Conclusion
The goal of screening is to identify
people at risk for falling in the imminent
future for further in-depth evaluation.
Conventional data analysis techniques
with ROC curves indicate that
the BBS has better discriminatory ability
for identifying people sustaining recurrent
or multiple falls than for identifying
those who fall once or sustain
an injury among community-dwelling
older people. The effectiveness of the
BBS as a dichotomous scale in identifying
people at risk for falling is lower
than that of a multilevel form of the
scale with likelihood ratios. This new
information, derived from a prospective
study, and the fact that the BBS
was not originally recommended as a
dichotomous scale justify the recommendation
that the use of a cutoff
value of 45 should cease. We evaluated
a method for integrating balance
assessment through the BBS with
other fall risk information into a prediction
of future fall risk. Likelihood
ratios preserve the risk gradient that is
present over the whole scale, overcome
the problem that fall risk is substantial
above a cutoff value of 45, and
permit calculation of the probability of
falling for a given individual.