Falls are the leading injury-related cause of Emergency Department (ED) visits in older adults and are both preventable and predictable, but the typical ED evaluation focuses on an injury assessment only. GAPcare, the Geriatric Acute & Post-acute Care Coordination Program for Fall Prevention in the Emergency Department, is an early stage investigation for preventing recurrent falls in older adults that present to the ED. Participants in this study will be adults ( 65 years old) who had a fall and present to the ED for care. We will randomly assign participants to an intervention or usual care arm. In the intervention arm physical therapists (PTs), pharmacists, and the ED physician collaborate to identify reasons the patient fell and address any identified risk factors. Seniors will return home with a standardized checklist containing details of their assessment and an exercise plan. These participants are referred to the same PT group for outpatient physical or occupational therapy, to provide continuity of care. Participants in the usual care arm receive care as provided by the ED physician only. Our long-term goal is to prevent the early morbidity and mortality of older adults who present to the ED after a fall. The overall objective of this investigation is to gather preliminary data on the feasibility, initial efficacy, and to solicit feedback on the GAPcare intervention to further refine our approach for the subsequent study. The central hypothesis is that GAPcare will lead to fewer falls by eliminating risk factors and giving patients tools for improving function. The rationale is that the ED visit is a teachable moment, in which patients and caregivers are engaged and collaboration of specialists is possible. Older adults have many barriers to accessing timely and comprehensive fall evaluations after discharge. We will pursue the following specific aims to test and further refine the GAPcare intervention: (1) Examine the feasibility of recruitment and retention of eligible patients into the GAPcare intervention, (2) determine the initial efficacy of the GAPcare intervention in reducing subsequent falls and healthcare utilization at 6 months. This will inform the effect size and sample size calculations for the subsequent study, and (3) solicit feedback from physicians and patients on their satisfaction with the GAPcare intervention. This investigation is expected to have two major contributions: 1. We will gather information on the feasibility, initial efficacy, and solicit feedback on the GAPcare intervention, which will help refine our approach for the subsequent study and 2. Dr. Goldberg will receive the training and preliminary data to submit a larger study as a K award to the National Institute on Aging. The public health significance of this intervention is immense as falls are the leading cause of fatal and non-fatal injury in older adults and no model of collaborative care exists to direct ED administrators and other stakeholders to reduce the occurrence of subsequent falls. This proposal is highly innovative because unlike other community-based programs it targets the most high-risk seniors in the ED during the period immediately after a fall when patients are most vulnerable for repeat falls and highly engaged in their care.
The proposed research is relevant to public health because preventing subsequent falls in older ED patients may prolong functional independence, improve quality of life, delay mortality, and reduce health care costs. GAPcare is relevant to the NIH mission because it examines a collaborative care model to reduce subsequent falls in high-risk Emergency Department seniors and supports the further training of Dr. Goldberg to become a leader in geriatric emergency care.
|Goldberg, Elizabeth M; McCreedy, Ellen M; Gettel, Cameron J et al. (2017) Slipping through the cracks: A cross-sectional study examining older adult emergency department patient fall history, post-fall treatment and prevention. R I Med J (2013) 100:18-23|