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Vol. 56, No. 2, 2010
Issue release date: March 2010
Gerontology 2010;56:190–199

Validation of the Falls Efficacy Scale and Falls Efficacy Scale International in Geriatric Patients with and without Cognitive Impairment: Results of Self-Report and Interview-Based Questionnaires

Hauer K. · Yardley L. · Beyer N. · Kempen G. · Dias N. · Campbell M. · Becker C. · Todd C.
aGeriatric Department, Robert Bosch Krankenhaus, Stuttgart, and bBethanien-Krankenhaus, University of Heidelberg, Heidelberg, Germany; cSchool of Psychology, University of Southampton, Southampton, UK; dDepartment of Physical Therapy and Institute of Sports Medicine, Bispebjerg Hospital, Copenhagen, Denmark; eSchool for Public Health and Primary Care, University of Maastricht, Maastricht, The Netherlands; fSchool of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK

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Background: Frail, old patients with and without cognitive impairment are at high risk of falls and associated medical and psychosocial issues. The lack of adequate, validated instruments has partly hindered research in this field. So far no questionnaire documenting fall-related self-efficacy/fear of falling has been validated for older persons with cognitive impairment or for different administration methods such as self-report or interview. Objective: To validate the self-report and interview version of the Falls Efficacy Scale (FES) and the Falls Efficacy Scale International Version (FES-I) in frail geriatric patients with and without cognitive impairment. Methods: 156 geriatric patients in geriatric rehabilitations wards with (n = 75) and without cognitive impairment (n = 81) were included in this study. Reports of fall-related self-efficacy were based on self-reported and interview-based questionnaires. Descriptive statistics, reliability estimates and validation results were computed for the total group and sub-samples with respect to cognitive status, for the 2 different questionnaires (FES/FES-I) and for the 2 administration methods. Test-retest reliability was tested in a subsample of 62 patients. Results: Internal reliability and test-retest reliability were good to excellent in both the FES and FES-I, with the FES-I showing better internal reliability and the FES better test-retest reliability with respect to cognitively impaired persons. The group of cognitively impaired persons tended to show lower test-retest reliability and mean fall-related self-efficacy and had significantly lower completion rates in self-administered questionnaires. As indicated by significant differences in parameters closely related to falls, such as vertigo, functional performances, fear of falling and history of falls, both the FES and the FES-I showed good construct validity. Effect sizes computed for the above-mentioned groups for fall-related parameters confirmed the results of construct validation. Conclusion: Both the FES as well as the FES-I showed good to excellent measurement properties in persons with and without moderate cognitive impairment. In frail older persons, especially in persons with cognitive impairment, an interview-based administration method is recommended.

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  1. Jørstad EC, Hauer K, Becker C, Lamb SE: Measuring the psychological outcomes of falling: a systematic review. J Am Geriatr Soc 2005;53:501–510.
  2. Tinetti ME, Richman D, Powell L: Falls efficacy as a measure of fear of falling. J Gerontol 1990;45:239–243.
  3. Stel VS, Pluijm SMF, Deeg DJ, Smit JA, Bouter CM, Lips P: A classification tree for predicting recurrent falling in community-dwelling older persons. J Am Geriatr Soc 2003;51:1356–1364.
  4. Yardley L, Todd C, Beyer N, Hauer K, Kempen G, Piot-Ziegler C: Development and initial validation of the Falls Efficacy Scale International (FES-I). Age Ageing 2005;34:614–619.
  5. Tinetti ME, Baker DI, McAvay G Claus, Garret P, Gottschalk M, Koch ML, Trainor K, Horwitz RI: A multi-factorial intervention to reduce the risk of falling among elderly people living in the community. N Engl J Med 1994;331:821–827.
  6. Wolf SL, Barnhart HX, Kutner NG, McNeely E, Coogler C, Xu T: Reducing frailty and falls in older persons: an investigation of Tai Chi and computerized balance training. Atlanta FICSIT Group. Frailty and Injuries: Cooperative Studies of Intervention Techniques. J Am Geriatr Soc 1996;44:489–497.
  7. Kempen G, Todd C, van Haastregt J, Zijlstra R, Beyer N, Freiberger E, Hauer K, Piot-Ziegler C, Yardley L: Cross-cultural validation of the Falls Efficacy Scale International (FES-I) in older persons living in the community. Results from Germany, the Netherlands and the United Kingdom were satisfactory. Disabil Rehabil 2007;29:155–162.
  8. Morris JC, Rubin EH, Morris EJ, et al: Senile dementia of the Alzheimer type: an important risk factor for serious falls. J Gerontol 1987;42:412–417.
  9. Buchner DM, Larson EB: Falls and fractures in patients with Alzheimer-type dementia. JAMA 1987;257:1492–1497.
  10. Lord S, Sherrington C, Menz HB: Falls in Older People. Cambridge, Cambridge University Press, 2001, p 68.
  11. Baker BR, Duckwort T, Wilkes E: Mental state and other prognostic factors in femoral fractures in the elderly. J R Coll Gen Pract 1978;28:557–559.
  12. Hauer K, Becker C, Lindemann U, Beyer N: Effectiveness of physical training on motor performance in cognitively impaired persons: a systematic review. Am J Phys Med Rehabil 2006;85:847–857.
  13. Hauer K, Jorstad EC, Lamb SE, Todd C, Becker C: Systematic review of definitions and methods of measuring falls in randomized controlled fall prevention trials. Age Ageing 2006;35:5–10.
  14. McHorney CA, Kosinski M, Ware JE Jr: Comparison of costs and quality norms for the SF-36 health survey collected by mail versus telephone interview. Results from a national survey. Med Care 1994;32:551–567.
  15. Coyne KS, Margolis MK, Gilchrist KA, Grandy SP, Hiatt WR, Ratchford A, Revicki DA, Weintraub WS, Regensteiner JG: Evaluating effects of methods of administration on walking impairment questionnaire. J Vasc Surg 2003;38:296–304.
  16. Durant LE, Carey MP: Self-administered questionnaires versus face-to-face interviews in assessing sexual behavior in young women. Arch Sex Behav 2003;29:309–322.
  17. Sullivan LS, Dukes KA, Harris L, Dittus RS, Greenfield S, Kaplan SH: A comparison of various methods of collecting self-reported health outcomes data among low-income and minority patients. Med Care 1995;33(suppl):AS183–AS194.
  18. Cummings SR, Nevitt MC, Kidd S: Forgetting falls. The limited accuracy of recall of falls in the elderly. J Am Geriatr Soc 1988;36:613–616.
  19. Parker SG, Peet SM, Jagger C, Farhan M, Castleden CM: Measuring the health status in older patients. The SF-36 in practice. Age Ageing 1998;27:13–18.
  20. Parker SG, Bechinger-English D, Jagger C, Spiers N, Lindesay J: Factors affecting completion of the SF-36 in older persons. Age Ageing 2006;35:376–381.
  21. Bedard M, Molloy DW, Guyatt GH, Standish T: Self-administered and interviewer-administered instruments for dementia research. Clin Gerontol 1998;19:25–35.
  22. Novella J, Ankri J, Morrone I, Guillemin F, Jolly D, Jochum C, Ploton L, Blanchard F: Evaluation of the quality of life in dementia with a generic quality of life questionnaire. The Duke Health Profile. Dement Geriatr Cogn Disord 2001;12:158–166.
  23. Folstein MF, Folstein SE, McHugh PR: ‘Mini Mental state’: a practical method for grading the cognitive state of patients for clinicians. J Psychatr Res 1975;21:189–198.

    External Resources

  24. Mahoney FI, Brody EM: Assessment of older people: self-maintaining and instrumental activity of daily living. Gerontologist 1969;9:179–186.
  25. Podsiadlo D, Richardson S: The timed ‘up & go’: a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc 1991;39:142–148.
  26. Maki BE, Holliday PJ, Topper AK: Fear of Falling and postural performance in the elderly. J Gerontol Med Sci 1991;46:M123–M131.
  27. Cohen J: A power primer. Psychol Bull 1992;112:155–159.
  28. Smith SC, Lamping DL, Banerjee S, Harwood R, Foley B, Smith P, Cook JC, Murray J, Prince M, Levin E, Mann A, Knapp M: Measurement of health-related quality of life for people with dementia: development of a new instrument (DEMQOL) and an evaluation of current methodology. Health Technol Assess 2005;9:1–93, iii–iv.
  29. Novella JL, Jochum C, Ankri J, Moronne I, Jolly D, Blanchard F: Measuring general health status in dementia: practical and methodological issues in using SF-36. Aging 2001;13:362–369.
  30. Jørstad-Stein EC, Hauer K, Becker C, Bonnefoy M, Nakash RA, Skelton DA, Lamb SE: Suitability of physical activity questionnaires for older adults in fall-prevention trials: a systematic review. J Aging Phys Act 2005;13:461–481.

    External Resources

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