A Multimodal Fall Prevention Intervention in the Setting of the Emergency Department.

Abstract

Background: The emergency department (ED) is an opportune setting for fall prevention interventions. We implemented and evaluated a multimodal falls prevention intervention addressing medications, mobility, and functional risk factors among older adults presenting to the ED for fall-related injuries.

Methods: We implemented a quality improvement intervention at two hospitals among ED visits for adults aged 65 and older with a chief complaint of fall between May 2023 and June 2024. The intervention included: (1) medication review by a pharmacist; (2) assessment by physical therapy (PT); and (3) assessment by occupational therapy (OT). We conducted a retrospective evaluation of electronic health records and reported the proportion of patients that received screening along with risk factors, recommendations, adherence to recommendations, and return visits at 3 and 6 months. We used logistic regression to examine factors associated with return visits.

Results: We identified 686 older adults who received ≥ 1 screening. Most patients received PT and OT evaluations (94.8% and 93.4%), while fewer (15.2%) received medication reviews. The most common problems identified by PT and OT were fall risk, decreased mobility, and impaired balance. Discharge to a skilled nursing facility was the most common recommendation (55.5% PT, 55.1% OT) followed by home care (33.1% PT, 31.2% OT). High-risk medications most often identified were anticoagulants, antidepressants, and gabapentin. The most common recommendation was to "discuss with a primary care physician." Among those who received ≥ 1 intervention, 8.9% experienced a return visit within 3 months and 12.8% within 6 months. Inpatient admission was associated with increased likelihood of return visits compared to discharge from the ED.

Conclusion: The most prevalent risk factors for falls among older adults presenting to the ED are likely modifiable through PT and OT intervention. Further research is needed to address uptake barriers and longitudinal impact on outcomes.