4EMF A Pilot Randomized Controlled Trial of GAPcare: The Geriatric Acute and Postacute Fall Prevention Intervention: Feasibility and Acceptability

Abstract

Study Objectives: To describe the Geriatric Acute and Post-acute Fall Prevention Intervention (GAPcare), a multidisciplinary intervention to reduce recurrent falls in older adults who seek care in the emergency department (ED). To determine its feasibility in the ED setting, its acceptability to patients and caregivers, and discuss lessons learned from study implementation.Methods: This is a single-blind, randomized pilot study of adults 65 years old who presented to one of two urban academic EDs within 7 days of a fall. Patients who resided in a nursing home, were altered or intoxicated, or likely to be admitted were excluded. Participants were randomized to an intervention (INT) or usual care (UC) arm. The INT arm consisted of a medication therapy management session delivered by a pharmacist and a fall risk assessment conducted by a physical therapist (PT). A medication-related and PT action plan were provided to participants and faxed to primary care providers at the conclusion of the visit. INT participants received referrals for outpatient PT services. UC participants received routine care as directed by the ED clinician and a home safety brochure. We used participant and caregiver surveys, as well as electronic health record review to characterize the participants, program, and determine feasibility and acceptability.Results: Of 110 participants, median age was 81, 67% (n¼74) were female, 16% (n¼18) had cognitive impairment, and 94% (n¼103) were white. All but one INT participant received the pharmacy consult, while the PT consult was delivered to most (46/55) participants. Median consult time was 20 minutes for both pharmacy and PT consults. ED LOS was not significantly increased in the INT arm. Acceptability surveys were completed by 99 participants and 35 caregivers. Patient and caregiver satisfaction were high in both arms (INT patient satisfaction 97%, INT caregiver satisfaction 94%; UC patient satisfaction 92%, UC caregiver satisfaction 94%).Conclusions: A multidisciplinary fall prevention intervention delivered by pharmacists and PTs in the ED is feasible and acceptable to patients and caregivers. GAPcare could provide a model of care for other US EDs to address and modify future fall risk of older adults.