Citation

Goldberg EM, Marks SJ, Ilegbusi A, Resnik L, Strauss DH, Merchant RC. J. Am. Geriatr. Soc. 2019; ePub(ePub): ePub.

Affiliation

Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island.

Copyright

(Copyright © 2019, John Wiley and Sons)

DOI

10.1111/jgs.16210

PMID

31621901

Abstract

OBJECTIVES: We aimed to describe a new multidisciplinary team fall prevention intervention for older adults who seek care in the emergency department (ED) after having a fall, assess its feasibility and acceptability, and review lessons learned during its initiation.

DESIGN: Single-blind randomized controlled pilot study. SETTING: Two urban academic EDs PARTICIPANTS: Adults 65 years old or older (n = 110) who presented to the ED within 7 days of a fall. INTERVENTION: Participants were randomized to a usual care (UC) and an intervention (INT) arm. Participants in the INT arm received a brief medication therapy management session delivered by a pharmacist and a fall risk assessment and plan by a physical therapist (PT). INT participants received referrals to outpatient services (eg, home safety evaluation, outpatient PT). MEASUREMENTS: We used participant, caregiver, and clinician surveys, as well as electronic health record review, to assess the feasibility and acceptability of the intervention.

RESULTS: Of the 110 participants, the median participant age was 81 years old, 67% were female, 94% were white, and 16.3% had cognitive impairment. Of the 55 in the INT arm, all but one participant received the pharmacy consult (98.2%); the PT consult was delivered to 83.6%. Median consult time was 20 minutes for pharmacy and 20 minutes for PT. ED length of stay was not increased in the INT arm: UC 5.25 hours vs INT 5.0 hours (P < .94). After receiving the Geriatric Acute and Post-acute Fall Prevention Intervention (GAPcare), 100% of participants and 97.6% of clinicians recommended the pharmacy consult, and 95% of participants and 95.8% of clinicians recommended the PT consult.

CONCLUSION: These findings support the feasibility and acceptability of the GAPcare model in the ED. A future larger randomized controlled trial is planned to determine whether GAPcare can reduce recurrent falls and healthcare visits in older adults.

© 2019 The American Geriatrics Society.

Language: en

Keywords

emergency department; falls; injury prevention; pharmacist; physical therapy