Reliability of the Home Falls and Accidents Screening Tool (HOME FAST) for identifying older people at increased risk of falls

Purpose: The Home Falls and Accidents Screening Tool (HOME FAST) was designed as part of a comprehensive health assessment instrument to measure falls risk for older people within their home environment. This paper describes the evaluation of the inter-rater reliability of the HOME FAST. Method: Forty home visits were undertaken, in urban and rural settings of the UK, by pairs of raters, one of whom was an expert rater. Occupational therapists, occupational therapy assistants and a social worker rated each home using the HOME FAST concurrently with an expert rater. The kappa statistic was used to determine the degree of agreement between pairs of raters. Results: The overall kappa value for the checklist was 0.62, indicating a fair to good level of agreement between raters. 'Hazardous outside paths' was the only item that demonstrated poor agreement (kappa = 0.30). The expert rater consistently identified more hazards than the other raters, and the level of agreement was stable between raters irrespective of the number of hazards present in the homes visited. Conclusions: Definitions of non-applicable household features and improving the objectivity of the operational definitions for recognizing hazards that demand more qualitative judgements will enhance the reliability of the HOME FAST.