Falls in the Elderly: Reliability of a Classification System

TLDR

Previous studies have classified falls by intrinsic and extrinsic factors, but lack operational definitions and reliability data, preventing consensus. The study aimed to develop and test a fall classification system for community‑dwelling elderly. In a 3‑year prospective study of 1,358 participants, 366 falls were independently classified by two reviewers using narrative descriptions and structured interviews. The classification system grouped falls into extrinsic (55 %), intrinsic (39 %), non‑bipedal stance (8 %), and unclassified (7 %) categories, achieving 89.9 % interrater agreement (kappa 0.828) and providing reliable, flexible operational definitions for elderly falls.

Abstract

To determine risk factors for falls, previous studies have classified falls according to the contribution of factors both intrinsic and extrinsic to the host. Due partly to the lack of operational definitions and the absence of information on reliability, no consensus on classification has been reached. Consequently, in a 3‐year prospective study of falls occurring in a probability sample of community‐dwelling elderly (n = 1,358), a fall classification system was developed and tested for interrater reliability. The 366 falls in the first year of the study were independently classified by two reviewers on the basis of a narrative description and structured interview. The falls in the four major categories of the classification system included: falls related to extrinsic factors (55%), falls related to intrinsic factors (39%), falls from a non‐bipedal stance (8%) and unclassified falls (7%). The interrater reliability for the four major categories was 89.9% with a kappa of 0.828. The system provides operational definitions for types of falls and a reliable and flexible method for classifying falls in the elderly.