Accidental Falls/Prevention and Control
Conditions
Keywords
Nursing Homes, Elderly, Dementia
Brief summary
The purpose of this study is to develop a consistent approach to prevent falls with injury in nursing home (NH) residents. A centralized Injury Liaison Service (ILS) will be developed and tested in four nursing home facilities (two in the Durham, North Carolina area and two in the Boston, Massachusetts area). The ILS will combine successful elements of a Fracture Liaison Service (FLS) and video telehealth staff education (ECHO) models with the goal of decreasing injurious falls in nursing home residents. The ILS Program has four main components: 1. Automated identification of NH residents at high risk for falls with injury 2. Recommendations by the ILS nurse to manage medications, including deprescribing medications associated with falls and a prescription for osteoporosis medications 3. Video telehealth sessions to educate staff 4. Shared decision making with residents and/or families. The central hypothesis of this study is that the ILS model will reduce injurious falls by changing care delivery in two areas: deprescribing psychoactive and cardiometabolic drugs to reduce falls, and increasing osteoporosis treatment to prevent injury in the setting of a fall. Qualitative interviews will be conducted with nursing home staff to gain a better understanding of effective and non-effective injury prevention strategies. Information from these interviews will be incorporated into the study design. Outcome measures will focus on acceptability, demand, practicality, and feasibility of the program, as well as safety.
Interventions
OTHERInjury Liaison Service
The Injury Liaison Service nurse will coordinate deprescribing of fall-related medications, osteoporosis management, staff support of behavior management using video case conferencing, and shared decision making with residents and/or families.
Sponsors
National Institute on Aging (NIA)
Duke University
Brown University
Hebrew SeniorLife
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
PREVENTION
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
60 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Facility inclusion criteria: 1. More than 80 long-stay beds 2. Within 30 miles of Boston, Massachusetts or Durham, North Carolina Resident inclusion criteria: 1. Age ≥ 60 years 2. NH length of stay ≥ 30 days 3. Estimated 2-year risk of hip fracture ≥ 6% using FRAiL model Provider inclusion criteria: The NH-PRIDE intervention will target the usual providers including nurses, certified nursing assistants (CNAs), physicians, nurse practitioners (NPs), and physician assistants (PAs) routinely caring for NH patients. Nurses should be providing care at a NH facility for a minimum of 2 shifts most weeks. Physicians, NPs, and PAs should spend, on average a minimum of four hours weekly in nursing home care. We estimate there will be 10 providers for the qualitative interviews on injurious falls prevention, 20 providers (4 from each facility) in the televideo sessions, and 60 providers (15 per facility) to participate in the post-intervention questionnaires. Additional eligibility criteria for providers include: 1. Worked in the facility for ≥ 90 days 2. Can communicate in English (in order to participate in interviews and questionnaires), 3. Over 21 years of age. Proxy/resident inclusion criteria: We will recruit 10 residents/proxies to participate in qualitative interviews on falls prevention. Residents/family must meet the following criteria: 1. Affiliated resident has lived in the facility for ≥ 30 days 2. Can communicate in English 3. Over 21 years of age 4. Able to provide informed consent to participate in the interviews
Exclusion criteria
Facility
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Number of Staff Members Who Attended One or More ECHO Sessions | 6 months |
| Number of Residents Who Accepted Osteoporosis Treatment Recommendations | 4 months |
| Attrition of Eligible Residents From the NH Facility Due to Transfer, Discharge to Community, or Death | 6 months |
| Proportion of Staff Members Who Indicated They Were Satisfied or Very Satisfied With the ILS on a Post-intervention Survey | 6 months |
| Number of High-risk Residents According to the FRAiL Model | baseline |
| Number of High-risk Residents With One or More Deprescribing Recommendations | 4 months |
| Number of Residents Whose Provider Accepted One or More Deprescribing Recommendations | 4 months |
| Number of Residents Who Accepted One or More Deprescribing Recommendations | 4 months |
| Number of High-risk Residents With a Recommendation for Osteoporosis Treatment | 4 months |
| Number of Residents Whose Provider Accepted Osteoporosis Treatment Recommendations | 4 months |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Average Number of Adverse Drug Events | 4 months | 1. Escalating behaviors, worsening depression, or functional decline following psychoactive medication deprescribing 2. Unplanned medical visits for hypertension, tachycardia, or hyperglycemia following cardiometabolic deprescribing 3. New gastroesophageal reflux disease or esophagitis following bisphosphonate prescription Adverse drug events were analyzed in residents who had one or more medications deprescribed (n=21). |
| Number of Injurious Falls | 4 months | — |
| Average Number of Deprescribing Recommendations That Were Made for Each Resident | 4 months | — |
Countries
United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Nursing Home Residents and Staff Nursing home residents at high risk for injurious falls, as well as nursing home staff at participating facilities. Participants included 46 nursing home residents, 28 qualitative interview participants, and 66 facility staff members.
Injury Liaison Service: The Injury Liaison Service nurse will coordinate deprescribing of fall-related medications, osteoporosis management, staff support of behavior management using video case conferencing, and shared decision making with residents and/or families. | 140 |
| Total | 140 |
Withdrawals & dropouts
| Period | Reason | FG000 |
|---|---|---|
| Overall Study | Death | 5 |
Baseline characteristics
| Characteristic | Nursing Home Residents and Staff | — |
|---|---|---|
| Age, Categorical <=18 years | 0 Participants | — |
| Age, Categorical >=65 years | 46 Participants | — |
| Age, Categorical Between 18 and 65 years | 94 Participants | — |
| Age, Continuous | 88 years | — |
| Race and Ethnicity Not Collected | — | — Participants |
| Region of Enrollment United States | 140 participants | — |
| Sex: Female, Male Female | 122 Participants | — |
| Sex: Female, Male Male | 18 Participants | — |
Adverse events
| Event type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | 5 / 46 |
| other Total, other adverse events | 1 / 46 |
| serious Total, serious adverse events | 9 / 46 |
Outcome results
Primary
Attrition of Eligible Residents From the NH Facility Due to Transfer, Discharge to Community, or Death
Time frame: 6 months
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Nursing Home Residents | Attrition of Eligible Residents From the NH Facility Due to Transfer, Discharge to Community, or Death | 6 Participants |
Primary
Number of High-risk Residents According to the FRAiL Model
Time frame: baseline
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Nursing Home Residents | Number of High-risk Residents According to the FRAiL Model | 46 Participants |
Primary
Number of High-risk Residents With a Recommendation for Osteoporosis Treatment
Time frame: 4 months
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Nursing Home Residents | Number of High-risk Residents With a Recommendation for Osteoporosis Treatment | 20 Participants |
Primary
Number of High-risk Residents With One or More Deprescribing Recommendations
Time frame: 4 months
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Nursing Home Residents | Number of High-risk Residents With One or More Deprescribing Recommendations | 36 Participants |
Primary
Number of Residents Who Accepted One or More Deprescribing Recommendations
Time frame: 4 months
Population: 21 residents had deprescribing recommendations accepted by their provider
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Nursing Home Residents | Number of Residents Who Accepted One or More Deprescribing Recommendations | 21 Participants |
Primary
Number of Residents Who Accepted Osteoporosis Treatment Recommendations
Time frame: 4 months
Population: 10 residents had osteoporosis treatment recommendations accepted by their provider
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Nursing Home Residents | Number of Residents Who Accepted Osteoporosis Treatment Recommendations | 10 Participants |
Primary
Number of Residents Whose Provider Accepted One or More Deprescribing Recommendations
Time frame: 4 months
Population: 36 participants had one or more deprescribing recommendations
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Nursing Home Residents | Number of Residents Whose Provider Accepted One or More Deprescribing Recommendations | 21 Participants |
Primary
Number of Residents Whose Provider Accepted Osteoporosis Treatment Recommendations
Time frame: 4 months
Population: 20 participants had a recommendation for osteoporosis treatment
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Nursing Home Residents | Number of Residents Whose Provider Accepted Osteoporosis Treatment Recommendations | 10 Participants |
Primary
Number of Staff Members Who Attended One or More ECHO Sessions
Time frame: 6 months
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Nursing Home Residents | Number of Staff Members Who Attended One or More ECHO Sessions | 21 Participants |
Primary
Proportion of Staff Members Who Indicated They Were Satisfied or Very Satisfied With the ILS on a Post-intervention Survey
Time frame: 6 months
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Nursing Home Residents | Proportion of Staff Members Who Indicated They Were Satisfied or Very Satisfied With the ILS on a Post-intervention Survey | 17 Participants |
Secondary
Average Number of Adverse Drug Events
1. Escalating behaviors, worsening depression, or functional decline following psychoactive medication deprescribing 2. Unplanned medical visits for hypertension, tachycardia, or hyperglycemia following cardiometabolic deprescribing 3. New gastroesophageal reflux disease or esophagitis following bisphosphonate prescription Adverse drug events were analyzed in residents who had one or more medications deprescribed (n=21).
Time frame: 4 months
Population: Adverse drug events were analyzed in residents who had one or more medications deprescribed (n=21).
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Nursing Home Residents | Average Number of Adverse Drug Events | 0.05 number of events | Standard Deviation 0.22 |
Secondary
Average Number of Deprescribing Recommendations That Were Made for Each Resident
Time frame: 4 months
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Nursing Home Residents | Average Number of Deprescribing Recommendations That Were Made for Each Resident | 2.2 number of recommendations | Standard Deviation 1.3 |
Secondary
Number of Injurious Falls
Time frame: 4 months
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Nursing Home Residents | Number of Injurious Falls | 0.07 number of injurious falls | Standard Deviation 0.25 |