Evaluation of RESPOND, a patient-centred program to prevent falls in older people presenting to the Emergency Department with a fall: A randomised controlled trial.

Abstract

Background: Falls are a leading reason for older people presenting to the emergency department (ED). Many experience further falls. Little evidence exists to guide secondary prevention in this population. This randomised controlled trial (RCT) investigated whether a 6-month telephone-based patient-centred program—RESPOND—had an effect on falls and fall injuries in older people presenting to the ED after a fall. Methods and findings: Community dwelling people aged 60-90 years presenting to the ED with a fall and planned for discharge home within 72 hours, were recruited from two EDs in Australia. Participants were enrolled if they could walk without hands-on assistance, use a telephone, and were free of cognitive impairment (MMSE>23). Recruitment occurred between 1st April 2014―29th June 2015. Participants were randomised to receive either RESPOND (intervention) or usual care (control). RESPOND comprised: (1 home-based risk assessment; (2) six months telephone-based education, coaching, goal setting and support for evidence-based risk factor management; and (3) linkages to existing services. Primary outcomes were falls and fall injuries in the 12-month follow-up. Secondary outcomes included ED presentations, hospital admissions, fractures, death, falls risk, falls efficacy and quality of life. Assessors blind to group allocation collected outcome data via postal calendars, telephone follow-up, and hospital records. There were 430 people in the primary outcome analysis—217 randomised to RESPOND and 213 to control. Mean age of participants was 73 years, 55% were female. Falls per person-year were 1.15 in the RESPOND group and 1.83 in the control (incidence rate ratio [IRR] 0.65 [95% CI 0.43 to 0.99]; p=0.042). There was no significant difference in fall injuries (IRR 0.81 [0.51 to 1.29]; p=0.374). The rate of fractures was significantly lower in the RESPOND group compared to the control (0.05 vs. 0.12; IRR 0.37 [95% CI 0.15 to 0.91]; p=0.03) but there was no significant difference in other secondary outcomes between groups: ED presentations, hospitalisations or falls risk, falls efficacy and quality of life. There were two deaths in the RESPOND group and one in the control. No adverse events or unintended harm were reported. Limitations of this study were the high number of drop outs (n=93), over or under reporting of falls, fall injuries and hospitalisations across both groups and the relatively small number of fracture events. Conclusions: In this study, providing a telephone-based, patient-centred falls prevention program reduced falls and fractures, but not fall injuries, in older people presenting to the ED with a fall. Adopting patient-centred strategies into routine clinical practice for falls prevention could offer an opportunity to improve outcomes and reduce falls in patients attending ED.