RESPOND—A patient-centred program to prevent secondary falls in older people presenting to the emergency department (ED) with a fall: Protocol for a multi-centre randomised controlled trial

The intervention will be delivered by a RESPOND clinician who is a registered health professional. The RESPOND program incorporates: (1) home-based risk factor assessment; (2) education, coaching, goal setting and follow-up telephone support for management of one or more of four risk factors with evidence of effective interventions; and (3) healthcare provider communication and community linkage as summarised below. (1) Home-based risk factor assessment The RESPOND clinician will visit the participant at their home within two weeks of discharge from hospital to perform the risk assessment. At this visit, the RESPOND clinician will perform a falls risk factor assessment using the validated FROP-Com (Falls Risk for Older People in the Community) tool, a detailed falls risk assessment tool for use in the community setting. (2) Education, coaching, goal setting and follow-up telephone support for management of one or more of four risk factors with evidence of effective interventions The RESPOND program targets four risk factors with a robust evidence-base: poor balance and/or loss of strength; vision impairment; long-time use of benzodiazepines; and poor bone health. Risk factor education and management will be provided at the baseline home visit and follow-up telephone phone calls. It will be supported by provision of four education leaflets that have been developed specifically for the project and include simple information on risk factors and positive health messages relating to management options. The RESPOND clinician will use motivational interviewing to assist in selection of risk factors for management. They will act as a ‘coach’ to support the participant to understand assessment findings, make guided decisions about how they will action recommendations and referrals, and to assist in tailoring care plans to address barriers identified. At the initial assessment the RESPOND clinician will support the participant to establish goals that target chosen risk factors. Risk factor goals will be mutually agreed and will be based on each participant’s individual risk factor profile, social factors and work/family commitments. Many RESPOND participants will have already participated in some form of falls risk assessment and may have existing recommendations and referrals from ED staff or other clinicians. In this instance, RESPOND clinicians will not duplicate assessments or recommendations but instead aim to optimise participant’s knowledge and participation. (3) Healthcare provider communication and community linkage During the coaching sessions, the RESPOND clinician will encourage participants to discuss their action plan with their general practitioners, specialist physicians or other primary care providers involved in their care. The RESPOND clinician will refer (as appropriate) each participant to their chosen program/s and provide ongoing support and trouble shooting by telephone regarding access to these programs. A simple written report including the participants falls risk status as determine by the FROP-Com assessment (low, medium or high falls risk), goals and action plan will be sent to each participant’s GP following the baseline assessment. The RESPOND clinician will communicate similar information by letter to other healthcare providers participants are consulting for falls-related factors. The patient–centred approach of RESPOND means the content, duration and frequency of the coaching sessions provided to each participant will be unique. However, in total RESPOND aims to provide an average of 10 hours coaching, of which 45 minutes delivered face-to-face at the first home visit and the remainder delivered by telephonefor each intervention participant. The clinician will provide an initial 45 minute face-to-face session, followed by a minimum of two 45 minute follow-up phone calls. The first follow-up phone call will be provided within two weeks of the intervention home visit being completed. The second follow-up phone call will be made within three months of the first intervention home visit. The RESPOND program intervention will be implemented over six months and participants followed up for a further six months.