Comprehensive tele-home follow-ups versus comprehensive usual home follow-ups to reduce fear of falling after hospital discharge in older adults with fragile hip fractures: a non-inferiority study.

Purpose: Fear of falling (FoF) is common in older adults with fragility hip fractures after hospital discharge, leading to negative health outcomes. Evidence on tele-home visits' effectiveness in managing FoF remains limited. This study compares FoF outcomes between tele-home visits and usual home visits 2 months post-discharge.

Methods: A prospective observational cohort study was conducted at a tertiary care hospital in Thailand, involving older adults aged 60 years and above who experienced fragility hip fractures and were hospitalized between March 2023 and May 2024. Participants were assigned to either tele-home or usual home visits based on their travel time from the hospital. The primary outcome was the change in FoF from 2 weeks to 2 months after discharge, measured using the Short Falls Efficacy Scale-International (Short FES-I). The study tested whether tele-home visits were non-inferior to usual home visits, using inverse probability of treatment weighting (IPTW) to adjust for baseline differences and a non-inferiority margin of 3.51.

Results: The study included 106 patients (mean age 78.96 ± 9.24 years; 77.36% female). After IPTW, both groups showed improvement in FoF, with a mean reduction of -5.06 (95% confidence interval; 95% CI -5.90 to -4.22) in the tele-home visits group and -4.02 (95% CI -5.24 to -2.80) in the usual home visits group. The difference was -1.04 (95% CI -2.52 to 0.45), supporting the non-inferiority of tele-home visits.

Conclusions: Tele-home visits are non-inferior to usual home visits in reducing FoF and can be provided for older adults with fragility hip fractures after hospital discharge. These findings offer greater convenience for continued care and improved access to care, even in remote areas.