falling 
behavioural problems [15,17]
disturbed vision [20,38,39,42,44]
hearing problems [42,44]
independency of transfers [14,16]
disturbed balance [13,14,17,19-22]
bad quality of co-ordination [6,38]
mobility impairments [13,14,17-29,32,33,35-37,39,41,44,51]
muscle weakness 
gait disorders [2,26-29,50]
foot defects 
inappropriate footwear 
environmental factors [2,6,26,33,47-49,51]
assistive devices [14,30,31]
protective devices [2,47]
First consultation of experts: suitability of factors
Seven of the eleven experts who were invited to join the expert meeting, actually attended the meeting. Risk factors that were considered to be relevant for a multidisciplinary fall risk evaluation tool among demented nursing home patients, according to at least 6 of the 7 experts present were: previous falls, chronic disease(s), medication, disturbed vision, independency of transfers, disturbed balance, bad quality of co-ordination, mobility impairments, muscle weakness, foot defects, assistive devices, and protective devices.
Final selection of risk factors
Risk factors for falls related to the inclusion criteria.
Risk factors for falls
Independency of transfers
Bad quality of co-ordination
• Medication; Number, type and doses of drugs as well as times of intake can influence the risk of falling.
• Locomotor functions; The factors muscle weakness, mobility impairments, disturbed balance, and independency of transfers, which all can increase the risk of falling, were taken together as one item called locomotor functions.
• Assistive and protective devices; For the assistive and protective devices, both the choice and the use of them have to be correct in order to create safe conditions for the patient because wrong choice and/or use enhances the fall risk.
Second consultation of experts: practical use of the tool
Practical use of the multidisciplinary fall risk evaluation tool for demented nursing home patients.
data from GP (hetero) anamnesis fall registration 
nursing home physician
nursing home physician
After a fall incident
At request ward
Periodical repetition (2 × per year)
Barthel index 
Tinetti (POMA) 
Assistive and protective devices
A fall is defined as an event which results in a person coming to rest advertently on the ground or other level (adjusted version of the definition of the Kellog International Work Group) . At admission to the nursing home, information with regard to the fall history in the previous 6 months has to be gathered from the general practitioner, family members and if possible from the patients themselves. Because information about the fall history is gathered retrospectively it is important to use more than one source of information, whenever possible. Obviously the self-report of falls among demented persons may be very unreliable due to their cognitive problems.
The information that has to be gathered includes the number of fall accidents, the possible causes and circumstances of the fall, the consequences of the fall, and the preventive actions already taken . Although obviously fall history it self cannot be influenced, the analysis of the fall history allows the nursing home team to assess whether the factors which caused the falls in this specific patient can be influenced. The more we know about the fall history, the better we can anticipate upon the fall related causes and circumstances. The fall history allows the team also to evaluate the fall preventive policy with regard to individual patients.
The medication used by the patient has to be registered by the nursing home physician who will consequently assess its influence on fall risk. The number of drugs as well as the type, doses and time of intake must be registered. The combination of four or more drugs enhances the risk of falling. Some drugs, particularly cardiovascular and psychotropic drugs, the latter often used in dementia patients, are known to have possible side effects such as drowsiness, dizziness, unstable blood pressure and confusion and thereby can enhance fall risk [13, 15–17, 19, 21, 23, 26–29, 32, 34, 38, 44, 45, 51].
Regular monitoring of the resident's medication is important because in most nursing home patients, including the demented, we observe polypharmacy, with all possible negative implications.
Clinical judgement of the patients' mobility by the multidisciplinary team occurs in every day routine and gives important information about possible problems with standing, walking, activities of daily living and transfers and with regard to wandering behaviour, restlessness during the night and other risky behaviour [2, 6, 13–29, 31–33, 35–39, 41, 44, 50, 51]. In addition to this clinical judgment the Barthel score and the Tinetti test (POMA) are valid screening tools, enabling us to measure more specifically the activities of daily living and the functioning of the mobility apparatus . The Tinetti test assesses both the balance (9 items) and the gait (6 items). The maximum score is 28 points. The scores 19–24 indicate an increased risk of falling. The scores below 19 indicate great risk of falling. The Tinetti test has important practical use: the scores tell us either to focus on balance, on gait or on both. Nurses can observe the general, functional locomotor functions during daily activities; the more specific tests can be performed by an occupational therapist or a physiotherapist.
Assistive and protective devices
Taking into account the physical abilities and mental status of the patients involved, the evaluation of both correct choice and use of assistive (walking aids, transfer aids) and protective (external hipprotector, alarmcushions/sensors) devices, can be performed by the clinical judgment of nurses, physiotherapists and occupational therapists [2, 14, 30, 31, 47].
Tailoring interventions based on the fall risk evaluation
Based on the results of the fall risk evaluation the nursing home staff using the tool has to decide what specific fall preventive interventions are needed for each individual patient. These interventions could include:
• Anticipating upon the causes and circumstances of the fall;
• Critically reviewing and monitoring medication intake (type, number, dose and time of intake);
• Offering exercise programmes specifically targeted at the needs of the individual patient;
• Carefully reassessing the need for assistive and protective devices, and promoting the correct use of these devices.
The aim of this study was to develop a feasible and evidence based multidisciplinary fall risk evaluation tool for multidisciplinary teams in wards for demented nursing home patients. The tool evaluates five important fall risk factors in demented elderly: previous falls, use of medication, locomotor functions, and (correct) choice and use of assistive and protective devices. The disciplines that may be involved in using this tool are nursing home physicians, nurses, occupational therapists and physiotherapists. It is important to incorporate the multidisciplinary fall risk evaluation tool in a cyclic monitoring procedure. The results of executing this tool target the multidisciplinary and multifactorial fall preventive actions tailored for each individual patient.
A strong aspect of this multidisciplinary fall risk evaluation tool is that it is both evidence and practice based. This has resulted in a tool, which is supported by evidence in scientific literature, and also seems to fit easily into the daily nursing home routine. The fact that we partly based the tool on opinions of experts, however, may at the same time be considered as a weak point of the study because the results obviously depend on the specific composition of the expert group. Despite that, in our opinion the group contributing to the development of the tool was well balanced and representative for the available Dutch expertise on falls in the community as well as in institutions for chronic care.
Obviously, performing this multidisciplinary fall risk evaluation tool in demented nursing home patients does not guarantee that all risk factors for falls in an individual patient will be detected. Therefore it remains very important that sufficient attention is paid to interventions with regard to other factors that in the opinion of nursing home physicians, nurses, and/or paramedical staff can contribute to falls in individual patients.
At this moment most nursing homes in the Netherlands do not have specific guidelines or structured programmes for the prevention of fall incidents among demented patients . In developing such guidelines the multidisciplinary fall risk evaluation tool, as presented here, involves the first step of an effective fall preventive programme. In addition, complete and integral fall preventive programmes should also include possible interventions that may be targeted by the results of using this evaluation tool. Of course, these programmes also should provide information about general fall preventive measures, for instance, educational programs for the nursing home team, and realisation of a safe nursing home environment [5, 57].
Currently we are performing a randomised controlled trial among demented nursing home patients in the Netherlands in which we are testing the effectiveness of the fall risk evaluation tool and the multifactorial interventions specifically targeted by this tool . The trial is accompanied by an evaluation of the feasibility and acceptability of the fall risk evaluation tool, in order to further optimise it and to make it more suitable for use in daily practice.
This evidence and practice based multidisciplinary fall risk evaluation tool can form the basis for a multifactorial and multidisciplinary intervention aimed to prevent falls and their negative consequences in demented nursing home patients.
This study was funded by the Netherlands Organisation for Health Research and Development (ZonMw), grant number 13650008.
- Dijcks BPJ, Neyens JCL, Schols JMGA, van Haastregt JCM, Crebolder HFJM, de Witte LP: Valincidenten in verpleeghuizen: gemiddeld bijna 2 per bed per jaar met bij 1,3% een fractuur als gevolg. Ned Tijdschr Geneeskd. 2005, 149: 1043-7.PubMedGoogle Scholar
- Rubenstein LZ, Josephson KR, Robbins AS: Falls in the nursing home. Ann Intern Med. 1994, 121: 442-451.View ArticlePubMedGoogle Scholar
- Vermeulen HBM: Vallen en valpreventie in het verpleeghuis: een interventiestudie naar het effect van een bed-alarm-systeem. 1994, Nijmegen, academisch proefschrift Katholieke Universiteit Nijmegen.Google Scholar
- van Dijk PTM, Meulenburg OGRM, van de Sande HJ, Habbema JDF: Falls in dementia patients. Gerontologist. 1993, 33 (2): 200-204.View ArticlePubMedGoogle Scholar
- Schols JMGA, Crebolder HFJM, van Weel C: Nursing home and nursing home physician: the Dutch experience. J Am Med Dir Assoc. 2004, 5: 207-212. 10.1016/S1525-8610(04)70116-4.View ArticlePubMedGoogle Scholar
- Gillespie LD, Gillespie WJ, Robertson MC, Lamb SE, Cumming RG, Rowe BH: Interventions for Preventing Falls in Elderly People. The Cochrane Library. 2002, 2Google Scholar
- American Geriatrics Society, British Geriatrics Society, and American Academy of Orthopaedic Surgeons Panel on Fall Prevention: Guideline for the Prevention of Falls in Older Persons. JAGS. 2001, 49: 664-672. 10.1046/j.1532-5415.2001.49115.x.View ArticleGoogle Scholar
- Perell KL, Nelson A, Goldman RL, Luther SL, Prieto-Lewis N, Rubenstein LZ: Fall risk assessment measures: an analytic review. Journal of Gerontology: Medical Sciences. 2000, 56: M761-M766.Google Scholar
- Boers I, Willibald G, Stalenhoef PA, Bloem BR: Falls in the elderly. Wien Klin Wochenschr. 2001, 113 (11–12): 398-407.PubMedGoogle Scholar
- Moreland JD: A meta-analysis of fall prevention programs for the elderly: how effective are they?. Nursing Research. 2002, 51 (1): 1-8.View ArticleGoogle Scholar
- Ray WA, Taylor JA, Meador KG, Thapa PB, Brown AK, Kajihara HK, Davis C, Gideon P, Griffin MR: A randomized trial of a consultation service to reduce falls in nursing homes. JAMA. 1997, 278: 557-562. 10.1001/jama.278.7.557.View ArticlePubMedGoogle Scholar
- Ooi WL, Hossain M, Lipsits LA: The assocation between orthostatic hypotension and recurrent falls in nursing home residents. Am J Med. 2000, 108: 106-111. 10.1016/S0002-9343(99)00425-8.View ArticlePubMedGoogle Scholar
- Bueno-Cavanillas A, Padilla-Ruiz F, Jiménez-Moleón JJ, Peinado-Alonso CA, Gálvez-Vargas R: Risk factors in falls among the elderly according to extrinsic and intrinsic precipitating causes. Eur J Epidemiol. 2000, 16: 849-859. 10.1023/A:1007636531965.View ArticlePubMedGoogle Scholar
- Kiely DK, Kiel DP, Burrows AB, Lipsitz LA: Identifying nursing home residents at risk for falling. JAGS. 1998, 46: 551-555.View ArticleGoogle Scholar
- Krueger PD, Brazil K, Lohfeld LH: Risk factors for falls and injuries in a long-term care facility in Ontario. Can J Public Health. 2001, 92: 117-120.PubMedGoogle Scholar
- Myers AH, Baker SP, Van Natta ML, Abbey H, Robinson EG: Risk factors associated with falls and injuries among elderly institutionalized persons. Am J Epidemiol. 1991, 133: 1179-1190.PubMedGoogle Scholar
- Thapa PB, Gideon P, Brockman KG, Fought RL, Ray WA: Clinical and biomechanical measures of balance as fall predictors in ambulatory nursing home residents. J Gerontol Med Sci. 1996, 51A: M239-M246.View ArticleGoogle Scholar
- Thapa PB, Brockman KG, Gideon P, Fought RL, Ray WA: Injurious falls in nonambulatory nursing home residents: a comparative study of circumstances, incidence and risk factors. JAGS. 1996, 44: 273-278.View ArticleGoogle Scholar
- Graafmans WC, Ooms ME, Hofstee HMA, Bezemer PD, Bouter LM, Lips P: Falls in the elderly: a prospective study of risk factors and risk profiles. Am J Epidemiol. 1996, 143 (11): 1129-1136.View ArticlePubMedGoogle Scholar
- Luukinen H, Koski K, Laippala P, Kivela SL: Risk factors for recurrent falls in the elderly in long-term institutional care. Pub Health. 1995, 109: 57-65. 10.1016/S0033-3506(95)80076-X.View ArticleGoogle Scholar
- Lipsitz LA, Jonsson PV, Kelley MM, Koestner JS: Causes and correlates of recurrent falls in ambulatory frail elderly. J Gerontol Med Sci. 1991, 46: M114-M122.View ArticleGoogle Scholar
- Maki BE: Gait changes in older adults: predictors of falls or indicators of fear?. JAGS. 1997, 45: 313-320.View ArticleGoogle Scholar
- Yip YB, Cumming RG: The association between medications and falls in Australian nursing-home residents. Med J Aust. 1994, 160: 14-18.PubMedGoogle Scholar
- Rawsky E: Review of the literature on falls among the elderly. Image J Nurs Sch. 1998, 30: 47-52.View ArticlePubMedGoogle Scholar
- Robbins AS, Rubenstein LZ, Josephson KR, Schulman BL, Osterweil D, Fine G: Predictiors of falls among elderly people: results of two population-based studies. Arch Intern Med. 1989, 149: 1628-1633. 10.1001/archinte.149.7.1628.View ArticlePubMedGoogle Scholar
- Tinetti ME, Speechley M, Ginter SF: Risk factors for falls among elderly persons living in the community. N Engl J Med. 1988, 319: 1701-1707.View ArticlePubMedGoogle Scholar
- Bueno Cavanillas A, Padilla Ruiz F, Peinado Alonso C, Espigares Garcia M, Galvez Vargas R: Factores de riesgo de caidas en una poblacion anciana institucionalizada. Estudio de cohorts prospectivo. (Risk factors associated with falls in institutionalized elderly persons. Prospective cohort study. Med Clin (Barc). 1999, 112: 10-15.Google Scholar
- Nurmi I, Sihvonen M, Kataja M, Lüthje P: Falls among institutionalized Elderly a prospective study in four institutions in finland. Scand J Caring Sci. 1996, 10: 212-220.View ArticlePubMedGoogle Scholar
- American Medical Directors Association (AMDA) and the American Health Care Association: Falls and Fall Risk. 1997Google Scholar
- Mahoney FI, Barthel D: Functional evaluation: the Barthel Index. Md Med J. 1965, 14: 61-65.Google Scholar
- Graafmans WC, Lips P, Wijlhhuizen GJ, Pluijm SM, Bouter LM: Daily physical activity and the use of a walking aid in relation to falls in elderly people in a residential care setting. Z Gerontol Geriatr. 2003, 36: 23-28. 10.1007/s00391-003-0143-8.View ArticlePubMedGoogle Scholar
- Campbell AJ, Borrie MJ, Spears GF: Risk factors for falls in a community-based prospective study of people 70 years and older. J Gerontol. 1989, 44: M112-7.View ArticlePubMedGoogle Scholar
- Stalenhoef PA, Diederiks JPM, Knottnerus JA, Kester ADM, Crebolder HFJM: A risk model for the prediction of recurrent falls in the community-dwelling elderly: a prospective cohort study. J Clin Epidemiol. 2002, 55: 1088-94. 10.1016/S0895-4356(02)00502-4.View ArticlePubMedGoogle Scholar
- Luukinen H, Koski K, Kivela SL, Laippala P: Social status, life changes, housing conditions, health, functional abilities and life-style as risk factors for recurrent falls among the home-dwelling elderly. Public Health. 1996, 110: 115-8. 10.1016/S0033-3506(96)80057-6.View ArticlePubMedGoogle Scholar
- Tinetti ME, Speechley M, Ginter SF: Risk factors for falls among elderly persons living in the community. N Engl J Med. 1988, 319: 1701-7.View ArticlePubMedGoogle Scholar
- Davis WJ, Ross PD, Nevitt MC, Wasnich RD: Risk factors for falls and for serious injuries on falling among older Japanese women in Hawaii. J Am Geriatr Soc. 1995, 43: 1214-21.View ArticleGoogle Scholar
- O'Loughlin JL, Robitaille Y, Boivin JF, Suissa S: Incidence of and risk factors for falls and injurious falls among the community-dwelling elderly. Am J Epidemiol. 1993, 137: 342-54.PubMedGoogle Scholar
- Tromp AM, Pluijm SMF, Smit HJ, Deeg DJH, Bouter LM, Lips P: Fall-risk screening test: a prospective study on predictors for falls in community-dwelling elderly. J Clin Epidemiol. 2001, 54: 837-44. 10.1016/S0895-4356(01)00349-3.View ArticlePubMedGoogle Scholar
- Lord SR, Dayhew J: Visual risk factors for falls in older people. J Am Geriatr Soc. 2001, 49: 508-15. 10.1046/j.1532-5415.2001.49107.x.View ArticlePubMedGoogle Scholar
- van Schoor NM, Smit JH, Pluijm SMF, Jonker C, Lips P: Different cognitive functions in relation to falls among older persons. Immediate memory as an independent risk factor for falls. J Clin Epidemiol. 2002, 55: 855-62. 10.1016/S0895-4356(02)00438-9.View ArticlePubMedGoogle Scholar
- Tinetti ME, Inouye SK, Gill TM, Doucette JT: Shared risk factors for falls, incontinence and functional dependence. Unifying the approach to geriatric syndromes. JAMA. 1995, 273: 1348-53. 10.1001/jama.273.17.1348.View ArticlePubMedGoogle Scholar
- Oliver D, Britton M, Seed P, Martin FC, Hopper AH: Development and evaluation of evidence based risk assessment tool (STRATIFY) to predict which elderly inpatients will fall: case-control and cohort studies. BMJ. 1997, 315: 1049-53.View ArticlePubMedPubMed CentralGoogle Scholar
- Tinetti ME, Williams TF, Mayewski R: Fall risk index for elderly patient based on number of chronic disabilities. Am J med. 1986, 80: 429-434. 10.1016/0002-9343(86)90717-5.View ArticlePubMedGoogle Scholar
- Vasallo M, Sharma JC, Allen SC: Characteristics of single fallers and recurrent fallers among hospital in-patients. Gerontology. 2002, 48: 147-50. 10.1159/000052833.View ArticleGoogle Scholar
- Tituarima JA, van der Meulen JH, de Haan RJ, van Straten A, Limburg M: Risk factors for falls of hospitalized stroke patients. Stroke. 1997, 28: 297-301.View ArticleGoogle Scholar
- Tideiksaar R: Falls in old age: its prevention and treatment. 1989, New York: SpringerGoogle Scholar
- Neufeld RR, Libow LS, Foley WJ, Dunbar JM, Cochen C, Breuer B: Restraint reduction reduces serious injuries among nursing home residents. J Am Geriatr Soc. 1999, 47: 1202-1207.View ArticlePubMedGoogle Scholar
- Close J, Ellis M, Hooper R, Glucksman E, Jackson S, Swift C: Prevention of falls in the elderly trial (PROFET): a randomised controlled trial. Lancet. 1999, 353: 93-7. 10.1016/S0140-6736(98)06119-4.View ArticlePubMedGoogle Scholar
- van Haastregt JC, Diederiks JP, van Rossum E, de Witte LP, Voorhoeve PM, Crebolder HF: Effects of a programme of multifactorial home visits on falls and impairments in elderly people at risk: a randomised controlled trial. BMJ. 2000, 321: 994-8. 10.1136/bmj.321.7267.994.View ArticlePubMedPubMed CentralGoogle Scholar
- Feder G, Cryer C, Donovan S, Carter Y: Guideline for the prevention of falls in people over 65. BMJ. 2000, 321: 1007-11. 10.1136/bmj.321.7267.1007.View ArticlePubMedPubMed CentralGoogle Scholar
- Stalenhoef PA, Crebolder HFJM, Knottnerus JA, Horst FGEM: Incidence, risk factors and consequences of falls among elderly subjects living in the community: a criteria based analysis. Eur J Pub Health. 1997, 7: 328-34. 10.1093/eurpub/7.3.328.View ArticleGoogle Scholar
- Kellogg International Work Group on the prevention of falls by the elderly.Google Scholar
- Arcares: Melding Incidenten Cliënten in Verpleeg- en Verzorgingshuizen. Arcares rapport oktober. 2002Google Scholar
- Woollacot MH, Shumway-Cook A: Concepts and methods for assessing postural instability. J Aging Phys Activ. 1996, 4: 214-233.Google Scholar
- Tinetti ME: Performance-oriented assessment of mobility problems in elderly patients. JAGS. 1986, 34: 119-126.View ArticleGoogle Scholar
- de Kinkelder A, Dierkx RIJ: Functionele mobiliteitstests voor het valrisico bij verpleeghuispatiënten, een literatuur onderzoek naar de diagnostische waarde. Tijdschr Gerontol Geriatr. 2001, 32: 69-73.PubMedGoogle Scholar
- Rubenstein LZ, Robbins AS, Josephson KR, Schulman BL, Osterweil D: The value of assessing falls in an elderly population. A randomized clinical trial. Annals of Internal Medicine. 1990, 113: 308-316.View ArticlePubMedGoogle Scholar
- Neyens JCL, Dijcks BPJ, Schols JMGA, van Haastregt JCM, van den Heuvel WJA, Crebolder HFJM, de Witte LP: Ontwikkeling en implementatie van een multifactoriële interventie gericht op de preventie van valincidenten en de gevolgen daarvan bij psychogeriatrische verpleeghuispatiënten. TVV. 2002, 26: 24-28.Google Scholar
- The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-2458/6/74/prepub
This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.