Aging
Conditions
Keywords
falls
Brief summary
Objective To reduce subsequent falls following Multifactorial Falls Assessment Design: Prospective Case Control Population: Frail elderly Veteran outpatient population referred for falls assessment Methods: Prospective controlled trial of Geriatric Multifactorial Falls Assessment Clinic patients followed for 1 year and outcomes compared to Acute Geriatric Evaluation and Management (GEM) Inpatient Unit discharge control group.
Detailed description
We designed a prospective controlled trial to compare the effectiveness of outpatient falls assessment and treatment for community-dwelling frail elderly patients with history of falls referred to an active management Geriatric Multifactorial Falls Assessment Clinic with a control group of patients discharged from an Acute Geriatric Evaluation and Management (GEM) Inpatient Unit during the same time period, but who were not specifically referred for falls assessment. We hypothesized that a population of frail elderly referred by their primary care physicians and who reported for evaluation to a Geriatric Multifactorial Falls Assessment Clinic would show a reduction in falls compared to controls, when provided a time-limited consult evaluation with active follow-up for 1 year.
Interventions
OTHERMultifactorial Falls Assessment
The Geriatric Multifactorial Falls Assessment Clinic is a component of GERIATRIC-PACT, a frail-elderly primary care patient-centered medical home with care provided by an inter-professional teamlet consisting of a geriatrician, geriatric nurse practitioner, clinical pharmacist, licensed practical nurse, nurse care manager, social worker, and dietitian. GERIATRIC-PACT operates with increased ancillary support compared to Primary Care PACT. Falls assessment patients were referred by primary care providers and were evaluated and treated by the GERIATRIC-PACT teamlet, including ordering of tests and medication adjustment, with an average of two visits and active follow-up for one year.
Sponsors
Powers, James S., M.D.
Study design
Allocation
NON_RANDOMIZED
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Masking description
No masking
Eligibility
Sex/Gender
ALL
Age
65 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Community-dwelling frail elderly with history of fall
Exclusion criteria
* Severe dementia
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Number of Participants Who Experienced Falls | 12 months | Number of participants who experienced falls in 12 months, based on self-recall and telephone interview. |
Countries
United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Treatment Geriatric Multifactorial Falls Assessment Clinic
Multifactorial Falls Assessment: The Geriatric Multifactorial Falls Assessment Clinic is a component of GERIACTRIC-PACT, a frail-elderly primary care patient-centered medical home with care provided by an inter-professional teamlet consisting of a geriatrician, geriatric nurse practitioner, clinical pharmacist, licensed practical nurse, nurse care manager, social worker, and dietitian. GERIATRIC-PACT operates with increased ancillary support compared to Primary Care PACT. Falls assessment patients were referred by primary care providers and were evaluated and treated by the GERIATRIC-PACT teamlet, including ordering of tests and medication adjustment, with an average of two visits and active follow-up for one year. | 54 |
| Control Geriatric Evaluation and Management Service (GEM) The Geriatric Evaluation and Management Service (GEM) is an acute inpatient service with over 150 discharges annually. Frail elderly treated on GEM receive inter-professional geriatric team assessment and treatment while hospitalized. Patients discharged to home return to the care of their primary physicians. | 42 |
| Total | 96 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | ineligible | 1 | 8 |
| Overall Study | Withdrawal by Subject | 2 | 2 |
Baseline characteristics
| Characteristic | Control | Total | Treatment |
|---|---|---|---|
| Age, Categorical <=18 years | 0 Participants | 0 Participants | 0 Participants |
| Age, Categorical >=65 years | 42 Participants | 96 Participants | 54 Participants |
| Age, Categorical Between 18 and 65 years | 0 Participants | 0 Participants | 0 Participants |
| Age, Continuous | 74.1 years STANDARD_DEVIATION 13.1 | 76.6 years STANDARD_DEVIATION 8.6 | 77.3 years STANDARD_DEVIATION 8.8 |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Asian | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Black or African American | 5 Participants | 14 Participants | 9 Participants |
| Race (NIH/OMB) More than one race | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) White | 37 Participants | 82 Participants | 45 Participants |
| Region of Enrollment United States | 42 participants | 96 participants | 54 participants |
| Sex: Female, Male Female | 1 Participants | 2 Participants | 1 Participants |
| Sex: Female, Male Male | 41 Participants | 94 Participants | 53 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 6 / 55 | 12 / 51 |
| other Total, other adverse events | 0 / 55 | 0 / 51 |
| serious Total, serious adverse events | 0 / 55 | 0 / 51 |
Outcome results
Primary
Number of Participants Who Experienced Falls
Number of participants who experienced falls in 12 months, based on self-recall and telephone interview.
Time frame: 12 months
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Treatment | Number of Participants Who Experienced Falls | 22 Participants |
| Control | Number of Participants Who Experienced Falls | 35 Participants |