None listed
Conditions
Brief summary
Hospital emergency departments (EDs) treat a high proportion of older people, many as a direct consequence of falling. Many of these people have fallen in the past year and are a high risk of future falls. At Sir Charles Gairdner Hospital (SCGH) ED, at least 1500 patients are diagnosed with a ‘Fall’ per annum. This accounts for nearly 3% of ED diagnoses at SCGH, although many more patients present ‘at risk’ of falls. The SCGH ED Care Coordination Team (CCT) which includes Occupational Therapists and Physiotherapists, primary aim is to assess and provide early interventions to patients who have presented with a fall. The CCT plans discharge by determining if the patient is able to safely return home and refers to hospital and community falls services. Studies show patients who have presented to ED with a fall are at high risk for recurrent fall and that they do not generally receive the care required avoid further falls. Additionally priorities within the ED dictate that the immediate clinical and functional consequences of a fall are dealt with and there is limited time available to consider future falls and injury prevention strategies. The CCT are targeting falls risk factors, providing education and referring patients to be followed up with Falls specific services. However the outcomes of these patients and the effectiveness of this falls risk assessment and education is unknown. This study aims to review the efficacy of a simple, quick to administer screening tool for discriminating between future fallers and non-fallers that is feasible for use in the busy ED setting. Additionally this study may allow us to gain insight into the effectiveness of falls education in the ED environment. Patients would be randomised to receive additional feedback on their falls risk assessment score and increased falls prevention education versus usual care. It will measure the effect by describing difference in the proportion and number of falls during the six month follow up period (measured with monthly phone calls), changes in physical status, medical history and community service use.
Interventions
This study involves determining the efficacy of the Two Item Falls Risk Screening Tool and the Falls Risk for Older People in the Community (FROP Com) Screen and is a prospective single centre clinical trial of scripted falls risk education compared with usual treatment.
On presenting to the Emergency Department (ED) all older persons over 65 years will be seen by the Care Coordination Team (Occupational Therapists and Physiotherapists) for assessment. This will include the two item screening
This study involves determining the efficacy of the Two Item Falls Risk Screening Tool and the Falls Risk for Older People in the Community (FROP Com) Screen and is a prospective single centre clinical trial of scripted falls risk education compared with usual treatment. On presenting to the Emergency Department (ED) all older persons over 65 years will be seen by the Care Coordination Team (Occupational Therapists and Physiotherapists) for assessment. This will include the two item screening tool and FROP Com Screen (plus intervention to determine their appropriateness to be discharged home.) The medical history and physical assessment data would be obtained. Information collected would include demographic factors, medical conditions, medications and pre-morbid functional status. On agreement to go into the trial the older person would be placed into either the control group or intervention group. The control group will receive usual practice i.e. review of individual falls risk factors, provision of a falls information pack and referral to outpatient and community services. The Intervention group will receive usual practice plus additional feedback on their future risk of falling as per the results of the two item screening tool and a scripted falls prevention education message. The treating Occupational Therapist or Physiotherapist will administer this message verbally in the ED at bedside. It will take approximately 10 minutes. Both the Control and Intervention groups will be further divided into people presenting to ED with falls and those with a non fall diagnosis. This intervention will be provided face-to-face, on a one off basis in the Emergency Department. It consists of administration of feedback on the participants future risk of falling (as per the Two Item Screening Tool Results) and the scripted falls prevention message. The Two Item Screening Tool provides a single score out of 3 indicating a participants future risk of falling. The scripted falls prevention education message highlights the serious nature of falls, consequences of falls and that falls can be reduced or prevented. It encourages participants to take action to decrease their risk of future falls.
Sponsors
Annette Barton
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Treatment
Masking
Blinded (masking used) (Subject, Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
All
Age
65 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Over the age of 65 years Seen by the Care Co-ordination Team - Occupational Therapist and Physiotherapist Being discharged home after the Emergency department presentation Cognitively able to understand and consent to the intervention Competent in understanding English Not residing in nursing home or requiring high level care
Exclusion criteria
Non English speaking Inability to consent Residency in community residential aged care facilities
Outcome results
None listed