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Background Slow gait speed and Timed Up-and Go (TUG) are often independent predictors of falls in regression analysis, although their ability to discriminate between fallers and non-fallers is questionable. Random forest plots can model complex interactions between predictor variables and have high classification accuracy. We compare the predictive and discriminative ability of UGS and TUG in predicting recurrent falls over 4 years using poisson regression and random forest plots. Methods Data from the first three waves of The Irish Longitudinal Study on Ageing (TILDA), a population-based study of community-dwelling adults aged ≥50 years were used. Baseline physical, neuro-cognitive, sensory and behavioural health were assessed. The outcome was recurrent (≥2) falls at Wave 2 or Wave 3. Poisson regression analysis was used to examine associations between UGS, TUG and falls adjusting for covariates. Random forest models were used. Predictive accuracy was calculated using 5 fold cross-validation and as there was class imbalance, the algorithm was trained using under-sampling of the larger class. Classification rate, area under the receiver operating characteristic curve (AUC) and area under the precision recall curve (PRROC) were obtained to assess predictive accuracy. Results In poisson regression analysis (n=4918), TUG predicted recurrent falls independent of covariates including UGS (IRR=1.06, 95% CI: 1.01, 1.12, p<0.05). The random forest model predicted 60.82% of participants correctly (61.85% of non-fallers; 55.37% of fallers). AUC was 0.63 and PRROC was 0.28. Conclusion Impaired mobility i.e. slower TUG performance, is an independent predictor of future recurrent falls, however it does not discriminate well between fallers and non-fallers. This is highlighted by the PRROC which provides a more conservative estimate of predictive accuracy than AUC as it accounts for the ability to identify both fallers and non-fallers. The analysis highlights the multifactorial nature and complexity of falls, and supports the need for comprehensive falls assessment. [ABSTRACT FROM AUTHOR]

Background The patient profile in a 160-bed rehabilitation hospital is evolving with increasing numbers of older adults admitted with falls and frailty. In 2018 a snapshot audit revealed over 60% of patients obtained scores indicative of cognitive impairment. Traditional falls prevention education delivered in a group format relies on attendees having an adequate level of sensory registration and cognitive abilities to comprehend and recall information given. The Occupational Therapists (OTs) proposed greater benefits from caregiver inclusion in such education to enhance understanding for both patients and caregivers on falls prevention and home environment modifications to facilitate safer home discharges. Methods A mixed-methods design was used. Quantitative data was gathered using a pre and post education 10-point Likert scale to assess attendees' perceived knowledge in four domains: (1) Falls risk factors (2) Modifiable environmental factors (3) Managing falls (4) Accessing support/information to reduce risk of falls Qualitative data was gathered through written feedback. Referrals were generated by OTs. Evening sessions facilitated increased caregiver attendance. OTs delivered a 45 minute PowerPoint presentation, demonstrated adaptive equipment and engaged in discussion with attendees. Information packs were provided to caregivers including a Home Safety Assessment Tool to aid with home environment modification. Results Data from April 2018-2019 was analysed using Microsoft Excel. 21 groups were facilitated with 385 attendees overall. Average percentage increase in knowledge in each of the four domains was 30%. Overall knowledge increased by 32%. Conclusion Increased knowledge of modifiable falls risk factors and supporting persons at risk of falls in the home was demonstrated. OTs reported reduced caregiver concerns regarding home environment modification. Home assessments completed after group attendance found caregivers had implemented recommendations made in the presentation. Further data could be collected to measure the degree of environmental modification completed prior to OT home assessments. Additional qualitative data is required to fully assess benefits to both patients and caregivers. [ABSTRACT FROM AUTHOR]