GAPcare: The Geriatric Acute and Post‐Acute Fall Prevention Intervention in the Emergency Department: Preliminary Data

Abstract

OBJECTIVES We aimed to describe a new multidisciplinary team fall prevention intervention for older adults who seek care in the emergency department (ED) after having a fall, assess its feasibility and acceptability, and review lessons learned during its initiation. DESIGN Single‐blind randomized controlled pilot study. SETTING Two urban academic EDs PARTICIPANTS Adults 65 years old or older (n = 110) who presented to the ED within 7 days of a fall. INTERVENTION Participants were randomized to a usual care (UC) and an intervention (INT) arm. Participants in the INT arm received a brief medication therapy management session delivered by a pharmacist and a fall risk assessment and plan by a physical therapist (PT). INT participants received referrals to outpatient services (eg, home safety evaluation, outpatient PT). MEASUREMENTS We used participant, caregiver, and clinician surveys, as well as electronic health record review, to assess the feasibility and acceptability of the intervention. RESULTS Of the 110 participants, the median participant age was 81 years old, 67% were female, 94% were white, and 16.3% had cognitive impairment. Of the 55 in the INT arm, all but one participant received the pharmacy consult (98.2%); the PT consult was delivered to 83.6%. Median consult time was 20 minutes for pharmacy and 20 minutes for PT. ED length of stay was not increased in the INT arm: UC 5.25 hours vs INT 5.0 hours (P < .94). After receiving the Geriatric Acute and Post‐acute Fall Prevention Intervention (GAPcare), 100% of participants and 97.6% of clinicians recommended the pharmacy consult, and 95% of participants and 95.8% of clinicians recommended the PT consult. CONCLUSION These findings support the feasibility and acceptability of the GAPcare model in the ED. A future larger randomized controlled trial is planned to determine whether GAPcare can reduce recurrent falls and healthcare visits in older adults. J Am Geriatr Soc 68:198–206, 2019

Care Transition Decisions After a Fall‐related Emergency Department Visit: A Qualitative Study of Patients’ and Caregivers’ Experiences

“…The GAPcare intervention study recruited 110 patients from January 2018 until March 2019. 18 None of the patients or caregivers called refused to participate or had hearing impairment. We conducted interviews until thematic saturation was achieved with a total of 22 interviews with 14 patients and 12 caregivers.…”

Hospital Costs and Reimbursement Model for a Geriatric Emergency Department

“…Our program does not seem to increase the percent of older adults with prolonged ED stays (stays greater than 8 hours). One program targeting fall risk evaluations for older adults in the ED did not find an increased length of stay, but other GED models have 1,12 . It is likely that the effect of GED programs on operational metrics is dependent on a multitude of factors inherent to each individual ED.…”

Sturzprophylaxe in der Akutklinik

“…An diesem Punkt stehen Pflegefachkräfte oft vor Schwierigkeiten, da die Patienten meist nicht kooperativ erscheinen bzw. häufig nicht über bereits erfolgte Stürze im häuslichen Umfeld sprechen wollen [5]. Zur Unterstützung der Pflegefachkräfte wurde der Expertenstandard Sturzprophylaxe entwickelt, um den Pflegenden aktuelles Wissen und Handlungsmöglichkeiten an die Hand zu geben und damit die Pflegequalität zu verbessern.…”