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Objective To reduce subsequent falls following Multifactorial Falls Assessment Design: Prospective Case Control
Population: Frail elderly Veteran outpatient population referred for falls assessment
Methods: Prospective controlled trial of Geriatric Multifactorial Falls Assessment Clinic patients followed for 1 year and outcomes compared to Acute Geriatric Evaluation and Management (GEM) Inpatient Unit discharge control group.
We designed a prospective controlled trial to compare the effectiveness of outpatient falls assessment and treatment for community-dwelling frail elderly patients with history of falls referred to an active management Geriatric Multifactorial Falls Assessment Clinic with a control group of patients discharged from an Acute Geriatric Evaluation and Management (GEM) Inpatient Unit during the same time period, but who were not specifically referred for falls assessment. We hypothesized that a population of frail elderly referred by their primary care physicians and who reported for evaluation to a Geriatric Multifactorial Falls Assessment Clinic would show a reduction in falls compared to controls, when provided a time-limited consult evaluation with active follow-up for 1 year.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Treatment | Experimental | Geriatric Multifactorial Falls Assessment Clinic |
|
| Control | No Intervention | Geriatric Evaluation and Management Service (GEM) |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Multifactorial Falls Assessment | Other | The Geriatric Multifactorial Falls Assessment Clinic is a component of GERIATRIC-PACT, a frail-elderly primary care patient-centered medical home with care provided by an inter-professional teamlet consisting of a geriatrician, geriatric nurse practitioner, clinical pharmacist, licensed practical nurse, nurse care manager, social worker, and dietitian. GERIATRIC-PACT operates with increased ancillary support compared to Primary Care PACT. Falls assessment patients were referred by primary care providers and were evaluated and treated by the GERIATRIC-PACT teamlet, including ordering of tests and medication adjustment, with an average of two visits and active follow-up for one year. |
| Measure | Description | Time Frame |
|---|---|---|
| Number of Participants Who Experienced Falls | Number of participants who experienced falls in 12 months, based on self-recall and telephone interview. | 12 months |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| James Powers, MD | TVHS GRECC | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| TVHS Nashville Campus | Nashville | Tennessee | 37232 | United States |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 21173416 | Result | Michael YL, Whitlock EP, Lin JS, Fu R, O'Connor EA, Gold R; US Preventive Services Task Force. Primary care-relevant interventions to prevent falling in older adults: a systematic evidence review for the U.S. Preventive Services Task Force. Ann Intern Med. 2010 Dec 21;153(12):815-25. doi: 10.7326/0003-4819-153-12-201012210-00008. | |
| 15031239 |
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Per Va IRB, no personal identifiers including age >89 can be shared. Aggregate data published: Powers JS, Samuels LR, Hu JR, Roumie CL. Veterans Geriatric Multifactorial Falls Assessment Clinic is Associated with Lower Fall Rate . J Gerontology and Aging Research 2017;1:102.
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| ID | Title | Description |
|---|---|---|
| FG000 | Treatment | Geriatric Multifactorial Falls Assessment Clinic Multifactorial Falls Assessment: The Geriatric Multifactorial Falls Assessment Clinic is a component of GERIACTRIC-PACT, a frail-elderly primary care patient-centered medical home with care provided by an inter-professional teamlet consisting of a geriatrician, geriatric nurse practitioner, clinical pharmacist, licensed practical nurse, nurse care manager, social worker, and dietitian. GERIATRIC-PACT operates with increased ancillary support compared to Primary Care PACT. Falls assessment patients were referred by primary care providers and were evaluated and treated by the GERIATRIC-PACT teamlet, including ordering of tests and medication adjustment, with an average of two visits and active follow-up for one year. |
| FG001 | Control | Geriatric Evaluation and Management Service (GEM) The Geriatric Evaluation and Management Service (GEM) is an acute inpatient service with over 150 discharges annually. Frail elderly treated on GEM receive inter-professional geriatric team assessment and treatment while hospitalized. Patients discharged to home return to the care of their primary physicians. |
| Title | Milestones | Reasons Not Completed | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Overall Study |
|
|
Intervention: 2 withdrawals, 1 bedfast, excluded from analysis Control: 2 withdrawals, 8 high functioning, excluded from analysis
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| ID | Title | Description |
|---|---|---|
| BG000 | Treatment | Geriatric Multifactorial Falls Assessment Clinic Multifactorial Falls Assessment: The Geriatric Multifactorial Falls Assessment Clinic is a component of GERIACTRIC-PACT, a frail-elderly primary care patient-centered medical home with care provided by an inter-professional teamlet consisting of a geriatrician, geriatric nurse practitioner, clinical pharmacist, licensed practical nurse, nurse care manager, social worker, and dietitian. GERIATRIC-PACT operates with increased ancillary support compared to Primary Care PACT. Falls assessment patients were referred by primary care providers and were evaluated and treated by the GERIATRIC-PACT teamlet, including ordering of tests and medication adjustment, with an average of two visits and active follow-up for one year. |
| Units | Counts |
|---|---|
| Participants |
|
| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes |
|---|---|---|---|---|---|---|---|---|---|
| Age, Categorical | Count of Participants |
| Type | Title | Description | Population Description | Reporting Status | Anticipated Posting Date | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Time Frame | Units Analyzed | Denominator Units Selected | Arm/Group Information | Denominators | Classes | Analyses | |||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Primary | Number of Participants Who Experienced Falls | Number of participants who experienced falls in 12 months, based on self-recall and telephone interview. | Posted | Count of Participants | Participants | 12 months |
|
1 year
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| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | Treatment | Geriatric Multifactorial Falls Assessment Clinic Multifactorial Falls Assessment: The Geriatric Multifactorial Falls Assessment Clinic is a component of GERIACTRIC-PACT, a frail-elderly primary care patient-centered medical home with care provided by an inter-professional teamlet consisting of a geriatrician, geriatric nurse practitioner, clinical pharmacist, licensed practical nurse, nurse care manager, social worker, and dietitian. GERIATRIC-PACT operates with increased ancillary support compared to Primary Care PACT. Falls assessment patients were referred by primary care providers and were evaluated and treated by the GERIATRIC-PACT teamlet, including ordering of tests and medication adjustment, with an average of two visits and active follow-up for one year. -- open label |
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Fall rates determined by patient recall at 1 year by telephone interview. All patients were consented so advanced demented patients were not included in the intervention.
Falls e-consults were limited by EMR information and provider discretion
| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| James S. Powers MD, Clinical Associate Director, GRECC | TVHS GRECC, Nashville TN | 615-873-8032 | james.powers2@va.gov |
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No masking
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|
| Chang JT, Morton SC, Rubenstein LZ, Mojica WA, Maglione M, Suttorp MJ, Roth EA, Shekelle PG. Interventions for the prevention of falls in older adults: systematic review and meta-analysis of randomised clinical trials. BMJ. 2004 Mar 20;328(7441):680. doi: 10.1136/bmj.328.7441.680. |
| 22868837 | Result | Moyer VA; U.S. Preventive Services Task Force. Prevention of falls in community-dwelling older adults: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2012 Aug 7;157(3):197-204. doi: 10.7326/0003-4819-157-3-201208070-00462. |
| 8078528 | Result | Tinetti ME, Baker DI, McAvay G, Claus EB, Garrett P, Gottschalk M, Koch ML, Trainor K, Horwitz RI. A multifactorial intervention to reduce the risk of falling among elderly people living in the community. N Engl J Med. 1994 Sep 29;331(13):821-7. doi: 10.1056/NEJM199409293311301. |
| 21226685 | Result | Panel on Prevention of Falls in Older Persons, American Geriatrics Society and British Geriatrics Society. Summary of the Updated American Geriatrics Society/British Geriatrics Society clinical practice guideline for prevention of falls in older persons. J Am Geriatr Soc. 2011 Jan;59(1):148-57. doi: 10.1111/j.1532-5415.2010.03234.x. |
| BG001 | Control | Geriatric Evaluation and Management Service (GEM) The Geriatric Evaluation and Management Service (GEM) is an acute inpatient service with over 150 discharges annually. Frail elderly treated on GEM receive inter-professional geriatric team assessment and treatment while hospitalized. Patients discharged to home return to the care of their primary physicians. |
| BG002 | Total | Total of all reporting groups |
| Participants |
|
| Age, Continuous | Mean | Standard Deviation | years |
|
| Sex: Female, Male | Count of Participants | Participants |
|
| Race (NIH/OMB) | Count of Participants | Participants |
|
| Region of Enrollment | Number | participants |
|
| OG001 | Control | Geriatric Evaluation and Management Service (GEM) |
|
|
| 6 |
| 55 |
| 0 |
| 55 |
| 0 |
| 55 |
| EG001 | Control | Geriatric Evaluation and Management Service (GEM) The Geriatric Evaluation and Management Service (GEM) is an acute inpatient service with over 150 discharges annually. Frail elderly treated on GEM receive inter-professional geriatric team assessment and treatment while hospitalized. Patients discharged to home return to the care of their primary physicians.- open label | 12 | 51 | 0 | 51 | 0 | 51 |
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