Interdisciplinary Falls Prevention for Seniors

The Comparative Effects and Expenses of a Proactive Nurse-Led, Multifactorial and Interdisciplinary Team Approach to Falls Prevention for Older At-Risk Home Care Clients

With an aging population, an associated increase in the number of falls and fall injuries, there is a need to examine how health care services, such as home care, can best prevent falls among older people. This project will directly address this area by evaluating the effects and expense of an innovative approach to home care service delivery for older people at-risk for falls.

Study Overview

• Status: Completed
• Conditions: Injuries
• Intervention / Treatment: Other: Falls Prevention

Detailed Description

Falls and fall injuries are common-potentially preventable-causes of mortality, morbidity, functional decline, and increased health-care use and cost among community-living seniors over 75 years of age.

The knowledge gained from this project will directly address the Canadian Patient Safety Institute's priority areas for research in the Applied Health Services Research Stream by evaluating an innovative approach to reducing adverse events in a community-based (home care) setting.

The project will also identify the prevalence, determinants and costs of falls and fall injuries among older people requiring home care services. The design will be a two-armed; single blind randomized controlled trial of 110 older people 75 years and over, at risk for falls receiving hom care in Ontario. Subjects will be randomly allocated to either usual home care (control) or the interdisciplinary team. In the interdisciplinary group, a team of professional home care service providers, with specialized training in falls prevention, will proactively provide a comprehensive, coordinated and evidence based approach to falls prevention. The results will inform policies and practice related to the allocation and delivery of home care services for falls prevention across Canada.

• Study Type: Interventional
• Enrollment (Actual): 109
• Phase: Phase 1

Contacts and Locations

Study Locations

• Canada
  • Ontario
    • Hamilton, Ontario, Canada, L8P 4M3
      • McMaster University - Faculty of Health Sciences at Frid

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 75 years and older (Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Must be English speaking
• 75 years of age and over
• Newly referred to and eligible for personal support services
• Living at home in the community
• Identified as being at risk for falls

Exclusion Criteria:

• Refusal to give informed consent
• Unable to read/write English and a translator is not available

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Prevention
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Double

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: 1; Subjects in the interdisciplinary group received home care services from a team of professional service providers (CCAC Case Manager, Registered Nurse, Occupational Therapist, Physiotherapist, Registered Dietician) with experience and training in falls prevention. The team provided a comprehensive, coordinated and evidence based approach to falls prevention through regular home visits, weekly case conferencing, a single accessible fall prevention plan,and joint client visits.	Other: Falls Prevention; Subjects in the interdisciplinary group will receive home care services from a team of professional service providers (CCAC Case Manager, Public Health Nurse (Registered Nurse), Occupational Therapist, Physiotherapist, Nutritionist) with experience and training in falls prevention. The team will provide a comprehensive, coordinated and evidence based approach to falls prevention through weekly case conferencing, a written interdisciplinary care plan, and joint client visits.; Other Names: Interdisciplinary Falls Prevention Team
No Intervention: 2; Participants allocated to the control group received standard home care services arranged by the CCAC. These include routine follow-up by the CCAC case manager whose focus is on assessing client's eligibility for in-home health services, arrangement and coordination of professional (i.e. nursing, occupational therapy, physiotherapy, social work, speech-language pathology, nutrition) and non-professional HSS, information and referral to community agencies, and ongoing monitoring and evaluating the plan of care through in-home assessments with clients.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
Number of self-reported falls: Falls surveillance report	10 minutes

Secondary Outcome Measures

Outcome Measure	Time Frame
Health-Related Quality of Life and Function: SF-36 Health Survey	15-20 minutes
Gait and Balance: Performance-Oriented Mobility Assessment	10 minutes
Depression: Centre for Epidemiological Studies in Depression Scale	5-10 minutes
Standardized Mini Mental State Examination	20-25 minutes
Confidence in Performing Activities of Daily Living: Modified Falls Efficacy Scale	5-10 minutes
Nutritional risk: Screen II Questionnaire	10-15 minutes
Cost of Use of Health Services: Health and Social Services Utilization Questionnaire	20 minutes
Caregiver burden: Caregiver Strain Index	5-10 minutes

Collaborators and Investigators

• Sponsor: Hamilton Health Sciences Corporation
• Collaborators: Ontario Ministry of Health and Long Term Care; Hamilton Niagara Haldimand Brant Community Care Access Centre; Canadian Patient Safety Institute; Mississauga Halton Community Care Access Centre; Halton Region Health Department; Community Rehab
• Investigators: Principal Investigator: Maureen Markle-Reid, RN MScN PhD, School of Nursing, McMaster University

Publications and helpful links

General Publications

• Isaranuwatchai W, Perdrizet J, Markle-Reid M, Hoch JS. Cost-effectiveness analysis of a multifactorial fall prevention intervention in older home care clients at risk for falling. BMC Geriatr. 2017 Sep 1;17(1):199. doi: 10.1186/s12877-017-0599-9.
• Markle-Reid M, Browne G, Gafni A, Roberts J, Weir R, Thabane L, Miles M, Vaitonis V, Hecimovich C, Baxter P, Henderson S. The effects and costs of a multifactorial and interdisciplinary team approach to falls prevention for older home care clients 'at risk' for falling: a randomized controlled trial. Can J Aging. 2010 Mar;29(1):139-61. doi: 10.1017/S0714980809990377.
• Markle-Reid M, Browne G, Gafni A, Roberts J, Weir R, Thabane L, Miles M, Vaitonis V, Hecimovich C, Baxter P, Henderson S. A cross-sectional study of the prevalence, correlates, and costs of falls in older home care clients 'at risk' for falling. Can J Aging. 2010 Mar;29(1):119-37. doi: 10.1017/S0714980809990365.

Study record dates

Study Major Dates

• Study Start: May 1, 2006
• Primary Completion (Actual): August 1, 2007
• Study Completion (Actual): August 1, 2007

Study Registration Dates

• First Submitted: April 18, 2007
• First Submitted That Met QC Criteria: April 18, 2007
• First Posted (Estimate): April 20, 2007

Study Record Updates

• Last Update Posted (Estimate): May 7, 2008
• Last Update Submitted That Met QC Criteria: May 5, 2008
• Last Verified: May 1, 2008

More Information

Terms related to this study

• Keywords: Home Care; Falls; Clinical Effectiveness; Health Economics; Aging Population
• Other Study ID Numbers: RFAAA0506164