Citation

Bhasin S, Gill TM, Reuben DB, Latham NK, Gurwitz JH, Dykes P, McMahon S, Storer TW, Duncan PW, Ganz DA, Basaria S, Miller ME, Travison TG, Greene EJ, Dziura J, Esserman D, Allore H, Carnie MB, Fagan M, Hanson C, Baker D, Greenspan SL, Alexander N, Ko F, Siu AL, Volpi E, Wu AW, Rich J, Waring SC, Wallace R, Casteel C, Magaziner J, Charpentier P, Lu C, Araujo K, Rajeevan H, Margolis S, Eder R, McGloin JM, Skokos E, Wiggins J, Garber L, Clauser SB, Correa-De-Araujo R, Peduzzi P. J. Gerontol. A Biol. Sci. Med. Sci. 2018; 73(8): 1053-1061.

Affiliation

Yale Center for Analytical Sciences; Yale University; New Haven, CT.

Copyright

(Copyright © 2018, Gerontological Society of America)

DOI

10.1093/gerona/glx190

PMID

29045582

Abstract

BACKGROUND: Fall injuries are a major cause of morbidity and mortality among older adults. We describe the design of a pragmatic trial to compare the effectiveness of an evidence-based, patient-centered multifactorial fall injury prevention strategy to an enhanced usual care.

METHODS: Strategies to Reduce Injuries and Develop Confidence in Elders (STRIDE) is a 40-month cluster-randomized, parallel-group, superiority, pragmatic trial being conducted at 86 primary care practices in 10 healthcare systems across USA. The 86 practices were randomized to intervention or control group using covariate-based constrained randomization, stratified by healthcare system. Participants are community-living persons, ≥70 years, at increased risk for serious fall injuries. The intervention is a co-management model in which a nurse Falls Care Manager performs multifactorial risk assessments, develops individualized care plans, which include surveillance, follow-up evaluation, and intervention strategies. Control group receives enhanced usual care, with clinicians and patients receiving evidence-based information on falls prevention. Primary outcome is serious fall injuries, operationalized as those leading to medical attention (non-vertebral fractures, joint dislocation, head injury, lacerations, and other major sequelae). Secondary outcomes include all fall injuries, all falls, and well-being (concern for falling; anxiety and depressive symptoms; physical function and disability). Target sample size was 5,322 participants to provide 90% power to detect 20% reduction in primary outcome rate relative to control.

RESULTS: Trial enrolled 5451 subjects in 20 months. Intervention and follow-up are ongoing.

CONCLUSIONS: The findings of the STRIDE study will have important clinical and policy implications for the prevention of fall injuries in older adults.

Language: en

Keywords

Fall prevention; clinical effectiveness; nurse falls care managers; patient and stakeholders in fall injury prevention research