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Is the Tinetti Performance Oriented Mobility Assessment (POMA) a feasible and valid predictor of short-term fall risk in nursing home residents with dementia?

Published online by Cambridge University Press:  02 December 2009

Carolyn S. Sterke
Affiliation:
De StromenOpmaatGroep, Nursing Home Smeetsland, Rotterdam, The Netherlands. Section of Geriatric Medicine, Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands.
Sawadi L. Huisman
Affiliation:
De StromenOpmaatGroep, Nursing Home Smeetsland, Rotterdam, The Netherlands. Section of Geriatric Medicine, Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands.
Ed F. van Beeck
Affiliation:
Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands.
Caspar W. N. Looman
Affiliation:
Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands.
Tischa J. M. van der Cammen
Affiliation:
Section of Geriatric Medicine, Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands.
Corresponding

Abstract

Background: The feasibility and predictive validity of balance and gait measures in more severe stages of dementia have been understudied. We evaluated the clinimetric properties of the Tinetti Performance Oriented Mobility Assessment (POMA) in nursing home residents with dementia with a specific objective of predicting falls in the short term.

Methods: Seventy-five ambulatory nursing home residents with dementia, mean age 81 ± 8 years, participated in a prospective cohort study. All participants underwent the full POMA-test. Fall statistics were retrieved from incident reports during a three-months follow-up period. The predictive validity was expressed in terms of sensitivity and specificity. Loglinear regression analysis was used to examine the relationship between POMA scores and the occurrence of a fall.

Results: The POMA showed several feasibility problems, with 41% of patients having problems in understanding one or more instructions. The inter-rater reliability of the instrument was good. The predictive validity was acceptable, with a sensitivity of 70–85% and a specificity of 51–61% for the POMA and its subtests, and an area under the curve (AUC) of 0.70 for POMA-Total (95% CI: 0.53–0.81), 0.67 for POMA-Balance (95% CI: 0.52–0.81), and 0.67 for POMA-Gait (95% CI: 0.53–0.81). After loglinear regression analysis, only POMA-T was significant in predicting a fall (adjusted HR = 1.08 per point lower; 95% CI 1.00–1.17).

Conclusions: Application of the POMA in populations with moderate to severe dementia is hampered by feasibility problems. Its implementation in clinical practice cannot therefore be recommended, despite an acceptable predictive validity. To refine our findings, large prospective studies on the predictive validity of the POMA in populations with mild, moderate and severe dementia are needed. In addition, the performance of mobility assessment methods that are less dependent on cognition should be evaluated.

Type
Research Article
Copyright
Copyright © International Psychogeriatric Association 2009

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References

American Geriatrics Society, British Geriatrics Society and American Academy of Orthopaedic Surgeons Panel on Falls Prevention (2001). Guideline for the prevention of falls in older persons. Journal of the American Geriatrics Society, 49, 664672.CrossRefGoogle Scholar
American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorders, 4th edn (DSM-IV-TR). Washington, DC: American Psychiatric Association.Google Scholar
Arcares, Inter-branch Organization Nursing Homes and Care Homes (2002). Incidence Registration System (MIC) (in Dutch). Available at: http://www.arcares.nl.Google Scholar
CBO, Dutch Institute for Healthcare Improvement (2004). Guideline for the Prevention of Fall Incidents in Old Age (in Dutch). Alphen aan den Rijn: Van Zuiden Communications BV.Google Scholar
Cipriany-Dacko, L. M., Innerst, D., Johannsen, J. and Rude, V. (1997). Interrater reliability of the Tinetti balance scores in novice and experienced physical therapy clinicians. Archives of Physical Medicine and Rehabilitation, 78, 11601164.CrossRefGoogle ScholarPubMed
Dijcks, B. P. J., Neyens, J. C. L., Schols, J. M. G. A., van Haastrecht, J. C. M., Crebolder, H. F. J. M. and de Witte, L. P. (2005). Falls in nursing homes: on average almost two per bed per year, resulting in a fracture in 1.3%. Nederlands Tijdschrift voor Geneeskunde, 149, 10431047.Google Scholar
Faber, M. J., Bosscher, R. J. and van Wieringen, P. C. W. (2006). Clinimetric properties of the Performance-Oriented Mobility Assessment. Physical Therapy, 86, 944954.Google ScholarPubMed
Hausdorff, J. M., Rios, D. A. and Edelberg, H. K. (2001). Gait variability and fall risk in community-living older adults: a 1-year prospective study. Archives of Physical and Medical Rehabilitation, 82, 10501056.CrossRefGoogle ScholarPubMed
Hosmer, D. W. and Lemeshow, S. (2000). Applied Logistic Regression, 2nd edn.Chichester: Wiley.CrossRefGoogle Scholar
Kellogg International Work Group on the Prevention of Falls by the Elderly (1987). The prevention of falls in later life: a report of the Kellogg International Work Group on the prevention of falls by the elderly. Danish Medical Bulletin, 34, 124.Google Scholar
Landis, J. R. and Koch, G. G. (1977). The measurement of observer agreement for categorical data. Biometrics, 33, 159174.CrossRefGoogle ScholarPubMed
Lamb, S. E., Jørstad-Stein, E. C., Hauer, K., Becker, C. and the Prevention of Falls Network Europe and Outcomes Consensus Group (2005). Development of a common outcome data set for fall injury prevention trials: the Prevention of Falls Network Europe consensus. Journal of the American Geriatrics Society, 53, 16181622.CrossRefGoogle ScholarPubMed
Lorbach, E. R., Webster, K. E., Menz, H. B., Wittwer, J. E. and Merory, J. R. (2007). Physiological falls risk assessment in older people with Alzheimer's disease. Dementia and Geriatric Cognitive Disorders, 24, 260265.CrossRefGoogle ScholarPubMed
Maastricht University Department of Health Care and Nursing Sciences (2008). The Dutch National Prevalence Survey of Care Problems (LPZ) (in Dutch). Maastricht: Maastricht University.Google Scholar
Nakamura, T., Meguro, K. and Sasaki, H. (1996). Relationship between falls and stride length variability in senile dementia of the Alzheimer type. Gerontology, 42, 108113.CrossRefGoogle ScholarPubMed
Neyens, J. C. et al. (2006). The development of a multidisciplinary fall risk evaluation tool for demented nursing home patients in the Netherlands. BMC Public Health, 6, 74. doi: 10.1186/1471-2458-6-74.CrossRefGoogle ScholarPubMed
O'Keeffe, S. T., Kazeem, H., Phillpott, R. M., Playfer, J. R., Gosney, M. and Lye, M. (1996). Gait disturbance in Alzheimer's disease: a clinical study. Age and Ageing, 25, 313316.CrossRefGoogle ScholarPubMed
Raîche, M., Hebert, R., Prince, F. and Corriveau, H. (2000). Screening older adults at risk of falling with the Tinetti balance scale. Lancet, 356, 10011002.CrossRefGoogle ScholarPubMed
Reisberg, B., Ferris, S. H., de Leon, M. J. and Crook, T. (1982). Global Deterioration Scale for assessment of primary degenerative dementia. American Journal of Psychiatry, 139, 11361139.Google Scholar
Rolland, Y. et al. (2007). Exercise program for nursing home residents with Alzheimer's disease: a 1-year randomized controlled trial. Journal of the American Geriatrics Society, 55, 158165.CrossRefGoogle ScholarPubMed
Russell, M. A., Hill, K. D., Day, L. M., Blackberry, I., Gurrin, L. C. and Dharmage, S. C. (2009). Development of the Falls Risk for Older People in the Community (FROP-Com) screening tool. Age and Ageing, 38, 4046.CrossRefGoogle ScholarPubMed
Shrout, P. E. and Fleiss, J. L. (1979). Intraclass correlation: uses in assessing rater reliability. Psychological Bulletin, 86, 420428.CrossRefGoogle ScholarPubMed
Sterke, C. S., Verhagen, A. P., van Beeck, E. F. and van der Cammen, T. J. M. (2008).The influence of drug use on fall incidents among nursing home residents: a systematic review. International Psychogeriatrics, 20, 890910. doi:10.1017/S104161020800714X.CrossRefGoogle Scholar
Studenski, S. et al. (1994). Predicting falls: the role of mobility and nonphysical factors. Journal of the American Geriatrics Society, 42, 297302.CrossRefGoogle ScholarPubMed
Tinetti, M. E. (1986). Performance-oriented assessment of mobility problems in elderly patients. Journal of the American Geriatrics Society, 3, 119126.CrossRefGoogle Scholar
Tinetti, M. E., Williams, T. F. and Mayewski, R. (1986). Fall risk index for elderly patients based on number of chronic disabilities. American Journal of Medicine, 80, 429434.CrossRefGoogle ScholarPubMed
Tinetti, M. E., Speechley, M. and Gibster, S. F. (1988). Risk factors for falls among elderly persons living in the community. New England Journal of Medicine, 319, 17011707.CrossRefGoogle ScholarPubMed
Tinetti, M. E., Baker, D. I., Garrett, P. A., Gottschalk, M., Koch, M. L. and Horwitz, R. I. (1993). YALE FICSIT: risk factor abatement strategy for fall prevention. Journal of the American Geriatrics Society, 41, 315320.CrossRefGoogle ScholarPubMed
Tromp, A. M., Pluijm, S. M. F., Smit, J. H., Deeg, D. J. H., Bouter, L. M. and Lips, P. (2001). Fall-risk screening test: a prospective study on predictors for falls in community-dwelling elderly. Journal of Clinical Epidemiology, 54, 837844.CrossRefGoogle ScholarPubMed
van Iersel, M. B., Benraad, C. E. and Olde Rikkert, M. G. (2007). Validity and reliability of quantitative gait analysis in geriatric patients with and without dementia. Journal of the American Geriatrics Society, 55, 632634.CrossRefGoogle ScholarPubMed
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Is the Tinetti Performance Oriented Mobility Assessment (POMA) a feasible and valid predictor of short-term fall risk in nursing home residents with dementia?
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