Older adult falls prevention behaviors 60 days post-discharge from an urban emergency department after treatment for a fall

Abstract

Background: Falls are a common and debilitating health problem for older adults. Older adults are often treated and discharged home by emergency department (ED)-based providers with the hope they will receive falls prevention resources and referrals from their primary care provider. This descriptive study investigated falls prevention activities, including interactions with primary care providers, among community-dwelling older adults who were discharged home after presenting to an ED with a fall-related injury. Methods: We enrolled English speaking patients, aged ≥ 65 years, who presented to the ED of an urban level one trauma center with a fall or fall related injury and discharged home. During subjects' initial visits to the ED, we screened and enrolled patients, gathered patient demographics and provided them with a flyer for a Matter of Balance course. Sixty-days post enrollment, we conducted a phone follow-up interview to collect information on post-fall behaviors including information regarding the efforts to engage family and the primary care provider, enroll in a falls prevention program, assess patients' attitudes towards falling and experiences with any subsequent falls. Results: Eighty-seven community-dwelling people between the ages of 65 and 90 were recruited, the majority (76%) being women. Seventy-one percent of subjects reported talking to their provider regarding the fall; 37% reported engaging in falls prevention activities. No subjects reported enrolling in a fall prevention program although two reported contacting falls program staff. Fourteen percent of subjects (n=12) reported a recurrent fall and 8% (7) reported returning to the ED after a recurrent fall. Conclusions: Findings indicate a low rate of initiating fall prevention behaviors following an ED visit for a fall-related injury among community-dwelling older adults, and highlight the ED visit as an important, but underutilized, opportunity to mobilize health care resources for people at high risk for subsequent falls.

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

“…Approaches to address fall prevention in US EDs have included studies evaluating staff‐directed educational initiatives and fall risk factors with and without referral to outpatient resources. ED interventions that consist of outpatient referrals alone suffer from poor compliance, with patients often citing lack of transportation, disinterest, and lack of sufficient motivation as the reasons they do not present for follow‐up after a fall . GAPcare addresses these barriers by initiating assessments immediately after the fall while the patient is in the ED.…”

“…Unfortunately, only 28% of older adults recall their last fall when presenting to their annual wellness visit . As a result, many older adults do not receive fall risk prevention measures after their falls …”

“…In the latter study, fall assessments were completed on average 5 to 10 weeks after the initial ED visit. Prompt evaluation and fall risk assessment, as can be done immediately after the injury in the ED, may prevent falls in the high‐risk immediate post‐fall period . The ED visit is an opportune time to initiate fall prevention measures because patients are optimally engaged, caregivers are often present, and hospital‐based staff, such as pharmacists and physical therapists (PTs), are available .…”

“…6 As a result, many older adults do not receive fall risk prevention measures after their falls. 6,7 Despite the need for an effective ED-based fall prevention approach, no applicable model exists to guide this care in the United States. 8 A London-based study of 397 patients after falls recruited from the ED into a home-based occupational therapy assessment significantly reduced falls (odds ratio [OR] = 0.39; 95% confidence interval [CI] = 0.23-0.60), 9 but when this program was implemented in the Netherlands, there was no reduction in falls.…”

“…Prompt evaluation and fall risk assessment, as can be done immediately after the injury in the ED, may prevent falls in the high-risk immediate post-fall period. 7,[11][12][13] The ED visit is an opportune time to initiate fall prevention measures because patients are optimally engaged, caregivers are often present, and hospital-based staff, such as pharmacists and physical therapists (PTs), are available. 14 However, EDs are busy environments, and ED clinicians lack the time and training 15 to perform fall risk assessments.…”