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The Falls Behavioural (FaB)
Scale for the Older Person
Instruction manual
Lindy Clemson, Robert G. Cumming,
& Robert Heard
2003
The University of Sydney
School of Occupation & Leisure Sciences
Faculty of Health Sciences
PO Box 170
Lidcombe NSW 1825
Facsimile: +61 2 9351 9166
Email:
L.Clemson@fhs.usyd.edu.au
http://www.ot.fhs.usyd.edu.au/publications.html
i
Acknowledgements
Thanks to Katrina McDonald and Tania Perry for reporting on the
usefulness of the FaB Scale for the Older Person in their occupational
therapy practice.
ISBN: 1 86487 5763
© Clemson, Cumming & Heard 2003
Freely copy this Instruction Manual and the FaB Scale for Older
People on condition that the work is attributed to the authors and is
not changed in any way without the author’s permission.
Available University web site:
http://www.ot.fhs.usyd.edu.au/publications.html
ii
iii
Contents
ACKNOWLEDGEMENTS I
INTRODUCTION 1
ADMINISTRATION 2
Instructions 2
Coding guidelines 3
INTERPRETATION OF SCORES 4
Comparative scores 5
Factor sub-scales 5
Limitations 6
RELIABILITY AND VALIDITY 6
Reliability 6
Validity 7
APPLICATIONS 8
REFERENCES 10
APPENDIX A
Test-retest reliability for FaB items and fab factor scales 11
APPENDIX B
Table of factor coefficient loadings 12
APPENDIX C
The Falls Behavioural
Scale (FaB) for Older People 13-1
iv
1
Introduction
The Falls Behavioural (FaB) Scale for the Older Person is an
assessment tool designed to identify the older person’s awareness of
and practice of behaviours that could potentially protect against
falling. People who do not use protective behaviours are potentially at
risk of falling, in particular, if they are in a group with risk factors for
falls such as declining function. Thus, the FaB includes the kinds of
day-to-day behaviours and actions, both habitual and intentional,
that if not done safely can place a person at undue risk of falling.
Behaviour has been operationally defined by Gochman (1988) as
something that people “do or refrain from doing, although not always
consciously or voluntarily” and relates to overt behaviour patterns,
actions, and habits. This working definition also includes “mental
events and feeling states that are ‘observed’ or measured indirectly.
These behaviour patterns, actions and habits also closely interact with
situational and environmental cues (Ronis, Yates, & Kirscht, 1989).
Falls occur across a range of environments and situations at home
and in the community and, while peaking during the mid morning and
early evening, they can occur throughout the day and night. They
most often occur while walking but can also occur during activity.
The FaB is intended to provide a way of focussing on everyday
situations identifying the behaviour patterns, actions and habits that
protect against falling. In developing the FaB scale a factor analysis
has highlighted ten dimensions that contribute to understanding the
nature of behavioural factors and falls. These dimensions are
Cognitive Adaptations, Protective Mobility, Avoidance, Pace,
Awareness, Practical Strategies, Displacing Abilities, Being Observant,
Changes in Level and Getting to the Phone.
The development of the tool has been published (Clemson, Cumming,
& Heard, 2003) )and we suggest you refer to this article to provide
essential background and further information. The tool was developed
as part of the first author’s PhD work. The aim was to fill a gap in
current fall assessment tools and provide a way of measuring
behaviours that could contribute to falling. The tool was originally
designed as an outcome measure in a randomized trial evaluating the
effectiveness of a multi-faceted falls prevention program (Clemson,
Cumming, Kendig et al., 2003; Clemson, Swann et al., in press) The
FaB has also been briefly trialed in clinical practice by occupational
therapists to explore its usefulness in practice and this has further
indicated some potential application.
2
Administration
The FaB Scale can be self-administered by the older person or
administered by interview. It usually takes about 5 to 10 minutes to
complete. It can also be mailed to the person prior to a home visit.
Respondents are encouraged to provide a rating (Never, Sometimes,
Often, or Always) for each statement and to avoid the “Doesn’t apply”
category unless absolutely necessary. This is why we have tried to
offer “Doesn’t apply” only for those items it seems to fit as a
possibility.
Instructions
The following are the verbal and written instructions given to the
person completing the instrument.
The FaB Scale is a list of 30 statements that describes things we
do in our everyday lives. Please read each statement carefully.
Circle how much each statement describes the things you do in
your daily life. For example:
Never
Some-
times
Often Always
Only circle ‘Doesn’t apply’ if the situation is something to which
you are not exposed (for example, if you do not have a phone).
Additional verbal explanation
There might be a tendency to answer some questions in a particular
way because this will appear to be more socially acceptable.
Alternatively, there are often things we do habitually and, therefore,
sub-consciously. So it may not be so easy to be aware of how, or to
what degree, we actually do some things. In order to pre-empt and,
therefore, decrease the chance of a social desirability effect or,
alternatively, to help the person reflect on what they actually do, we
suggest providing the following explanation.
This scale describes things you might do in your daily life. We
don’t expect that you do everything properly or perfectly because
the reality is that we all have little habits that can make us a little
haphazard or a little less safe at times. It’s what makes us
individuals. For example, we all think that it is better not to have
clutter around the house. But, in reality, many of us (me
included) often do leave clutter around and we tend not to see it.
So, if you could really think carefully about each of these
everyday things and let me know which one is closest for you.
3
Coding guidelines
The following FaB statements sometimes need clarifying when coding.
2. I do things at a slower pace. This is about if they consciously take
things more slowly. Have they consciously slowed their pace to
what they were used to doing?
6. When I am feeling unwell I take particular care doing everyday
things. When unwell do they make a conscious effort to take
things easier and do things with a bit more care or do they not
feel there is a need to do s? If they say that they always take
care doing everyday things and that being unwell makes no
difference, rate as ‘always.’
13. When I am feeling ill I take special care of how I get up from a chair
and move around. As above, if they say that they always take
special care of how they get up from a chair and move around
then rate as ‘always.’
15. I notice spills on the floor. This statement is trying to get at if the
person thinks that they see spills on the floor, that is, if they are
always aware of spills that happen.
The protective behavior expected to follow from noticing a spill is
that the spill is cleaned up straight away and, if it is a grease or
oil based spill, that a detergent is used to clean it up. The first
version of the FaB included a statement ‘I clean up spills
straight away.” This, however, was dropped as most people
answered “always" to it. Thus, we found the “I notice spills on
the floor” statement to be more discriminating.
17. I adjust the lighting at home to suit my eyesight. Most people seem
to answer- never “ I have not really done anything to change the
lighting at home” or “sometimes,” for example, “I have reduced
the glare by adjusting the curtains to get rid of the afternoon
sun” or “ done things that have made more natural light in the
living area” or “improved the lighting by buying higher wattage
globes.” If people do not understand the question then these
examples can also be given as prompts. However, first try and
get the person to say if they have or have not made any changes
to, such as, improving dimness or reducing glare.
18. I clean my spectacles. ‘….when they need cleaning
’ is understood.
Therefore, a rating of ‘always’ means “as soon as they need
cleaning I immediately clean them.”
4
21. When I walk outdoors I look ahead for potential hazards. The safe
practice here is to scan at least four paces ahead when walking
to allow time to adjust their step to avoid a hazard. It is not
acceptable if the person tends to look directly downwards rather
than a little ahead. In this case the response is scored as
‘never.’ They are meant to look down when they get to the
potential hazard to safely step over it or to negotiate steps or
stairs.
23. I go out on windy days. ‘Always’ does not mean you are out on
every windy day. It is referring to if you were planning to go out
and the day is windy. Do you alter your plans – always, often,
sometimes, or never?
29. I carry groceries up the stairs only in small amounts. This tends to
have an ‘always,’ ‘never’ or, if they don’t ever climb steps, a ‘does
not apply’ response. This is potentially a protective behavior for
some people where they avoid carrying groceries that are too
heavy or difficult to manage. If they do not have stairs at home,
prompt to see if they have steps or stairs at their shops.
30. I ask my pharmacist or Dr. questions about side effects of my
medications. Some people say that they don’t ask but the Dr.
always explains. Before rating this answer as a ‘never’
response, use the following prompts to clarify. Does he always
explain to your satisfaction? Would you ever ask your
pharmacist or Dr. a question? How often might that be? If later
you are a bit unsure, would you clarify anything with your
pharmacist? How often might that be?
Interpretation of scores
Recode the following six items (1(never) = 4 (always), 2 (sometimes) = 3
(often), 3 = 2, and 4 = 1) prior to analysis to ensure high scores equal
the safest behaviours and low scores the riskiest behaviours.
FaB
Item
number
Item
7. I hurry when I do things
8. I turn around quickly.
9.
To reach something up high I use the nearest chair, or
whatever furniture is handy, to climb on.
10. I hurry to answer the phone.
19.
When wearing bifocals I misjudge a step or do not see a
change in floor level
23. I go out on windy days
5
In comparing total FaB scores we recommend using the total FaB
mean scores for items rather than a total FaB summed score.
We found higher scores for people who reported that they had had a
fall in the past year (Clemson, Cumming, & Heard, 2003). We
concluded that this meant safer behaviours were used by people who
had fallen. These results were statistically significant but not strong.
It does, however, provide a benchmark to compare further
investigations. We expect that a program aimed at behavioural change
should show a difference in pre and post FaB scores. The tool is
currently being used as an outcome measure in a randomized trial of
a falls prevention program (see, Clemson, Cumming, Kendig et al,
2003). This will provide further investigation of the FaB’s usefulness
in research and program evaluation.
Comparative scores
These initial comparative scores are from the group of 418 older
volunteers reported in the Clemson, Cumming and Heard (2003)
study. The mean age of the group was 76.8 years. Thirty four percent
of the group reported one or more falls in the past year with no
significant difference between females and males. Physical
functioning, measured by the physical functioning dimension of the
SF-36 Health Survey (Ware, Snow, Kosinski, & Gandek, 1993), was
found to be similar to Australian norms for same age and gender.
The mean score for the group was 2.97 (standard deviation 0.48) with
a median of 3.00. Table 1 shows mean scores for age and gender.
Table 1 FaB means for age and gender
Age
65-74 75-85 85-98
Gender
M SD n M SD n M SD n
Female 2.5
5
0.4
8
2.92 0.4
8
3.1
6
0.3
1
Male 2.7
7
0.4
2
3.15 0.4
2
3.3
4
0.3
8
Factor sub-scales
Factor sub-scales can be computed by listing items and calculating
their average score. This is the recommended and easiest method and
should closely approximate the alternate but more complex method
below.
Alternative methods can be used using the item loading coefficients
(Appendix B) as weightings. In this case, the following formula is
recommended. We have used loading coefficients for factor 1
(Cognitive Adaptations) as an illustration:
6
Factor 1 = ((Var1 x 0.067)/n
1
) + ((Var2 x 0.207)/n
2
)+ ((Var3 x
0.292)/n
3
) ………+ ((Var30 x 0.427)/n
30
).
Thus, the factor sub-scale is the mean of the values for (Var1 x 0.067)
through to (Var30 x 0.427). Var1 is the score for the first item When I
stand up I pause to get my balance and the number, 0.067, is the
loading coefficient obtained in the factor analysis for that variable in
factor 1 (see Appendix B). The mean is obtained by dividing by the
number of cases (n).
Limitations
Both the FaB’s strengths and limitations need to be considered to
place in perspective the usefulness of the tool. The tool is designed to
rely on the older person’s self perceptions of their own behaviours.
While the development process produced a broad range of situations
and resultant behaviours, it is not a fully comprehensive list. For
example, most people perceived that they did not leave objects lying
on the floor in and about walkways and, therefore, a related item was
not found to be not useful and therefore not included in the final tool.
If using this tool to determine the entire range of behavioural factors
as an intervention measure, then other methods such as observation
and discussion may need to supplement the FaB results.
The FaB provides a profile of the person’s perception of their
behaviours. See ideas for usefulness in the Application section. The
interpretation of whether some actions are risky for individuals needs
to be interpreted in conjunction with other evaluations of capabilities
such as mobility, gait and environment.
The sample groups used in the development of this tool were
substantially from English speaking Western cultures. The
appropriateness of using this tool cross-culturally (for example, the
meanings of words may differ) has not been tested. Further work is
needed to determine its usefulness with people from different cultural
backgrounds.
Reliability and Validity
The development, reliability and validity of this tool have been
published as Clemson, Cumming and Heard (2003). Results are from
the 418 volunteer sample they reported and which is briefly described
on page 5.
Reliability
Internal consistency of the FaB scale was 0.84 using Cronbach alpha.
The internal consistency of the factors was variable and is reported in
the published paper.
7
The test-retest reliability was determined using an additional sample
of 37 volunteers, aged 69 to 93 years with an average age of 80.3
years. Respondents were given the tool to complete by themselves and
then once again over a two-week period. These results are presented
in Appendix A
Validity
Content validity was established in the development phase from a
content analysis of literature and other data from current relevant
research (Clemson, Manor, & Fitzgerald, 2003) followed by an expert
review process using a delphi panel approach. The scale then
underwent a factor analysis resulting in the final 30-item scale
(Appendix C). The Content Validity Index (Lynn, 1986; Waltz &
Bausell, 1981) was estimated as 0.93.
The factor analysis (Clemson, Cumming & Heard, 2003)delineated ten
behavioural dimensions that are described below. The FaB items that
factor on each dimension are listed in the published paper. Factors
seven and ten had only one item each (interpreting the loading
coefficient cutoff level as > 0.40, (Bryant & Yarnold, 1995).
Behavioural
Dimensions
Description of high scores
1. Cognitive
Adaptations
This dimension describes behaviours associated
with thinking and planning.
2. Protective
Mobility
Strategies used when negotiating the
environment in a supportive or protective
manner.
3. Awareness Behaviours associated with noticing things
such as traffic way hazards.
4. Avoidance The person who scores high on this dimension
avoids risky situations.
5. Pace This person avoids doing things quickly.
6. Practical
Strategies
Practical strategies that often involve
anticipation or planning.
7. Displacing
Activities
Avoiding activities that cause displacement, in
particular, going out on windy days.
8. Being Observant Behaviours associated with being observant or
vigilant in looking out for particular hazards.
9. Changes in level Behaviours about coping with changes in levels
suggesting the person has strategies in place to
cope with higher activity levels.
10. Getting to the
phone
Taking care getting to or reaching for things,
such as, the phone.
8
Construct Validity was supported by showing that, as expected, FaB
scores were positively associated with increasing age (r
s
=.46, p<.01)
and negatively associated with greater physical mobility (r
s
= –.68,
p<.01) and leaving home more often in the past week (r
s
= –.51, p<.01).
Associations due to gender were also explored. Pace and Protective
Mobility were used equally by males and females whereas females
favored Avoidance and Cognitive Adaptation strategies. The strongest
association was Avoidance used more often by females (t=6.37, p <
.01).
Applications
1. The FaB Scale has been used as an epidemiological assessment
tool to show a difference in the participants’ use of protective
behaviours compared to controls.
2. It could be used pre and post a falls prevention intervention to
indicate the extent the participants are using risk taking or safe
behavioural strategies.
3. The FaB Scale has also been found useful as:
An assessment in clinical practice. It can give a profile of the
range of strategies people are using.
A goal setting tool.
A prompt to discuss behavioural factors and falls and as an
aide in reflective learning.
A way of raising awareness of the broader focus of the therapist
visit.
The following provide illustrative examples:
Mrs. Williams said she cleaned he
r
glasses after completing the FaB as she
suddenly realized that dirty glasses
could contribute to her falls. This was
much more effective as she made the
connection rather than the health
professional prompting.
9
If you have any examples of usefulness (or limitations) of the
FaB scale please let us know.
Mrs Duncan was referred to the Falls Clinic by her General Medical
Practitioner. She had had a stroke four years previously and currently
has Chronic Airways Limitations and limited vision in one eye due to a
right retinal hemorrhage. The FaB was mailed to her prior to the
home visit and she completed it with her daughter. On the home visit
by the occupational therapist the FaB scale was reviewed as the first
assessment. The issues they identified together as risk factors using
the FaB were:
Never uses a walking stick or mobility aid
Never notices spills on the floor
Misjudges steps when wearing bifocals, and
Not asking the pharmacist for advice on medications.
hus, the intervention strategies included:
Investigating a mobility aid to improve safety and to
compensate for her decreased vision
Education on depth perception and compensatory strategies,
particularly with steps and changes of levels.
Education with Mrs. Duncan and her daughter about
clearing pathways around the home and removing the heater
extension cord.
In addition to the FaB, other evaluations were a review of the
environment for hazards and an assessment of Mrs. Duncan’s
functional abilities.
T
he FaB was found to be a reasonably short scale for Mrs. Duncan to
complete. It allowed the occupational therapist to concentrate falls
education on the client’s needs. For example, she was well informed
about safe footwear and did have safe and well fitting footwear so time
was not wasted on this aspect.
10
References
Bryant, F. B., & Yarnold, P. R. (1995). Principal-components analysis and exploratory and
confirmatory factor analysis. In L. G. Grimm & P. R. Yarnold (Eds.), Reading and
understanding multivariate statistics (pp. 99-136). Washington, DC: American
Psychological Association.
Clemson, L., Cumming, R. G., & Heard, R. (2003). The development of an assessment to
evaluate behavioral factors associated with falling. American Journal of Occupational
Therapy 57, 380-388.
Clemson, L., Cumming, R. G., Kendig, H., Swann, M., Heard, R., & Taylor, K. (in press).
The effectiveness of a community-based program for reducing the incidence of falls
among the elderly: A randomized trial. Journal of the American Geriatrics Society.
Clemson, L., Manor, D., & Fitzgerald, M. H. (2003). Behavioral factors contributing to older
persons falling in public places. Occupational Therapy Journal of Research:
Occupation, Participation and Health, 23(3) 107-117.
Clemson, L., Swann, M., Twible, R., Cumming, R. G., Kendig, H., & Taylor, K. (2003
Stepping On: building confidence and reducing falls. A community based program
for older people. Lidcombe, NSW: The University of Sydney. Available USYD Co-
ooperative Bookshop
Lynn, M. R. (1986). Determination and quantification of content validity. Nursing Research,
35(6), 382-385.
Ronis, D. L., Yates, J. F., & Kirscht, J. P. (1989). Attitudes, decisions, and habits as
determinants of repeated behavior. In A. R. Pratkanis & S. J. Breckler & A. G.
Greenwald (Eds.), Attitude, structure and function (pp. 213-239). NY: Erlbaum.
Waltz, C., & Bausell, R. B. (1981). Nursing research: Design, statistics & computer analysis.
Philadelphia: F.A. Davis Co.
Ware, J. E., Snow, K. K., Kosinski, M., & Gandek, B. (1993). SF-36 Health Survey Manual
& Interpretation Guide. Boston, MA: Health Institute, New England Medical Center.
11
Appendix A Test-retest Reliability for FaB items and
FaB factor scales
FaB items ICC
F df
Use walking aid when need 0.98** 42.30 25
Use light at night 0.97** 37.87 35
Clean my spectacles 0.93** 14.52 34
Buy shoes check sole 0.93** 14.52 33
Do things slower 0.92** 12.28 36
Carry groceries stairs 0.91** 10.58 22
Hurry do things 0.90** 10.19 36
Get help reach high 0.90** 10.89 34
Hold onto handrail 0.90** 9.85 33
Avoid crowds 0.90** 10.14 32
Adjust lighting 0.89** 8.12 34
Misjudge step with bifocals 0.89** 8.96 23
Go out on windy days 0.89** 9.23 35
Keep shrubbery trimmed 0.89** 8.62 16
Hurry answer phone 0.86** 7.09 34
Talk with someone 0.85** 7.18 35
Turn around quick 0.85** 6.64 36
I stand up pause 0.84** 6.40 36
Get help change light 0.83** 5.61 35
Bend over with firm hold 0.79** 4.80 34
Cross at traffic lights 0.79** 4.87 30
Walk outdoors look ahead 0.77** 4.51 34
Outdoors think how 0.76** 4.07 34
Feeling ill take care up 0.75** 3.93 34
Notice spills 0.69** 3.12 35
Ask pharmacist medication 0.68** 3.02 33
Reach high nearby chair 0.67** 2.94 26
Avoid ramps 0.65** 3.00 35
Feeling unwell take care 0.61** 2.55 35
Factor Scales
Protective Mobility .96** 22.94 36
Pace .93** 14.82 36
Avoidance .91** 11.27 36
Getting to the Phone .91** 11.02 36
Awareness .86** 6.96 36
Being Observant .83** 5.67 36
Cognitive Adaptation .82** 5.92 36
Displacing Activities .81** 5.27 36
Practical Strategies .79** 4.59 36
Changes in Level .78** 4.48 36
**Significant at the .01 level.
ICC Intra-class correlation coefficients.
© Clemson, Cumming & Heard, 2003
12
Appendix B Table of factor coefficient loadings
*Factors
FaB Item
1 2 3 4 5 6 7 8 9 10
1. When I stand up I pause to get my balance. 0.067 0.701 0.078 0.182 -0.101 0.373 0.100 0.063 0.018 -0.062
2. I do things at a slower pace. 0.207 0.676 -0.137 -0.070 0.200 0.013 0.100 0.201 0.105 0.204
3. I talk with someone I know…. 0.292 0.217 -0.064 0.202 -0.128 0.623 0.034 0.217 0.150 0.022
4. I bend over to reach … if have firm handhold. 0.287 0.599 0.325 -0.020 -0.024 0.241 0.055 -0.111 -0.134 0.272
5. I use a walking stick aid when I need it. 0.074 0.709 0.134 -0.012 0.395 -0.119 -0.285 -0.008 -0.138 -0.106
6. When I am feeling unwell take particular care….. 0.488 0.425 0.195 -0.044 0.170 0.171 0.279 -0.171 0.219 0.070
7. I hurry when I do things. -0.005 0.194 -0.136 0.099 0.800 0.134 0.009 0.027 0.108 0.052
8. I turn around quickly. 0.079 0.038 0.035 -0.111 0.764 -0.037 0.054 0.127 0.010 0.149
9. To reach something up high use nearest chair ….. 0.055 0.029 0.214 0.042 0.343 0.458 -0.243 0.230 0.065 0.100
10. I hurry to answer the phone. -0.053 0.063 0.008 0.106 0.285 0.118 -0.049 0.073 0.031 0.760
11. I get help when I need to change a light bulb. 0.127 0.111 0.808 -0.094 -0.192 -0.055 -0.059 0.091 0.031 0.063
12. I get help when need reach something very high. 0.427 0.038 0.499 0.081 -0.181 0.055 -0.142 0.271 -0.086 0.399
13. When feeling ill take special care get up from chair
0.526 0.327 0.321 -0.034 0.080 0.100 0.340 0.054 0.165 -0.071
14. When getting down step stool think about bottom 0.263 0.204 -0.023 0.283 -0.043 -0.175 0.254 0.109 0.578 -0.268
15. I notice spills on the floor. 0.161 -0.075 0.091 0.663 -0.179 -0.417 -0.083 0.105 0.147 0.110
16. I use a light if I get up during the night. 0.221 0.148 0.687 0.093 0.273 0.032 0.121 -0.357 0.014 -0.011
17. I adjust the lighting at home to suit my eyesight. 0.188 -0.157 0.494 0.352 0.124 0.142 0.092 0.358 0.004 -0.256
18. I clean my spectacles. 0.157 -0.097 -0.003 0.607 0.140 0.356 -0.196 0.060 0.112 -0.376
19. When wearing bifocals I misjudge a step ….. 0.116 -0.115 0.029 -0.096 0.136 0.015 -0.156 0.004 0.750 0.085
20. When I buy shoes I check the soles to see ….. 0.133 0.125 0.089 0.077 0.176 0.091 0.036 0.762 0.041 0.096
21. When walk outdoors look ahead for hazards ….. 0.618 0.146 -0.093 0.095 0.263 -0.107 0.126 0.410 -0.331 -0.165
22. I avoid ramps and other slopes. 0.228 0.476 0.419 -0.194 0.104 0.087 0.050 0.154 -0.200 -0.135
23. I go out on windy days. 0.122 0.014 0.039 0.071 0.041 0.025 0.854 0.037 -0.111 -0.045
24. When I go outdoors think about how to move …….
0.652 0.186 0.098 0.031 0.162 0.263 0.210 0.129 0.010 0.024
25. I cross at traffic lights …... 0.741 -0.031 0.200 -0.015 -0.159 0.110 -0.010 -0.082 0.230 -0.101
26. I hold onto a handrail when I climb stairs. 0.622 0.296 0.206 0.048 0.041 0.151 -0.122 0.191 0.097 0.091
27. I avoid walking about in crowded places. 0.267 0.171 0.082 -0.021 0.100 0.696 0.151 -0.087 -0.236 0.135
28. I keep shrubbery trimmed back on pathways ….. 0.060 -0.097 -0.142 0.737 -0.134 0.062 0.223 -0.065 -0.271 0.117
29. I carry groceries up stairs only in small amounts. 0.069 0.095 0.534 0.041 -0.108 0.302 0.398 0.382 0.210 0.022
30. I ask …… about side effects of my medications. -0.240 0.238 0.079 0.739 0.167 0.169 0.051 0.097 0.059 0.082
Extraction Method: Principal Component Analysis. Rotation Method: Varimax with Kaiser Normalization. Rotation converged in 16
*Factors: 1.Cognitive Adaptations, 2. Protective Mobility, 3. Avoidance, 4, Awareness, 5. Pace, 6. Practical strategies, 7. Displacing activities, 8.
Being observant, 9. Changes in level, 10. Getting to the phone.
ID No._____________
© Clemson, Cumming & Heard, 2003 1
The Falls Behavioural (FaB) Scale for the Older Person
The FaB Scale is a list of 30 statements that describes things we
do in our everyday lives. Please read each statement carefully.
Circle how much each statement describes the things
you do in your daily life. For example:
Never Some-
times
Often Always
Only circle ‘Doesn’t apply’ if the situation is something
to which you are not exposed (for example, if you do
not have a phone).
Would this describe the things you
do in your daily life?
Circle which one applies
1. When I stand up I pause to get
my balance.
Never
Some-
times
Often Always
2. I do things at a slower pace.
Never
Some-
times
Often Always
3. I talk with someone I know about
things I do that might help
prevent a fall.
Never
Some-
times
Often Always
4. I bend over to reach something
only if I have a firm handhold.
Never
Some-
times
Often Always
Doesn’t
apply
5. I use a walking stick or walking
aid when I need it.
Never
Some-
times
Often Always
Doesn’t
apply
6. When I am feeling unwell I take
particular care doing everyday
things.
Never
Some-
times
Often Always
Doesn’t
apply
7. I hurry when I do things.
Never
Some-
times
Often Always
8. I turn around quickly.
Never
Some-
times
Often Always
ID No._____________
© Clemson, Cumming & Heard, 2003 2
Would this describe the things you
do in your daily life?
Circle which one applies
Now, these are things you do indoors
9. To reach something up high I use
the nearest chair, or whatever
furniture is handy, to climb on.
Never
Some-
times
Often Always
Doesn’t
apply
10. I hurry to answer the phone.
Never
Some-
times
Often Always
Doesn’t
apply
11. I get help when I need to change
a light bulb.
Never
Some-
times
Often Always
12. I get help when I need to reach
something very high.
Never
Some-
times
Often Always
13. When I am feeling ill I take
special care of how I get up from
a chair and move around.
Never
Some-
times
Often Always
Doesn’t
apply
14. When I am getting down from a
ladder or step stool I think about
the bottom rung/step.
Never
Some-
times
Often Always
Doesn’t
apply
Now, these are about lighting and eyesight
15. I notice spills on the floor.
Never
Some-
times
Often Always
16. I use a light if I get up during the
night.
Never
Some-
times
Often Always
17. I adjust the lighting at home to
suit my eyesight.
Never
Some-
times
Often Always
18. I clean my spectacles.
Never
Some-
times
Often Always
Doesn’t
apply
19. When wearing bifocals or trifocals
I misjudge a step or do not see a
change in floor level.
Never
Some-
times
Often Always
Doesn’t
apply
Now, these are about shoes
20. When I buy shoes I check the
soles to see if they are slippery.
Never
Some-
times
Often Always
Now, these are things outdoors
21. When I walk outdoors I look
ahead for potential hazards.
Never
Some-
times
Often Always
22. I avoid ramps and other slopes.
Never
Some-
times
Often Always
ID No._____________
© Clemson, Cumming & Heard, 2003 3
Would this describe the things you
do in your daily life?
Circle which one applies
23. I go out on windy days.
Never
Some-
times
Often Always
24. When I go outdoors I think about
how to move around carefully.
Never
Some-
times
Often Always
25. I cross at traffic lights or
pedestrian crossings whenever
possible.
Never
Some-
times
Often Always
Doesn’t
apply
26. I hold onto a handrail when I
climb stairs.
Never
Some-
times
Often Always
Doesn’t
apply
27. I avoid walking about in crowded
places.
Never
Some-
times
Often Always
28. I keep shrubbery and plants
trimmed back on the pathways to
my front/back doors.
Never
Some-
times
Often Always
Doesn’t
apply
29. I carry groceries up the stairs
only in small amounts.
Never
Some-
times
Often Always
Doesn’t
apply
And, finally, these are about medications
30. I ask my pharmacist or Dr.
questions about side effects of my
medications.
Never
Some-
times
Often Always
Doesn’t
apply
Thank you for completing the Falls Behavioural Scale for the Older Person
... Veterans were administered the Falls Behavioral Scale (FAB) [49] to help identify their insight and practice of behaviors that might potentially protect against falling, and the Falls Efficacy Scale-International (FESI) [50] to assess their concerns about falling. The veterans were asked to complete scales independently of their partners. ...
Article
Full-text available
Cognitive impairment significantly increases the risk of accidental falls in older adults, and falls outcomes are more severe in this population. However, few interventions exist to reduce falls among individuals with cognitive impairment. To address this gap, we developed Stepping Out, by modifying the evidenced-based falls prevention program, Stepping On, tailoring it to meet the cognitive needs of individuals with mild cognitive impairment (MCI) who are at risk for falls. Our objectives were to determine whether incorporating specific teaching and learning strategies among people with MCI would be associated with program feasibility as well as with positive trends in reducing fall risk. 16 older veterans with MCI at risk for falls (mean age 77.5, SD 6.75) participated in Stepping Out. The intervention comprised a group program, each with four veterans and their partners, conducted in two-hour weekly sessions for seven weeks, with a follow-up phone call and subsequent booster session. Teaching and learning adaptations for cognitive impairment included cognitive and compensatory strategies, addition of a partner, increased incorporation of procedural memory, and use of principles of self-determination theory to enhance motivation. Pre-post measures included physical measures of balance and mobility and self-reported falls. The program was found to be feasible for participants, as measured by an attendance rate of 95%. While no change was exhibited on balance or mobility tasks, participants displayed a significant reduction in falls over a six-month period (median change 2.00 falls, range 0-12 falls, p=0.002). The findings of this feasibility and pilot study support the notion that individuals with MCI can benefit from specific teaching and learning techniques incorporated into a multifactorial, cognitively-based program to reduce falls risk. Stepping Out has potential for further investigation with a randomized control group to assess efficacy.
Article
Background Outdoor falls present a significant challenge to the health and well-being of older adults. Safe strategy use is an important component of falls prevention, yet little is known regarding use of outdoor falls prevention strategies. Aims To examine outdoor falls prevention strategy use among naturally occurring retirement community residents at risk for falls, and to examine associations with neighborhood walkability. Methods Descriptive analyses of pretest data from an intervention study ( N = 97) were conducted to examine frequency of outdoor falls prevention strategy use. Walk Score ® data were added to the dataset, and chi-square tests of independence were used to examine associations between walkability categories and outdoor falls prevention strategy use. Results Some strategies, such as visual scanning and holding rails on stairs, were used by 70% or more of participants while others, such as route planning, were infrequently or inconsistently used. With the exception of avoiding cell phone use while walking outdoors, no significant associations were found between walkability categories and outdoor falls prevention strategy use. Conclusion Study findings serve as a needs assessment for health education and behavioral training.
Article
Objectives: To investigate the effects of an occupational therapy fall reduction home visit program for older adults admitted to the emergency department (ED) for a fall and discharged directly home. Design: Single-blind, multicenter, randomized, controlled trial. Settings: EDs in three acute care hospitals in Hong Kong. Participants: Individuals aged 65 and older who had fallen (N = 311). Interventions: After screening for eligibility, 204 consenting individuals were randomly assigned to an intervention group (IG) and received a single home visit from an occupational therapist (OT) within 2 weeks after discharge from the hospital or a control group (CG) and received a well-wishing visit from a research assistant not trained in fall prevention. Measurements: Both groups were followed for 12 months through telephone calls made every 2 weeks by blinded assessors with a focus on the frequency of falls. Another blinded assessor followed up on their status with telephone calls 4, 8, and 12 months after ED discharge. Prospective fall records on hospital admissions were retrieved from electronic databases; 198 individuals were followed for 1 year on an intention-to-treat basis. Results: The percentage of fallers over 1 year was 13.7% in the IG (n = 95) and 20.4% in the CG (n = 103). There were significant differences in the number of fallers (P = .03) and the number of falls (P = .02) between the two groups over 6 months. Significant differences were found in survival analysis for first fall at 6 months (log-rank test 5.052, P = .02) but not 9 or 12 months. Conclusion: One OT visit after a fall was more effective than a well-wishing visit at reducing future falls at 6 months. A booster OT visit at 6 months is suggested.
Article
Purpose: To develop a French Canadian version of the Falls Behavioral (FaB) Scale and examine its psychometric properties. Methods: The FaB was adapted in French Canadian (FaB-FC) and validated according to standard guidelines for cross-cultural adaptation of questionnaires. The internal consistency and construct validity of the FaB-FC were studied among 64 community-dwelling adults aged 60 and over. The concurrent validity and test-retest reliability of the FaB-FC were respectively examined among subsamples including 31 bilingual and 33 unilingual participants. Results: The FaB-FC showed good concurrent validity with the original FaB (ICC2 = 0.94; 0.87-0.97), as well as good test-retest reliability (ICC2 = 0.94; 0.88-0.97). The FaB-FC also demonstrated high internal consistency (α = 0.91). Moreover, analyses showed significant associations of the FaB-FC scores with fear of falling and balance confidence scores, attesting to its construct validity. Conclusion: This study provides evidence that the FaB-FC has sound psychometric properties. Since falls are associated with multiple risk factors, including behavioral factors, the FaB-FC is undoubtedly a relevant assessment tool for clinicians and researchers working toward fall prevention among French-speaking community-dwelling seniors. Implications for rehabilitation: Fall-related behaviors should be addressed in the assessment of community-dwelling seniors' fall risks. Like the original FaB, the French Canadian version of the tool (FaB-FC) is valid and reliable for assessing fall-related behaviors. The FaB-FC is a relevant complementary assessment tool for identifying seniors at risk for falls. The FaB-FC could also be useful in guiding fall prevention interventions and measuring the impact of these interventions on seniors' behaviors.
Article
Rasch modelling was used to establish the validity and robustness of the Falls Behavioural (FaB) Scale for Older people. The sample comprised 678 community-residing elderly people aged 65 - 98 years. Data were analysed by calculating goodness of fit statistics, principal components analysis of residuals and by exploring the effectiveness of the category rating response-scale. A partial-credit rating scale was the best fitting solution and the major change to the original version of the FaB. Analysis supported a 29-item intervention version and a briefer 24-item outcome evaluation (research) version. The latter produced item mean infit statistics of 1.00 (Z = 0.0, SD = 0.33) and mean outfit statistics of 1.03 (Z = 0.0, SD = 0.53), a person separation of 2.36 and internal reliability of 0.85. The 29 item partial rating scale is valid, reliable and would be useful in clinical situations when used as a prompt for discussion and in raising clients' awareness of potential hazards; it also can be used as an outcome measure. The short form is a useful alternate for evaluating the effectiveness of fall reduction interventions that aim to encourage protective strategies when negotiating the environment, mobilizing and doing activities of daily living. Both scales would be improved by adding very difficult and very easy items to increase the range of ability levels of the people to whom it can be applied with precision.
Article
Activity recall, in-depth interviews, and reenactment of the fall were used to elucidate the behavior patterns, actions, and habits that contribute to older adults falling in public places. The aim was to improve older adults' capacity to understand behavioral risks associated with falls and develop safe adaptive strategies so they can play an active role in minimizing falls and maintaining meaningful activity. Ten major themes were identified: not attending to the route ahead, lack of familiarity, pace, mobility behaviors, environmental influences, eyesight behaviors, health factors affecting physical abilities, lack of confidence, overexertion, and unnoticed environmental hazards. The findings add to knowledge about the extent and nature of behavioral factors that contribute to falls in public places and provide guidelines for some specific areas of focus for falls prevention. A recommendation is that fall prevention interventions with older adults employ strategies that actively engage them in critical reflective thinking.
Chapter
discusses in turn each of these 3 procedures [of multivariate analysis]: PCA [principal-components analysis], EFA [exploratory factor analysis] and CFA [confirmatory factor analysis] / PCA and EFA are largely used as dimension-reducing procedures / for a collection of continuous variables, these techniques can identify a small set of synthetic variables, called eigenvectors or factors, that explain most of the total (PCA) or common (EFA) variation present in the original variables / CFA is typically used for purposes of theory testing (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
The arbitrary assertion of two of three experts does not establish content validity. Application of a two-stage process that incorporates rigorous instrument development practices and quantifies the aspects of content validity is required. In the first stage of this process, the content domain or dimensions are identified and items are generated to reflect the scope of the content domain of a cognitive variable or each of the dimensions of an affective variable. Once generated, the items are assembled in a usable, testable format. The instrument and domain or dimension specifications are then presented to a panel of experts, the size of which is an a priori decision, for their judgment of the items using a 4-point ordinal rating scale. Using the item evaluation, CVI calculations are applied to both the items and the entire instrument. The experts are asked, as a part of the content validity assessment, to identify areas of omission and to suggest areas of item improvement or modification. Admittedly, there are times when adherence to such rigor may not be feasible. When less stringent methods of determining validity are applied, it should not be said that content validity has been determined. Opponents of the process described in this article might argue that these applications and expectations exceed practical application and that this process is therefore too rigorous. Content validity, by its nature and definition, demands rigor in its assessment, and its assessment is, in fact, critical. Such a rigorous process for content validity determination is offered because content validity is an inexpendable form of validity which is rapidly losing credibility due to its less than standardized and rigorous assessments. Content validity, different from all other forms of validity, is crucial to the understanding of research findings and their practical or theoretical applications. It is worth the rigor.
Article
The purpose of this study was to report the development of the Falls Behavioral (FaB) Scale for Older People, an assessment designed to evaluate behavioral factors that could potentially protect against falling. Instrument development included content analysis, expert review, and factor analysis. Ten behavioral dimensions were identified including Cognitive Adaptations, Protective Mobility, Avoidance, Awareness, Pace, Practical Strategies, Displacing Activities, Being Observant, Changes in Level, and Getting to the Phone. The final 30-item scale had a Content Validity Index of 0.93. Test-retest reliability was ICC = 0.94 (p < .01). Construct validity was established by showing that, as expected, scale scores were positively associated with increasing age (rs = 0.46, p < .01) and negatively associated with greater physical mobility (rs = -0.68, p < .01). People who had fallen utilized safer behaviors than those who had not reported a fall (p < .05) providing a benchmark for using the scale in future studies. The FaB is an easily completed, reliable, and valid tool for determining the presence or absence of protective behaviors. It has potential to assist in goal setting for falls prevention and to evaluate behavioral outcomes of fall prevention programs.
Nursing research: Design, statistics & computer analysis
  • C Waltz
  • R B Bausell
Waltz, C., & Bausell, R. B. (1981). Nursing research: Design, statistics & computer analysis. Philadelphia: F.A. Davis Co.
Attitudes, decisions, and habits as determinants of repeated behavior
  • D L Ronis
  • J F Yates
  • J P Kirscht
Ronis, D. L., Yates, J. F., & Kirscht, J. P. (1989). Attitudes, decisions, and habits as determinants of repeated behavior. In A. R. Pratkanis & S. J. Breckler & A. G. Greenwald (Eds.), Attitude, structure and function (pp. 213-239). NY: Erlbaum.
Stepping On: building confidence and reducing falls. A community based program for older people
  • L Clemson
  • M Swann
  • R Twible
  • R G Cumming
  • H Kendig
  • K Taylor
Clemson, L., Swann, M., Twible, R., Cumming, R. G., Kendig, H., & Taylor, K. (2003 Stepping On: building confidence and reducing falls. A community based program for older people. Lidcombe, NSW: The University of Sydney. Available USYD Coooperative Bookshop