Skip to main content Accessibility help

Feasibility and accuracy of fall reports in persons with dementia: a prospective observational study

  • Tania Zieschang (a1), Michael Schwenk (a1), Clemens Becker (a2), Peter Oster (a1) and Klaus Hauer (a1)...


Background: The feasibility, test-retest reliability, and accuracy of different fall recording methods have not been studied in older persons with dementia.

Methods: This was a prospective observational study, nested within a randomized controlled trial on motor training, in which 110 participants were monitored for falls over 12 months. Seven methods of fall recording were compared: face-to-face interviews; phone interviews: weekly for three months, monthly for 9 months, a final interview after 12 months; prospective calendar method; interviews with a proxy and the general practitioner (GP). Summing the count of falls and removing duplicate reporting of the same fall was found to provide the best approximation of the actual number of falls and was chosen as the criterion-standard.

Results: The combination of calendar method and phone interviews showed the highest accuracy (74% of falls, 93% of fallers). As a single measure, weekly phone calls were superior to calendars or proxy-report. Monthly phone calls recorded only half the falls that were picked up by weekly calls (p = 0.002) and were inferior to the calendars (p<0.001) and proxy-report (p = 0.015). GPs knew of only 14% of falls and 19% of fallers. In addition, 49% of subjects who documented a fall prospectively did not recall a fall after 12 months.

Conclusion: The combination of fall calendars with regular telephone interviews can be recommended for persons with mild to moderate stage dementia. If feasible, recall periods should be as short as one week; additional information by care-givers increases accuracy of reports. Retrospective recall of falling with long recall periods is not recommended.


Corresponding author

Correspondence should be addressed to: Tania Zieschang, MD, Agaplesion Bethanien Hospital, Centre of Geriatric Medicine at the University of Heidelberg, Rohrbacher Str. 149, 69126 Heidelberg, Germany. Phone: +49–6221-3191746; Fax: +49–6221-3191505. Email:


Hide All
Allan, L. M., Ballard, C. G., Rowan, E. N. and Kenny, R. A. (2009). Incidence and prediction of falls in dementia: a prospective study in older people. PloS ONE. 4, e5521.
American Geriatrics Society (2001). Guideline for the prevention of falls in older persons. (American Geriatrics Society, British Geriatrics Society, and American Academy of Orthopedic Surgeons Panel on Falls Prevention). Journal of the American Geriatrics Society, 49, 664772.
Bourke, A. K. et al. (2010). Evaluation of waist-mounted tri-axial accelerometer based fall-detection algorithms during scripted and continuous unscripted activities. Journal of Biomechanics, 43, 30513057.
Cicchetti, D. V. and Sparrow, S. A. (1981). Developing criteria for establishing interrater reliability of specific items: applications to assessment of adaptive behavior. American Journal of Mental Deficiency, 86, 127–37.
Cumming, R. G., Kelsey, J. L. and Nevitt, M. C. (1990). Methodological issues in the study of frequent and recurrent health problems: Falls in the elderly. Annals of Epidemiology, 1, 4956.
Cummings, S. R., Nevitt, M. C. and Kidd, S. (1988). Forgetting falls: the limited accuracy of recall of falls in the elderly. Journal of the American Geriatrics Society, 36, 613616.
Fleming, J., Matthews, F. E. and Brayne, C. (2008). Falls in advanced old age: recalled falls and prospective follow-up of over-90-year-olds in the Cambridge City over 75s Cohort study. BMC Geriatrics, 8, 6.
Folstein, M. F., Folstein, S. E., McHugh, P. R. (1975). “Mini-mental state”: a practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189198.
Ganz, D.A., Higashi, T. and Rubenstein, L. Z. (2005). Monitoring falls in cohort studies of community-dwelling older people: effect of the recall interval. Journal of the American Geriatrics Society, 53, 21902194.
Hale, W. A., Delaney, M. J. and Cable, T. (1993). Accuracy of patient recall and chart documentation of falls. Journal of the American Board of Family Practice, 6, 239242.
Hannan, M.T. et al. (2010). Optimizing the tracking of falls in studies of older participants: comparison of quarterly telephone recall with monthly falls calendars in the MOBILIZE Boston study. American Journal of Epidemiology, 171, 10311036.
Hauer, K., Lamb, S.E., Jorstad, E.C., Todd, C. and Becker, C. (2006). Systematic review of definitions and methods of measuring falls in randomized controlled fall prevention trials. Age and Ageing, 35, 510.
Hauer, K. et al. (2010). 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. Gerontology, 56, 190199.
Hill, A.-M. et al. (2010). Measuring fall events in acute hospitals: a comparison of three reporting systems to identify missing data in the hospital reporting system. Journal of the American Geriatrics Society, 58, 13471352.
Hüger, D., Zieschang, T., Schwenk, M., Oster, P., Becker, C. and Hauer, K. (2009). Designing studies on the effectiveness of physical training in older adults with cognitive impairment. Zeitschrift für Gerontologie und Geriatrie, 42, 1119.
Kanten, D. N., Mulrow, C. D., Gerety, M. B., Lichtenstein, M. J., Aguilar, C. and Cornell, J. E. (1993). Falls: An examination of three reporting methods in nursing homes. Journal of the American Geriatrics Society,41, 662666.
Kellogg International (1987). The prevention of falls in later life (Kellogg International Work Group on the Prevention of Falls by the Elderly). Danish Medical Bulletin, 34, 124.
Kiyak, H. A., Teri, L. and Borson, S. (1994). Physical and functional health assessment in normal aging and in Alzheimer's disease: self-reports vs. family reports. The Gerontologist, 34, 324330.
Lamb, S. E., Jorstad-Stein, E. C., Hauer, K. and Becker, C. (2005). Development of a common data set for fall injury prevention trials: The Prevention of Falls Network Europe consensus. Journal of the American Geriatrics Society, 53, 16181622.
Landis, J. R. and Koch, G. G. (1977). The measurement of observer agreement for categorical data. Biometrics, 33, 159174.
McKhann, G., Drachman, D., Folstein, M., Katzmann, R., Price, D. and Stadlan, E. M. (1984). Clinical diagnosis of Alzheimer's disease: report of the NINCDS-ADRDA work group under the auspices of Department of Health and Human Services Task Force on Alzheimer's Disease. Neurology, 34, 939944.
Morris, J.C., Mohs, R.C., Rogers, H., Fillenbaum, G. and Heyman, A. (1988). Consortium to establish a registry for Alzheimer's disease (CERAD) clinical and neuropsychological assessment of Alzheimer's disease. Psychopharmacological Bulletin, 24, 641652.
Novella, J. L. et al. (2001). Evaluation of the quality of life in dementia with a generic quality of life questionnaire: the Duke Health Profile. Dementia and Geriatric Cognitive Disorders, 12, 158166.
Parry, S. W., Steen, N., Baptist, M. and Kenny, R. A. (2005). Amnesia for loss of consciousness in carotid sinus syndrome. Journal of the American College of Cardiology, 45, 18401843.
Peel, N. (2000). Validating recall of falls by older people. Accident Analysis and Prevention, 32, 371372.
Roman, G. C. et al. (1993). Vascular dementia: diagnostic criteria for research studies. Report of the NINDS-AIREN International Workshop. Neurology, 43, 250260.
Rubenstein, L. Z. et al. (2004). Detection and management of falls and instability in vulnerable elders by community physicians. Journal of the American Geriatrics Society, 52, 15271531.
Teri, L. and Wagner, A. W. (1991). Assessment of depression in patients with Alzheimer's disease: concordance among informants. Psychology and Aging, 6, 280285.
van Doorn, C. et al. (2003). Dementia as a risk factor for falls and fall injuries among nursing home residents. Journal of the American Geriatrics Society, 51, 12131218.
Yardley, L. et al. (2006). Older people's view of falls-prevention interventions in six European countries. The Gerontologist, 46, 650660.


Feasibility and accuracy of fall reports in persons with dementia: a prospective observational study

  • Tania Zieschang (a1), Michael Schwenk (a1), Clemens Becker (a2), Peter Oster (a1) and Klaus Hauer (a1)...


Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed