Falls recall-limitations of the most used inclusion criteria
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The demographic changes in the industrialized countries place new and important challenges to health care providers, politicians, and modern society. Many older persons wish to maintain independence and mobility as long as possible. Falls and their consequences constitute a serious threat to these most important goals of the older person, and they do occur frequently in the community-dwelling cohort of people aged 65 years and older. This article discusses the limitations of one of the most important independent risk factors to predict future falls: a positive fall history. Several issues arise with assessing fall history in an older population. Firstly, several studies indicated that self-reported recall of falls may lead to underreporting and that older persons perceive a fall differently compared to health professionals and researchers. Secondly, falls can be reported retrospectively or prospectively. In general, a prospective design is favored by researchers with "daily fall calendar" considered the golden standard. Thirdly, different research has been conducted to find the most reliable time frame for self-recorded falls in the past. Self-reported recall of falls by older persons may lead to underreporting due to older persons not recognizing (the severity of) a fall or not remembering a fall and due to different interpretation of "a fall". Data on fall history should be expanded with questions about trips, slips, and self-perceived problems in balance, gait or mobility and preferably fear of falling or a quick physical assessment. In general, a prospective design is favored by researchers with "daily fall calendar" considered the golden standard. Computerized interactive response technology may be of additional value to prospectively monitoring falls in older persons. The best time frame for obtaining self-reported falls seems a period of 12 months, ruling out any seasonal influence.