Content area
Abstract
Background: Older adults who sustain falls can face physical, emotional, and financial consequences. Various healthcare professionals are involved in the task of determining which patients are at risk of falling . As specialists of the hearing and balance organ Audiologists can play an integral role in determining which older adults may sustain future falls.
Purpose: 1) To determine the fall risk assessment protocols audiologists used to complete the Physician’s Quality Reporting System (PQRS). 2) The explore the clinical utility of the audiologists reported protocols within an outpatient audiology clinic. 3) To determine the clinical performance of the fall risk assessment protocol in a large otolaryngology practice.
Methods: 1) Distribution of a 43-item survey to practicing audiologists. A total of 55 surveys were collected. Analysis included: descriptive statistics and qualitative analysis of open-ended survey questions. 2) Prospective pilot study (n = 25) of audiologists reported fall risk assessment protocols reported from the survey. Exploratory analysis included: Descriptive Statistics , Pearson Correlations, Chi-Square 2x2 Contingency Table Analysis, Binary Logistic Regression, and Clinical Utility Analysis. 3) Retrospective chart review (n = 52) of older adults who participated in a fall risk assessment protocol at a large otolaryngology clinic. Analysis included the same statistics completed in study 2.
Results: 1) Majority of audiologists did not complete fall risk assessment protocols (45.4%). Of the remaining subsample (n = 21) audiologists reported a variety of case history questions, questionnaires, and functional measures. 2) Across all reported protocols there was a tradeoff in sensitivity and specificity. Protocols 3 and 6 had the highest reported sensitivity (93.0%/100.0%) but low specificity (11.0%/0.0%). 3) Both participant and audiologist related factors appear to influence the clinical performance of fall risk assessment protocols. Protocol 3, 5, and 6 all report sensitivity of 100.0% yet, have poor specificity scores.
Discussion: Between the university clinic setting and the large otolaryngology practice the use of case history questions, with the mCTSIB-bedside, and Dizziness Handicap Inventory had the highest sensitivity. The inability to distinguish between those with and without a history of falls presents increased challenges to allocating appropriate fall risk interventions.
