PCORI, NIA Partner on New Approach to Prevent Fall-Related Injuries among the Elderly
It’s an all-too-common story. An aging parent, otherwise largely able to care for herself, falls and suffers injuries that rob her of her independence. In fact, falls are the No. 1 cause of injury among older adults, with the Centers for Disease Control and Prevention estimating that one in three adults age 65 and older suffers a fall each year, and 30 percent of those result in severe injuries. The burden of these injuries on families and the healthcare system as a whole is enormous and likely to become more so as our population ages. What’s especially frustrating is that rates of fall-related injuries remain high despite research pointing to effective interventions that can address the problem. But we’re hoping a new joint effort by PCORI and the National Institute on Aging (NIA), part of the National Institutes of Health (NIH), will offer some solutions.
The Fall Injuries Prevention Partnership, a research partnership between PCORI and NIA with funds provided by PCORI to NIH, issued a five-year, $30 million national study that will test the effectiveness of a comprehensive strategy to prevent serious injuries from falls in the elderly. Under this approach, nurses trained as falls care managers will work with each patient’s primary care provider on a four-stage approach to preventing injuries from falls.
Evaluating a Comprehensive Plan
Despite the evidence regarding interventions that can effectively prevent falls and the injuries they cause, no trial has combined interventions to identify the best mix of risk assessment, treatment, and delivery strategies to meet patients’ individual needs. To achieve that goal, several of the country’s top geriatric physicians will be involved in the new PCORI-funded study, which also will include robust engagement of older Americans. The research team is led by three directors of Claude D. Pepper Older Americans Independence Centers (OAICs)—NIA-funded centers of research expertise on complex geriatric conditions. These joint principal investigators are Shalender Bhasin, MD, of Brigham and Women’s Hospital, Harvard Medical School; Thomas M. Gill, MD, of Yale School of Medicine; and David B. Reuben, MD, of the David Geffen School of Medicine at UCLA.
| The Four Stages of the Fall-Prevention Strategy |
| 1. Working with physicians and family caregivers, a nurse specially trained as a falls care manager assesses a patient’s risk using a standardized assessment tool and produces visit notes. |
| 2. Using the visit notes and evidence-based protocols, the falls care manager discusses the identified risks with the patient (and caregivers, as appropriate) and suggests interventions, taking into account patient preferences and readiness to participate. |
| 3. The falls care manager and patient jointly develop an individually tailored falls-prevention plan, which the patient’s primary care physician reviews. |
| 4.The falls care manager implements the plan, monitors the patients’ responses, and reassesses the risk factors at scheduled intervals, revising the plan as needed. |
The trial will recruit 6,000 individuals, age 75 and older, representing diverse populations from 80 community-based primary care practices affiliated with 10 healthcare delivery systems. These practices represent diverse geographic locations and healthcare contexts — they are located in urban, suburban, and rural communities in 12 states across the country, include organizations reimbursed through Medicare and managed care, many of which are affiliated with Accountable Care Organizations. Study participants will represent a wide range of racial and ethnic populations. That diversity will broaden the applicability of our findings so they can be used to help more patients and families. Practices participating in the study will be randomized to either provide participants with the experimental intervention or serve as “usual care” controls, in which older patients will be assessed for their risk of falling and provided with information about preventing falls. The trial will compare rates of fall-related injuries between the two groups.
Local and National Councils Assure Engagement
To ensure systematic and robust engagement of patients and other stakeholders throughout all phases of the study, each of the participating health systems will create local councils. There will also be a National Patient and Stakeholder Council (NPSC). At least half the members of each local council and the NPSC will be patients who have a history of, or are at risk for, falls. They will be joined by caregivers, advocacy and consumers groups, clinicians, government agencies (including the Centers for Medicare & Medicaid Services and the Agency for Healthcare Research and Quality), and others.
The project employs PCORI’s model for engagement, which was developed based on interviews with hundreds of patients and caregivers to determine best practices for patient engagement in research. The councils will provide ongoing advice and feedback on the design and implementation of the study. This important new collaboration to prevent fall-related injuries capitalizes on PCORI’s expertise in supporting comparative clinical effectiveness research that engages patients and other stakeholders throughout the research process and NIA’s expertise in supporting and managing large, multi-center clinical trials in geriatrics. Working together, we hope this will be a landmark study that will make a real difference in improving the health and lives of older adults.
Selby is PCORI’s Executive Director Hodes is Director of the National Institute on Aging