Research Reveals Real-World Challenges of Preventing Falls

By Jonathan Springston, Editor, Relias Media

Even when clinicians work hand in hand with patients to create a carefully individualized fall prevention plan, such actions do not appear to make a significant difference when it comes to reducing fall rates among older adults, according to the results of a recent study.

Backed by the Patient-Centered Outcomes Research Institute and the National Institutes of Health, researchers conducted the multisite, randomized, pragmatic Strategies to Reduce Injuries and Develop Confidence in Elders (STRIDE) trial. The authors randomly assigned patients from 86 primary care practices across 10 healthcare systems to the intervention group (n = 2,802) or enhanced usual care (control) group (n = 2,649).

Observed participants were community-dwelling adults age 70 years or older at a higher risk for fall injuries (e.g., those with low vitamin D levels, poor vision, balance impairment). Care managers worked with participants in the intervention group to recognize risk factors and select which to change. Those in the control group went through usual care, received an educational pamphlet, and were encouraged to speak with their personal physicians about prevention.

The primary outcome was the first serious fall injury. The authors estimated the event rate would be 20% lower among intervention group patients vs. control group patients. However, the observed rate was closer to 8% to 10%.

“The study reflects just how challenging it is to implement interventions to prevent fall injury in the real world,” Shalender Bhasin, MD, study co-author and director of research programs in Men’s Health, Aging, and Metabolism at Brigham and Women’s Hospital, said in a statement. “Our falls care managers were passionate about the care of their patients and creating individualized plans for them. But measures that may reduce risk in the setting of a clinical trial can be less effective in the real world, where daily challenges such as being unable to afford transportation, or the cost of follow-up care, may delay or prevent access for patients. To achieve a larger reduction in serious fall injuries, we need to think about how to improve the delivery and access to key interventions like exercise in our health systems."

The upcoming September issue of ED Legal Letter will include an article about factors that become important in malpractice lawsuits involving fall injuries. What are some common allegations in these lawsuits? What specific documentation can help the defense? On the other hand, what factors help the plaintiff prevail? What kind of documentation, if missing from the emergency department chart, can help the plaintiff’s case? Be sure to read the issue, available soon, to find out.