This chapter will explore the data obtained from the client records of men aged 65 to 74 years old relative to their risk of falls, with demographic data including participants age and ethnicity.
An analysis of participants’ individual clinician-assessed falls risk level and self-assessment of falls risk is presented at time point one (on assessment) and time point two (on discharge) to determine the research question; ‘Is there is a relationship between the clinician-assessed falls risk and self-assessed confidence in completing ADLs without falling?’.
The standardised assessments, as mentioned in Chapter 3, include the TUG, 30-second sit to stand test, and the 4-stage balance test. These assessments will indicate an individual’s overall risk of falls and will be referred to at both time point one and time point two. The combined assessments have been abbreviated to ‘CA-1’ (clinician-assessed overall falls risk at time point one) and ‘CA-2’ (for time point two). Participants’ self-assessed mFES score are abbreviated to ‘SA-1’ (self-assessed confidence in completing ADLs without falling at time point one) and
‘SA-2’ (at time point two).
4.1- Demographic data analysis
Demographic data recorded included each participant’s age and ethnicity. The total sample population consisted of 3011 participants but after excluding females (n= 1912) and males below 65 years old or above 74 years old (n= 1031), 68 male participants remained.
The data collected from participants sampled was obtained between 2018 to 2022. Data was only obtained and analysed if participants had completed the falls intervention with the private health company and completed the standardised assessments and self-rated assessments upon commencement and completion of the intervention. The dates of referral included in the research ranged from January 2018 to July 2021.
The participant’s age range was from 65 to 74 years old, with the average participant age being 71 (see Figure 4). Of the total number of participants, 76% (n=52) were aged 70 to 74 and only 24% of participants (n= 16) from 65 to 69 years old.
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Participants age
Note. N = number of participants; SD = standard deviation.
A breakdown of ethnicities show that NZ European/ Pakeha comprised of 50% of the population sampled, followed by Indian (11.8%), Māori (10.3%), and Pacifika (8.9%) (see Table 4).
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Ethnicity
N %
NZ European/ Pakeha 34 50.0
Indian 8 11.8
NZ Māori 7 10.3
Pacifika 6 8.9
(Cook Island Māori) 1 1.5 (Pacific Island not further defined) 1 1.5
(Samoan) 3 1.5
(Tongan) 1 1.5
Asian 6 8.9
(Asian not further defined) 1 1.5
(Chinese) 1 1.5
(Other Asian) 2 2.9
(Southeast Asian) 2 2.9
Other European 5 7.4
Fijian 2 2.9
Total 68 100.0
Note. N = number of participants; % = percentage of participants.
4.2- Time Point One
4.3- Falls risk: Clinician-assessed (CA-1)
Participants completed three falls risk assessments, the Timed Up and Go, the 30-second sit to stand test, and the four-stage balance test, which was assessed by the clinician at time point one (CA-1). The individual falls risk assessments analysed lower extremity function, mobility, leg strength, endurance, and static balance showed the participants who passed all three tests were classified as being at no risk of falls. If they failed, they were classified as being at low, medium, or high risk of falls.
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Participants scoring ≥ 12 seconds in the TUG test were classified as being at risk of falls (see Figure 1). At CA-1 the average time recorded for participants to complete the TUG test was 24.3 seconds (SD= 16.1). Only 19.1% of participants (n= 13) were able to complete the TUG in under 12 seconds at time point one and were classified as no risk of falls. One participant was unable to finish the test and scored a zero, and 3% of participants (n= 2) did not take the test.
The 30-second sit to stand test scores were matched against the individual’s age group (see Figure 2). At CA-1, only 5.9% (n= 4) of participants were able to score ≥ 12 stands in 30 seconds and were classed as no risk of falls. Further analysis was completed to review participant’s score in the two age groups mentioned above. From the four participants who were classed as no risk of falls following the 30-second sit to stand test, only one participant was aged between 65-69 years old and the remaining three participants who were classed as no risk of falls were from 70-74 years old.
The four-stage balance test requires participants to achieve either a tandem hold or a one-legged hold for ten seconds without moving their feet or requiring support to be classified as no risk of falls (see Figure 3). If a participant cannot progress to either a tandem or one-legged stance, they are classified as being at risk of falling. At CA-1, 30.9% (n= 21) of participants were classified as no risk of falls, with 23.5% achieving a tandem stance and 7.4% achieving a one- legged stance. Of the participants who failed the test, 57.3% of participants (n= 39) were only able to complete a parallel stance or semi-tandem stance, with roughly 12% of participants (n=
8) either unable to complete the test or had missing data.
4.4- Overall falls risk levels
The four-point scale, as proposed in 3.7.2 (see Table 1) was used to estimate each participant’s level of risk at CA-1. For participants who passed all three tests received a zero score, indicating no risk of falls. If they failed only one test, they were assigned a 1 indicating low risk, 2 indicating medium risk, and 3 indicating high risk (see Table 1).
At CA-1, 97.1% of participants (n= 66) completed all three clinician-assessed falls risk assessments (see Table 5). More than half of participants, 54.4% (n= 37) were assessed as high risk of falls, followed by 32.4% of participants (n= 22) being assessed as medium, and 7.4%
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of participants (n= 5) assessed as low risk of falls, with only 2.9% of participants (n=2) classified as no risk of falls.
Table 5
Overall risk levels at time point one
Time Point One N %
No risk 2 2.9
Low risk 5 7.4
Medium risk 22 32.4
High risk 37 54.4
Total 66 97.1
Missing 2 2.9
Total 68 100.0
Note. N = number of participants; % = percentage of participants.
Overall, the results highlight that the majority of participants at CA-1 had a medium to high risk of falls.
4.5- Activities of Daily Living: Self-assessed (SA-1)
As discussed in 3.7.3, participants were asked to score their confidence in completing each of the 14 activities of daily living (ADLs) without falling using the mFES assessment at SA-1 (self-assessed at time point one).
In relation to the ten basic ADLs assessed, participants rated basic ADL 5 as the highest mean score activity to complete without falling, scoring a mean of 7.7 out of 10 by 97.1% of participants (n=66). The lowest basic ADL score was ADL 9, scoring a mean of 5.4 by 86.8%
of participants (n=59). Six basic activities (ADLs 1, 2, 4, 5, 6, and 7) scored a mean of ≥ 7 in confidence with the remaining 4 basic ADLs (ADLs 3, 8, 9, and 10) scoring a mean of 5 or 6 in confidence levels (see Table 10).
When reviewing the four complex ADLs, the highest mean score rated was ADL 12, scoring 5.5 out of 10 by 89.7% of participants (n= 61) while ADL 13 scored the lowest mean scores averaging 4.4 out of 10 and completed by 79.4% of participants (n= 54). The complex ADL scores ranged between 4 and 5 out of 10, indicating participants were either fairly confident or
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just less than fairly confident, but not as confident as the basic ADLs. Participants were also less likely to answer the complex ADL questions which will have contributed to skewed results.
Analysing the mean scores of all ADLs, basic ADL 5 remained the highest rated activity, while complex ADL 13 remained the lowest scoring ADL. Participants rated their confidence as 6.1 on average from all 14 ADLs and were classified as being fearful of falling as the scores overall were ≤ 8 out of 10.
Table 6
Activities of Daily Living on the modified Falls Efficacy Scale
ADL Mean % N
Basic 1 Get dressed or undressed 7.3 97.1 66
Basic 2 Prepare a simple meal 7.0 94.1 64
Basic 3 Take a bath or a shower 6.7 97.1 66
Basic 4 Get in/out of a chair 7.3 95.6 65
Basic 5 Get in/out of bed 7.7 97.1 66
Basic 6 Answer the door or telephone 7.3 97.1 66
Basic 7 Walk around the inside of your house 7.1 95.6 65
Basic 8 Reach into cabinets or closets 6.1 97.1 66
Basic 9 Light housekeeping 5.4 86.8 59
Basic 10 Simple shopping 6.1 92.6 63
Complex 11 Using public transportation 4.4 73.5 50
Complex 12 Crossing roads 5.5 89.7 61
Complex 13 Light gardening or hanging out washing 4.2 79.4 54 Complex 14 Using the front or rear steps at home 5.3 91.2 62
Overall Score 6.1
Note. N = number of participants; % = percentage of participants.
Overall, the analysis of ADLs have provided insightful data into how participants view their confidence in completing activities without falling. At SA-1, the mean average of 6.1 from participants scores indicates that participants are fearful of falling. The aim of the next section is to now analyse the scores indicated from both CA-1 and SA-1 to answer the research question.
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4.6- Analysing participants risk levels and the mean mFES score
The following figure (Figure 5) shows the collated comparison of the CA-1 falls risk level (see Table 5) against participants mean total of their individual SA-1 scores (see Table 6). For example, one participants total SA-1 score was 9 out of 10, and their CA-1 score was classified as low risk, so they are represented as the individual blue box on the ‘x’ axis of Figure 5. The CA-1 falls risk level has been categorised into four colours to represent the risk level, with blue as no risk, red as low risk, purple as medium risk, and green as high risk. The ‘x’ axis represents the average mFES score each participant rated themselves as at the start of assessment, with 1 being low confidence, and 10 being high confidence in completing the ADLs without falling.
The ’y’ axis represents the number of participants on an even-numbered scale.
Figure 5
Comparison of overall risk level and participants mean mFES scores
Participants who were assessed as no risk (n=2) in the CA-1 falls risk (see Table 5) have rated their confidence of completing ADLs without falling as high. Both of the ratings were above 8 or higher on the mFES scale, with a score of ≥ 8 deeming participants as being fearless of completing ADLs without falling. These results identify that there is a relationship between the two participants who completed the SA-1 and how they scored through the CA-1 falls risk. The
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participants assessed as low risk of falls (n= 5) have scored their confidence of completing ADLs without falling in the mid to upper confidence levels, from 6 out of 10 to 9 out of 10.
Three participants assessed their confidence as 8 or higher on the mFES scale, which is classified as being unfearful of falling, whilst two participants assessed their confidence as 6 or 7 out of 10 on the mFES assessment which is classified as being fearful of falling (see Figure 6).
Participants assessed as medium risk (n= 22) have rated their confidence variably across the mFES scale, although rated no lower than a 3 in confidence. Whilst participants were clinically assessed as high risk (n= 37) and self-assessed as low in confidence, there were seven participants who rated themselves as 8 or higher on the mFES. This indicates that they felt confident in completing ADLs without falling despite being assessed at high risk of falls (see Figure 6).
The participants assessed as no risk and low risk appears to be proportionally distributed on the graph, although the medium risk and high risk individuals are less evenly distributed.
4.7- Conducting Spearman’s correlation analysis
A statistical analysis using Spearman’s correlation was conducted to ascertain if the CA-1 rating correlated to participants mean score at SA-1. The results provided below are both overall scores (see Table 7) and individual ADL questions in the mFES. The correlations that can be achieved in this study, as discussed in chapter 3 (Table 3), range between -.00 to -1. A strong correlation between CA-1 and SA-1 is indicated as the number increases closer to a -1 score. The closer the number is to -1, the stronger the relationship is between the two variables.
After analysing the general trend of the CA-1 overall risk level and SA-1 mean scores on Figure 5, a Spearman’s correlation analysis was completed to understand if there was a correlation, or relationship, between the two variables and to what extent.. The Spearman’s correlation at time point one is -.419 (see Table 7), revealing a low negative correlation relationship (see Table 3) between CA-1 and SA-1. The correlation has a strong statistical significance of p = <.001 that indicates there is a less than 0.1% chance the calculation of -.419 is inaccurate or by chance (see Table 7). The CA-1 has been completed by 97% of all participants (n= 66) in the research, with the SA-1 completed by 96% of participants (n= 65).
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Spearman’s correlation comparing mFES score and overall risk level
Risk mFES Score
Risk r 1.000 -.419**
p . <.001
N 66 65
mFES Score r -.419** 1.000
p <.001 .
N 65 66
**. Correlation is significant at the 0.01 level (2-tailed).
Note. r = Spearman’s correlation coefficient; p = significance value; N = number of participants
4.8- Analysing overall risk level to individual Activities of Daily Living
The Spearman’s correlation analysis identifies that there is a relationship between CA-1 for men compared to their SA-1 confidence in completing ADLs without falling, with a low negative correlation (-.419) at time point one. Following this, a further analysis of participant’s individual ADL scores has been completed against their overall falls risk to provide further insight into the relationship CA-1 and SA-1 scores. All 14 ADLs have been analysed to understand this relationship more comprehensively (see Table 8) and ranked in order from highest correlated CA-1 and SA-1 scores to the lowest.. From an understanding that there is a low negative relationship between the two variables at time point one, analysing what ADLs equated to higher correlations and what ADLs equated to lower or no correlations can support clarity of participants confidence levels in each ADL.
Initially, it becomes evident that only two ADLs equated to a moderate negative correlation, and more than half of the ADLs failed to achieve a correlating relationship (see Table 8).
Examining the ADLs closer, one basic ADL (10) of ‘simple shopping’ and one complex ADL (13) of ‘light gardening or hanging out the washing’ achieved this moderate negative correlation, -.572 and -.508 consecutively. The outcome of the two ADL results was reinforced with a statistically significant correlation of p = <.001. The correlations indicate that there was a reasonable relationship between participants confidence levels in completing the two ADLs and their level of falls risk and this outcome was not by chance. Reflecting the moderate negative relationship, Table 6 highlights participants overall mean score of ADL 10 as 6.1, slightly above fairly confident, and the average score of ADL 13 as 4.2, slightly under fairly
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confident on the mFES scale. Subsequently, four ADLs achieved a low negative correlation, with these divided evenly between basic and complex ADLs. ADL 7 of ‘walk around the inside of your house’ scored -.358 (p = .004) and ADL 8 of ‘reach into cabinets or closets’ scoring - .312 (p = 0.12) (see Table 8). Whilst both of these ADLs achieved a low negative correlation, they both were statistically significant at a 0.01 level. The low negative correlation indicates that there is a relationship between the four ADLs and their clinician-assessed falls risk levels.
Lastly, the correlation of individual ADLs highlights eight ADLs failed to achieve a correlation and are classified as negligible correlations, meaning there is no relationship between the two variables). All of the ADLs were basic activities except for ADL 14, a complex ADL of ‘using front or rear steps at home’ which achieved a -.242 correlation outcome (see Table 8).
Table 8
Spearman’s correlation of risk level compared to individual ADLs
ADL r p N Rank
Basic 1 Get dressed or undressed -.254* .043 64 8
Basic 2 Prepare a simple meal -.186 .149 62 14
Basic 3 Take a bath or a shower -.225 .074 64 12
Basic 4 Get in/out of a chair -.192 .131 63 13
Basic 5 Get in/out of bed -.298** .017 64 7
Basic 6 Answer the door or telephone -.244 .052 64 9
Basic 7 Walk around the inside of your house -.358** .004 63 5 Basic 8 Reach into cabinets or closets -.312** .012 64 6
Basic 9 Light housekeeping -.244 .068 57 10
Basic 10 Simple shopping -.572** <.001 61 1
Complex 11 Using public transportation -.459** .001 48 3
Complex 12 Crossing roads -.442** <.001 59 4
Complex 13 Light gardening or hanging out washing -.508** <.001 52 2 Complex 14 Using the front or rear steps at home -.242 .060 60 11
*. Correlation is significant at the 0.05 level (2-tailed).
**. Correlation is significant at the 0.01 level (2-tailed).
Note. r = Spearman’s correlation coefficient; p = significance value; N = number of participants
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Analysing the individual ADLs provided an insightful examination into answering the research question as while it was established there is a relationship between CA-1 and SA-1, this relationship consisted of only six ADLs out of the 14 ADLs reviewed. The analysis also raised awareness into the complex ADLs participants assessed and the relationship this has with a participants overall falls risk.
4.9- Time Point Two
4.10- Falls risk: Clinician-assessed (CA-2)
At time point two, the same falls risk assessments as at time point one have been analysed (TUG, 30-second sit to stand test, and the 4-stage balance test) to discuss the participants individual falls risk level. The clinician-assessed falls risk assessments at time point two will be referred to as ‘CA-2’ and self-assessed confidence in completing ADLs without falling will be referred to as SA-2. The results of each falls risk assessment will be discussed and any participants who were unable to pass one or more of the assessments have been classified as being at risk of falls.
Participants were classified as being at falls risk if they were unable to score ≤12 seconds on the TUG test (see Figure 1). At CA-2, the average time recorded was 24.2 with a standard deviation of 25.6 seconds and the maximum recorded time was 152 seconds. A total of 27% of participants (n=18) were able to complete the TUG in under 12 seconds, with 3% of participants (n= 2) being unable to complete the test and 9% of participants (n= 6) did not complete the test.
At CA-2, participants were asked to complete the 30-second sit to stand test, with their number of stands scored within their age bracket (see Figure 2). Overall, 22% of participants were classified as no risk of falls (n= 15). Of the 15 participants who were classed as no risk of falls, three participants were aged between 65-69 years old, with the 12 participants aged between 70-74 years old. Additionally, only one participant was able to complete 17 stands in 30 seconds, with the participants age as 71 years old, with the remaining 14 participants scoring between 12 and 15 in the test.
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Participants were asked to hold one stance at a time for 10 seconds before moving on to the next stance, completing up to four stances (see Figure 3). At CA-2, 52.9% of participants (n=
36) were able to complete either a tandem stance or one-legged stance and were classified as having no risk of falls for the four-stage balance test. Of the remaining participants, 30.9% (n=
21) were only able to hold a semi-tandem stance or parallel stance, while 16.2% (n= 11) were unable to complete the test or had a missing data set.
4.11- Overall falls risk levels
At CA-2, the categorised order of participants level of risk remained the same as time point one, from participants being assessed at high risk of falls through to no risk of falls, however, the number of participants assessed into each category were close to one another (see Table 9).
Participants classified as high risk reduced to 32.4%, followed closely by medium risk at 26.5%, a 5.9% decrease from assessment to discharge. Approximately 58.9% of participants were classed as high or medium risk of falls, one quarter of participants were assessed as low risk at 25.0%, and participants classified as no risk improved from 2.9% to 8.8% (see Table 9).
Table 9
Overall risk levels at time point two
Time Point One N %
No risk 6 8.8
Low risk 17 25.0
Medium risk 18 26.5
High risk 22 32.4
Total 63 92.6
Missing 5 7.4
Total 68 100.0
Note. N = number of participants; % = percentage of participants.
The results at CA-2 has demonstrated the relationship between how individuals were assessed for individual falls risk assessments before explaining how the scores were combined, using a Likert scale, to highlight individuals overall risk levels at time point two.