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Reducing Patient Falls: Primary Care Setting May Hold the Key

Although falling is a major public health problem among older adults, a growing body of research shows that fall injuries can be prevented through assessment, care plans, and follow-up by primary care providers. Twelve Brigham and Women’s Hospital (BWH) primary care practices are now participating in the largest-ever national research study on fall prevention – Strategies to Reduce Injuries and Develop Confidence in Elders (STRIDE).

Falls are all too common among older persons and their results can be devastating. The Centers for Disease Control and Prevention (CDC) reports that in 2014:

  • More than 2.8 million older adults were treated in emergency departments after falling.
  • Approximately 27,000 of these patients died due to fall-related injuries, such as head trauma, fractures, dislocations, and soft tissue damage.
  • Fall-related Medicare costs were $31.3 billion, not including indirect costs, which can be much higher.

Furthermore, these falls often trigger a series of adverse events that contribute to functional decline, loss of independence, and social isolation. Falls also increase the risk of early death.

Study participants, who are aged 75 years or older, are first assessed for their risk of falling with an in-depth questionnaire. This is part of an evaluation by nurses specially trained as falls care mangers (FCM), and those who screen positive (indicating a high risk of falling) work closely with the FCM to develop a personalized prevention plan.

Research shows that fall injuries can be prevented through assessment, care plans, and follow-up by primary care providers.

The FCM uses a technique called motivational interviewing to engage with patients and determine their risk factors for falling and then works with the patient and primary care providers to develop an individualized, comprehensive care plan that addresses those risk factors. Risk factors can range from vision loss and hazards in the home to medication side effects and lack of strength or balance. The FCM refers patients to the appropriate services for reducing risks, such as an exercise program to increase strength and balance or an eye doctor to prescribe new glasses.

The FCM also is responsible for following up with patients to ensure that they are implementing the care plan. If patients encounter barriers, such as transportation or timing, the FCM works with them to address those challenges. Patients will be followed for up to three years to evaluate the study’s effects.

“A fall can have catastrophic effects that can drastically change someone’s life,” says Shalender Bhasin, MD, Director of Research Programs in Men’s Health, Aging, and Metabolism at BWH and STRIDE Principal Investigator. “We are committed to changing the way these patients are cared for to improve their outcomes and quality of life.”