Falls Prevention Programs in the ED
Studies that found decreased falls
Close J et al (Lancet 1999) - PROFET study
- The intervention group had comprehensive general exams followed by a single home visit by an occupational therapist at discharge
- The risk of falling, rate of hospital admission, and fracture rate was significantly reduced in the intervention group.
- This landmark paper led to the introduction of several multidisciplinary and multifactorial interventions that both screen for health and environmental risk factors and address these factors.
- It was also a major driving factor in the development of the AGS/BGS Clinical Practice Guidelines for the Prevention of Falls in Older Persons in 2001.
Davison et al (Age Ageing 2005)
- This study similarly found that multifactorial intervention was effective at reducing the fall burden in cognitively intact older persons with recurrent falls attending the ED, but did not reduce the proportion of subjects still falling.
Studies that found no effect between control and intervention groups
Hendricks et al (J Am Geriatr Soc 2008)
This study tried to recreate PROFET in Holland and reported no difference in outcome between the control and intervention groups at either 4 months or 12 months. The multidisciplinary fall-prevention program was not effective in preventing falls and functional decline in this Dutch healthcare setting.
Baraff et al (Acad Emerg Med 1999)
The attempted implementation of a practice guideline for the ED management of falls in community-dwelling elders did not result in a reduction in total falls or in hospitalizations for falls, injuries, or fractures.
Shaw FE. J Neural Transm (Vienna). 2007;114(10):1259–1264.
Evidence is lacking that falls can be prevented in patients with dementia.
Russell MA et al. J Am Geriatr Soc. 2010;58(12):2265–2274.
This study showed similar results.
Study with possible decreased fall risk
Matchar et al (Arch Phys Med Rehabil 2017)
Study found that higher risk falls patients benefited the most from a multidisciplinary targeted falls prevention program.
This study showed mixed results. Patients with more risk factors were more likely to benefit from a multidisciplinary, targeted, fall-prevention intervention
References
Close J et al. Lancet. 1999;353(9147):93–97.
Davison J et al. Age Ageing. 2005;34(2):162–168.
AGS, American Geriatrics Society; BGS, British Geriatrics Society; ED, emergency department; PROFET, Prevention Of Falls in the Elderly Trial.
Hendriks MR et al. J Am Geriatr Soc. 2008;56(8):1390–1397.
Baraff LJ et al. Acad Emerg Med. 1999;6(12):1224–1231.
Shaw FE. J Neural Transm (Vienna). 2007;114(10):1259–1264.
Russell MA et al. J Am Geriatr Soc. 2010;58(12):2265–2274.
Matchar DB et al. Arch Phys Med Rehabil. 2017;98(6):1086–1096.
Abbreviations
ED, emergency department; PROFET, PRevention Of Falls in the Elderly Trial.