Background: Accidental falls are a major cause of disability and death in older adults. However, the reliability of instruments designed to estimate the risk of future falls has not been adequately established in community dwellers.
Methods: Departing from a previous cross-sectional study of older adults living in rural Ecuador that estimated the potential risk of future falls, we carried out a prospective longitudinal study to assess the reliability of the Downton Fall Risk Index (DFRI) as a predictor of incident falls during three years of follow-up.
Results: Of 254 individuals, 158 (62%) experienced incident falls. The mean score of the baseline DFRI was 1.6±1.3 points, with 54 (21%) individuals showing an increased risk for future falls (DFRI score ≥3 points). Forty-seven of the 54 individuals with a positive DFRI had incident falls as opposed to 111/200 individuals with a negative DFRI (p<0.001). An adjusted logistic regression model found that individuals with a positive DFRI have a fivefold increase in incident falls compared with those having a negative DFRI (OR: 4.91; 95% C.I.: 1.94 – 12.4). Receiver operator characteristics curve analysis showed an area under the curve (AUC) of 0.612 (95% C.I.: 0.568 – 0.657) for a positive DFRI to predict incident falls. However, the AUC for the predictive value of incident falls given a history of previous falls (as a single variable) was 0.908 (95% C.I.: 0.875 – 0.942).
Conclusions: The DFRI has only a moderate predictive value for the occurrence of incident falls that is surpassed by that of previous falls.
