Every second, an older person in the United States falls and injures themselves, and every 20 minutes one of them dies from the fall. More than 30 percent of adults 65 and older fall every year and 25 percent of them have moderate to severe injuries. These falls result in 3 million visits to the emergency department, 800,000 hospitalizations, and 30,000 deaths each year. The problem is especially acute in Florida where more than 3.3 million residents are over age 65.
Although there are comprehensive guidelines on fall prevention, most efforts at the primary care level and in emergency departments have not shown great promise in preventing injury. Moreover, primary care physicians rarely perform recommended routine fall-risk assessments and fall prevention strategies.
Researchers from Florida Atlantic University’s Schmidt College of Medicine have received a $1 million grant from the Florida Medical Malpractice Joint Underwriting Association for a two-year project titled, “The Geriatric Emergency Department Fall Injury Prevention Project (The GREAT FALL).”
The randomized controlled study will investigate several emergency department-based prevention strategies in older patients at high risk for recurrent falls and injury. The tailored multicomponent intervention will identify effective fall prevention strategies that target limited resources to high-risk individuals who come to the emergency department to improve patient outcomes, improve safety, and reduce overall costs of health care.
“The emergency department provides an opportunity to target efforts and maximize resources to reduce the risk of fall-related injuries,” said Richard Shih, M.D., principal investigator, a professor of emergency medicine, and division director of the emergency medicine residency program, FAU Schmidt College of Medicine. “Importantly, older patients who have injured themselves after a fall and come to the emergency department have an even higher risk for recurrent falls and subsequent injuries. Therefore, targeting older individuals and their caregivers in the emergency department could provide the most beneficial return when limited resources are available to enhance safety in these individuals.”
“The GREAT FALL” builds upon two prior FAU prevention projects: “The GREAT STOP” to prevent head trauma in older adults on blood thinners, and the “STAR” program that included many different types of high-risk older patients. “The GREAT STOP” project enrolled about 6,000 head injury patients among whom the vast majority suffered their injury due to a ground-level fall. The work has led to a number of important insights regarding fall-related head injuries in the older population.
Shih leads a collaborative group of emergency medicine and geriatric medicine researchers with vast experience in this field. The team is collaborating with the Palm Beach Health Network’s Delray Medical Center, which treats more than 50,000 adult patients in its emergency department and includes a busy level 1 trauma center, the highest level of trauma care available.
The main outcome measure of the study will determine the rate of recurrent falls requiring an emergency department visit and fall-related injury over a six-month follow-up period. Additional secondary outcomes will include types of fall-related injuries, fall-related deaths, and all-cause deaths.
Study participants will be randomized to three strategies: current care; a phone-based fall-prevention strategy; and a home-visit fall prevention strategy. The phone-based strategy will include providing the patient and caregiver with easy-to-read materials before they are discharged from the emergency department and a structured phone call around 14 days after discharge. Both the home-visit fall prevention strategy and phone strategy are based on the U.S. Centers for Disease Control and Prevention’s “Stopping Elderly Accidents, Deaths & Injuries.”
“Florida is an ideal location to perform this important study as it has the highest percentage of geriatric patients in the U.S., and in particular, Palm Beach County has more than 365,000 residents age 65 and older, which makes up 24.4 percent of the county’s population,” said Julie G. Pilitsis, M.D., Ph.D., dean and vice president of medical affairs, FAU Schmidt College of Medicine. “This project will provide vital data on the best strategies to prevent falls in high-risk individuals and improve their safety as well as patient outcomes.”
Co-investigators of the study are Lisa Clayton, D.O., an associate professor of emergency medicine and chair, FAU Department of Emergency Medicine; Joseph G. Ouslander, M.D., a professor of geriatric medicine, senior advisor to the dean, and editor-in-chief of the Journal of the American Geriatrics Society; Scott Alter, M.D., an assistant professor of emergency medicine and associate research director of FAU’s emergency medicine residency program; Joshua Solano, M.D., an associate professor of emergency medicine and director of quality improvement and patient safety, FAU’s emergency medicine residency program; and Patrick Hughes, D.O., an associate professor of emergency medicine and assistant program director, FAU’s emergency medicine residency program.