Falls After Hospital Discharge: A Randomized Clinical Trial of Individualized Multimodal Falls Prevention Education

Abstract

<jats:title>Abstract</jats:title> <jats:sec> <jats:title>Background</jats:title> <jats:p>Older people are at high risk of falls after hospital discharge. The study aimed to evaluate the effect of providing individualized falls prevention education in addition to usual care on falls rates in older people after hospital discharge compared to providing a social intervention in addition to usual care.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>A randomized clinical trial at three hospitals in Western Australia: participants followed for 6 months after discharge. Baseline and outcomes measured by assessors masked to group allocation. Participants: aged 60 years and over, admitted for rehabilitation. Eligibility included: cognitively able to undertake education (Abbreviated mental test score &amp;gt;7/10). Intervention: tailored education comprising patient video and workbook, structured discussion and goal setting led by trained therapist. Main outcomes: falls in the 6 months after discharge; proportion of participants sustaining one or more falls.</jats:p> </jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>There were 382 (194 intervention; 188 control) participants (mean age 77.7 [SD 8.7] years). There were 378 falls (fall rate per 1,000 patient-days, 5.9 intervention; 5.9 control) reported by 164 (42.9%) participants in the 6 months following hospital discharge; 188 (49.7%) of these falls were injurious. There were no significant differences in falls rates between intervention and control groups: (adjusted IRR, 1.09; 95% CI [0.78 to 1.52]) or the proportion of participants who fell once or more (adjusted OR, 1.37; 95% CI [0.90 to 2.07]).</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>Providing individualized falls prevention education prior to discharge did not reduce falls at home after discharge. Further research is warranted to investigate how to reduce falls during this high-risk transition period.</jats:p> </jats:sec>

Evaluation of Tailored Falls Education on Older Adults' Behavior Following Hospitalization

“…The study found tailored education provided in addition to usual care did not significantly increase engagement of older adults in fall prevention strategies within 6 months after hospital discharge. This lack of intervention effect was consistent with findings of the main trial . During the 6‐month follow‐up period, there was a high incidence of falls in both groups (5.9 falls per 1000 patient days), reported by 42.9% of participants, and 49.7% of these falls were injurious.…”

“…All participants provided written informed consent prior to participation in the study. The RCT was prospectively registered in the Australian and New Zealand Clinical Trials Registry (ACTRN12615000784516) …”

“…A process evaluation was conducted alongside an RCT (n = 390) that delivered tailored falls education. The intervention (patient education) provided during the RCT was intended to have the effect of reducing posthospitalization falls incidence by facilitating older adults to initiate and sustain engagement in personalized fall prevention strategies . The protocol for this process evaluation has been previously described in detail …”

“…The education intervention was based on a pedagogically sound program previously found to be effective for improving knowledge and motivation of older adults to engage in fall prevention strategies . Education was delivered by an experienced physiotherapist on a one‐to‐one basis at the patients' bedside while in the hospital, using a workbook, video, and individual discussions . Tailoring the education was a behavior change technique that involved personalizing the fall prevention strategies based on participants' experiences and preferences, followed by individualized goal setting and action planning for their imminent discharge home.…”

“…A ward‐based falls education program reduced inpatient falls incidence by improving fall prevention behaviors on hospital wards, while a pilot trial of a tailored falls education program delivered prior to discharge improved fall prevention behaviors and reduced incidence of falls within the first month following hospital discharge . However, a recent large randomized controlled trial (RCT) that evaluated a tailored fall prevention education program delivered prior to hospital discharge found no reduction of falls or risk of falling during the 6‐month period following hospital discharge . Since the discharge intervention was designed to facilitate changes in older patients’ health behaviors over an extended period after hospital discharge, a process evaluation was necessary to understand if the intervention had the intended effect of promoting engagement in fall prevention behaviors in the context of their life‐circumstances following hospitalization …”