Fall-Risk Screening Tool for Older Adults with Diabetes Mellitus in Primary Health Care

Description

Background: Falls are a major concern among older adults with diabetes mellitus (DM), yet systematic screening and prevention remain limited in Indonesian primary health care (PHC). This study aimed to identify key determinants of fall risk and explore contextual needs to inform the development of a multidomain fall-risk screening tool for Indonesian primary care. Methods: A mixed-methods design was employed at five PHCs. Quantitative data included the Timed Up and Go test (TUG), modified Clinical Test of Sensory Interaction on Balance (mCTSIB), short Falls Efficacy Scale-International (FES-I), and Five Times Sit-to-Stand Test (5×STS) to assess lower-limb functional strength in 412 patients with DM. Semi-structured interviews were subsequently conducted with healthcare personnel and patients with DM from the participating PHCs. Results: Vestibular disorders showed a strong association with functional mobility (TUG) and sensory balance (mCTSIB), while diabetes duration, peripheral neuropathy, visual impairment, and poorer lower-limb functional strength assessed using the 5×STS were also associated with these outcomes. Concern about falling (FES-I) was primarily associated with sex and age. ROC analysis using recurrent falls (≥2 falls in the previous 12 months) as the reference standard, ROC analysis showed modest discriminatory ability for TUG (AUC 0.626; cut-off ≥14.61 s; sensitivity 68.3%; specificity 59.1%), mCTSIB (AUC 0.622; cut-off ≤88.32 s; sensitivity 73.2%; specificity 46.7%), and FES-I (AUC 0.576; cut-off ≥12; sensitivity 58.5%; specificity 53.3%). Qualitative findings revealed functional decline, sensory challenges, low awareness, and the absence of routine screening in PHC. Conclusion: Fall risk in older adults with diabetes is multidimensional. The modest discriminatory performance of individual assessments supports their use as complementary components rather than stand-alone indicators, while further development and validation of a feasible multidomain screening approach are required.

Steps to reproduce

This data consists of respondent characteristics including age, gender, body mass index, HbA1c levels, hypertension status, and history of falls. Physical examinations include neuropathy levels, neuropathic pain, visual acuity scores, vestibular disorders, lower extremity strength, and static and dynamic balance. These variables will be analyzed to determine their association with fall risk.

Institutions

• Universitas Muhammadiyah Surakarta

  Jawa Tengah, Surakarta

Categories

Funders

• Ministry of Education and Culture

  Jakarta, Indonesia

  Grant ID: Grant Contract Number 127/C.3/DT.05.00/PL/2025] and [Derivative Contract Number 007/LL6/PL/AL.04/2025, 168.12/A.3-III/LRI/VI/2025

Licence