Development of Taiwan Fall-Risk Screening Tool for Community-Dwelling Older People and a Randomized Controlled Trial of Fall Prevention in the Cognitively Impaired

Although there are considerable studies on incidence, prevalence, and risk factors of falls among older people in Taiwan, only a few on developing the fall-risk assessment and fall-prevention interventions. The fall-risk assessment can help identify risk factors or high-risk groups for effective fall-prevention interventions; however, no common consensus has been agreed on which fall-risk assessment is most appropriate for community-dwelling older people. In addition, current fall-prevention intervention strategies do not work for older people who are cognitively impaired. One of the most important reasons for the unsuccessful may result from the inability of current assessment tools to discriminate between older people with and without cognitive impairment. Hence, it is required for a community fall-risk tool to screen out those who are cognitively impaired and at a high risk of falling. Moreover, little is known on whether computerized cognitive training has an effect on motor functions (e.g., balance and gait) and fall prevention, despite evidence showing that cognitive decline can be improved by the training. This 3-year project aims to develop a fall-risk screening tool appropriate for Taiwanese community older people and identify effective fall-prevention approaches among those with cognitive impairment. In the first year, 320 subjects will be recruited to develop a Taiwan fall-risk screening tool (TaifaScreen) and validate the tool across different older populations. In the second year, clinimetric properties of the TaifaScreen, including practicality, retest reliability, and concurrent and predictive validities, will be compared with other two fall-risk screening tools (FROP-Com Screen and QuickScreen) among 560 subjects. In the third year, a single-blinded randomized controlled trial will be conducted to compare effects of fall-prevention education, computerized cognitive training, and tai chi exercise on falls, balance and gait, fear of falling, and health-related quality of life among 165 (55 for each intervention group) subjects with cognitive impairment. The effect of adherence to the three interventions will be examined as well.