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Primary care falls prevention plan ‘reduces older admissions’

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Older adults given a falls prevention plan in primary care settings are less likely to be hospitalised, according to a US study by nurse researchers.

It found the Stopping Elderly Accidents, Deaths, and Injuries (STEADI) initiative lowered the number of falls-related admissions among older adults compared to not giving any falls prevention care plan.

“These system-wide changes were shown to have a positive impact on reducing hospitalisations”

Yvonne Johnston

In both the US and the UK, guidelines recommend a multifactorial approach to falls prevention and the NHS possesses a guide. However, these steps are not always followed in primary care facilities.

This discrepancy led researchers at Binghamton University in New York to implement the STEADI approach and monitor the impact that it had on the number of falls in the New York Health System.

The researchers grouped 12,346 participants, aged 65 or older, into three categories – at-risk and no falls plan of care, at-risk with a plan, and not-at-risk.

The STEADI programme included a variety of materials, from clinical algorithms to training videos, in order to aid healthcare providers in discussing fall prevention care plans with older adults.

The initiative, described in the journal The Gerontologist, is split into three core parts – screening, assessing, and intervening.

Older adults were screened to identify who had an increased risk of fall. They then were assessed to identify modifiable risk factors, such as home evaluations, blood pressure tests, medication reviews, and balance tests.

“This study included a limited number of interventions such as providing fall prevention educational materials”

Study authors

Finally, healthcare providers gave interventions with tested strategies to reduce risk of falls, such as a strength and balance programme, corrective eyewear, or medication management.

The STEADI initiative was implemented by training health care providers in its use and by modifying the outpatient electronic health records to include testing for STEADI associated data.

At the end of their two-year monitoring of patients, the researchers found that older adults who had a STEADI fall prevention plan were 0.6 times less likely to fall and their post-intervention odds were similar to those who were not at risk for a fall at all.

The researchers said: “This study shows that the STEADI conceptual framework for fall prevention can be used to identify and address modifiable risk factors in primary care settings to reduce the number of older adult fall-related hospitalisations.

“This study included a limited number of interventions such as providing fall prevention educational materials, prescribing an assistive device, and/or referring at-risk older adults to physical therapy or a community falls prevention programme,” they said.

“Implementing additional evidence-based falls prevention interventions such as vision checks, podiatrist referrals, and medication review and management would address additional modifiable risk factors and have the potential to reduce fall injuries even further, they added.

Study author Yvonne Johnston, research associate professor at the Binghamton University Decker school of nursing, said the findings demonstrated that screening and referral for older adults in the primary care setting could be done.

“The STEADI initiative can be feasibly modified to streamline office workflow, and incorporation of a fall risk screening protocol in the electronic health record can provide a supportive infrastructure for addressing fall risk among older adults.

“These system-wide changes – screening for fall risk among older adults in primary care and developing a plan of care for those identified as being at risk for fall – were shown to have a positive impact on reducing hospitalisations,” added Ms Johnston.

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