Falls After Hospital Discharge: A Randomized Clinical Trial of Individualized Multimodal Falls Prevention Education

Anne-Marie Hill¹, Steven M McPhail^{2

3}, Terry P Haines⁴, Meg E Morris⁵, Christopher Etherton-Beer⁶, Ronald Shorr^{7

8}, Leon Flicker⁶, Max Bulsara⁹, Nicholas Waldron¹⁰, Den-Ching A Lee⁴, Jacqueline Francis-Coad¹¹, Amanda Boudville¹²

Affiliations

¹ School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia.
² School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia.
³ Centre for Functioning and Health Research, Metro South Health, Buranda, Queensland, Australia.
⁴ School of Primary and Allied Health Care, Monash University, Clayton, Victoria, Australia.
⁵ Healthscope and La Trobe Centre for Sport and Exercise Medicine Research, La Trobe University, Bundoora, Victoria, Australia.
⁶ Western Australian Centre for Health & Ageing, Medical School, University of Western Australia, Crawley, Western Australia, Australia.
⁷ Malcom Randall VA Medical Center, Geriatric Research Education and Clinical Center (GRECC), Gainesville, Florida.
⁸ College of Medicine, University of Florida, Gainesville.
⁹ Institute for Health Research, The University of Notre Dame Australia, Fremantle, Western Australia, Australia.
¹⁰ Department of Aged Care and Rehabilitation, Armadale Kelmscott Memorial Hospital, East Metropolitan Health Service, Armadale, Western Australia, Australia.
¹¹ School of Physiotherapy, Institute for Health Research, The University of Notre Dame Australia, Fremantle, Western Australia, Australia.
¹² Department of Aged Care and Rehabilitation, St John of God Midland Public and Private Hospital, Midland, Western Australia, Australia.

PMID: 30721940
PMCID: PMC7330456
DOI: 10.1093/gerona/glz026

Randomized Controlled Trial

Falls After Hospital Discharge: A Randomized Clinical Trial of Individualized Multimodal Falls Prevention Education

Anne-Marie Hill et al. J Gerontol A Biol Sci Med Sci. 2019.

. 2019 Aug 16;74(9):1511-1517.

doi: 10.1093/gerona/glz026.

Authors

Affiliations

¹ School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia.
² School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia.
³ Centre for Functioning and Health Research, Metro South Health, Buranda, Queensland, Australia.
⁴ School of Primary and Allied Health Care, Monash University, Clayton, Victoria, Australia.
⁵ Healthscope and La Trobe Centre for Sport and Exercise Medicine Research, La Trobe University, Bundoora, Victoria, Australia.
⁶ Western Australian Centre for Health & Ageing, Medical School, University of Western Australia, Crawley, Western Australia, Australia.
⁷ Malcom Randall VA Medical Center, Geriatric Research Education and Clinical Center (GRECC), Gainesville, Florida.
⁸ College of Medicine, University of Florida, Gainesville.
⁹ Institute for Health Research, The University of Notre Dame Australia, Fremantle, Western Australia, Australia.
¹⁰ Department of Aged Care and Rehabilitation, Armadale Kelmscott Memorial Hospital, East Metropolitan Health Service, Armadale, Western Australia, Australia.
¹¹ School of Physiotherapy, Institute for Health Research, The University of Notre Dame Australia, Fremantle, Western Australia, Australia.
¹² Department of Aged Care and Rehabilitation, St John of God Midland Public and Private Hospital, Midland, Western Australia, Australia.

PMID: 30721940
PMCID: PMC7330456
DOI: 10.1093/gerona/glz026

Abstract

Background: Older people are at high risk of falls after hospital discharge. The study aimed to evaluate the effect of providing individualized falls prevention education in addition to usual care on falls rates in older people after hospital discharge compared to providing a social intervention in addition to usual care.

Methods: A randomized clinical trial at three hospitals in Western Australia: participants followed for 6 months after discharge. Baseline and outcomes measured by assessors masked to group allocation. Participants: aged 60 years and over, admitted for rehabilitation. Eligibility included: cognitively able to undertake education (Abbreviated mental test score >7/10). Intervention: tailored education comprising patient video and workbook, structured discussion and goal setting led by trained therapist. Main outcomes: falls in the 6 months after discharge; proportion of participants sustaining one or more falls.

Results: There were 382 (194 intervention; 188 control) participants (mean age 77.7 [SD 8.7] years). There were 378 falls (fall rate per 1,000 patient-days, 5.9 intervention; 5.9 control) reported by 164 (42.9%) participants in the 6 months following hospital discharge; 188 (49.7%) of these falls were injurious. There were no significant differences in falls rates between intervention and control groups: (adjusted IRR, 1.09; 95% CI [0.78 to 1.52]) or the proportion of participants who fell once or more (adjusted OR, 1.37; 95% CI [0.90 to 2.07]).

Conclusions: Providing individualized falls prevention education prior to discharge did not reduce falls at home after discharge. Further research is warranted to investigate how to reduce falls during this high-risk transition period.

Keywords: Accidental falls; Patient discharge; Patient education; Randomized controlled trial.

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Figures

**Figure 1.**
Participant flow through the study.

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References

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Falls After Hospital Discharge: A Randomized Clinical Trial of Individualized Multimodal Falls Prevention Education

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Falls After Hospital Discharge: A Randomized Clinical Trial of Individualized Multimodal Falls Prevention Education

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