Can an Emergency Department Initiated Intervention Prevent Subsequent Falls and Healthcare Utilization in Older Adults? A Randomized Controlled Trial
Abstract
Objective To determine if an Emergency Department-initiated fall prevention intervention can reduce subsequent fall-related and all-cause ED visits and hospitalizations in older adults. Methods The Geriatric Acute and Post-acute Fall Prevention (GAPcare) intervention was a randomized controlled trial conducted from January 2018 to October 2019. Participants at two urban academic EDs were randomly assigned (1:1) to an intervention or usual care arm. Intervention participants received a brief tailored, structured pharmacy and physical therapy (PT) consultation in the ED with automated communication of their recommendations to participants’ primary care physicians. Results Of 284 study eligible participants, 110 non-institutionalized older adults (≥65 years old) with a recent fall consented to participate; median age was 81 years old, 67% were female, 94% were white, and 16.3% had cognitive impairment. As compared to usual care participants (n=55), intervention participants (n=55) were half as likely to experience a subsequent ED visit (adjusted incidence rate ratio (aIRR): 0.47 (0.29–0.74)) and one third as likely to have fall-related ED visits (aIRR 0.34 (0.15–0.76)) within six months. Intervention participants experienced half the rate of all hospitalizations (aIRR 0.57 (0.31–1.04), but confidence intervals were wide. There was no difference in fall-related hospitalizations between groups (aIRR 0.99 (0.31–3.27). Self-reported adherence to pharmacy and PT recommendations was…
How strong is the evidence?
Evidence Hub reads this as a randomized trial, done in people. Its evidence level is 2 of 5 (High · randomized trial). Randomized trials of a reasonable size are the strongest single-study design. Reported size: 284 participants or records.
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