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ACTIONS FOR POLICY AND IMPLEMENTATION

Tools which inform care decisions require careful assessment for their current validity and effectiveness.

PH-FRAT need to be updated to reflect the current aged care population profile by incorporating any relevant factors or replaced by other appropriate tools.

Given risk factors for falls change over time in long-term care settings, residential aged care facilities should focus on the use of dynamic fall risk predictive tools, which may serve to better identify residents at risk of falls.

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RESEARCH CONTEXT

The Peninsula Health Falls Risk Assessment Tool (PH-FRAT) is a widely used tool in Australian residential aged care facilities (RACFs). The tool is used for the identification of individuals at risk of falls and management strategies for reducing fall risk. The PH-FRAT was developed over 20 years ago using a small sample of about 300 individuals from a single site receiving subacute and residential aged care services. Despite its widespread use, there has been little evidence of its effectiveness in predicting falls in long-term settings such as RACFs. This study aimed to understand the extent of use and the performance of PH-FRAT in predicting the occurrence of falls using a large routinely collected aged care data.

The study included nearly 6000 residents from 25 RACFs in metropolitan Sydney, News South Wales. The uptake of PH-FRAT was high with 9 of 10 eligible residents receiving at least one assessment. However, the tool demonstrated a poor predictive performance. It accurately predicted a fall (within six months of PH-FRAT assessment) in only 33.6% of residents. The area under the curve, one of the key performance measures, was only 0.57 indicating poor performance.

The poor performance of PH-FRAT raises concerns about its value in RACFs and whether it may be contributing to misleading care decisions. This has important safety implications as incorrect risk profiling may be preventing some residents from gaining access to necessary fall prevention interventions.

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