GAPcare: The Geriatric Acute & Post-acute Care Coordination Program for Fall Prevention in the Emergency Department
Trial Snapshot
- Phase
- Not Applicable
- Status
- Completed
- Sponsor
- Rhode Island Hospital
- Enrollment
- 110
- Locations
- 4
- Primary Endpoint
- Feasibility of Implementing Intervention in Emergency Department
Study Overview
Brief Summary
GAPcare (Geriatric Acute & Post-acute Care Coordination Program for Fall Prevention) is an early stage investigation that enrolls older adults who present to the Emergency Department after a fall to determine the feasibility of an Emergency Department (ED)-based multidisciplinary intervention for preventing recurrent falls in older adults.
Detailed Description
Falls are the leading cause of fatal and non-fatal injury among older adults. EDs frequently evaluate older adults after their falls, but the typical evaluation consists of an injury assessment alone. There is a critical need for an ED-based intervention that addresses reasons for the fall and provides on-the-spot assessment and guidance to prevent subsequent falls. Failure to prevent subsequent falls will result in increased morbidity, mortality, healthcare utilization, loss of independence, and rising health care costs as the population of older adults increases.
Participants in GAPcare will be older adults (≥65 years-old) who present to the ED for a fall. We will pursue the following specific aims to test and further refine the GAPcare intervention: (1) Examine the feasibility of recruitment and retention of eligible patients into the GAPcare intervention, (2) determine the initial efficacy of the GAPcare intervention in reducing subsequent falls and healthcare utilization at 6 months. Our long-term goal is to prevent the early morbidity and mortality of older adults who present to the ED after a fall. The overall objective of this survey is to gather preliminary data on the feasibility of an ED based fall prevention project.
Study Design
- Study Type
- Interventional
- Allocation
- Randomized
- Intervention Model
- Parallel
- Primary Purpose
- Prevention
- Masking
- Single (Outcomes Assessor)
Masking Description
Data extractors will be blinded to the specific study arm each participant has been randomized to.
Eligibility Criteria
- Ages
- 65 Years to — (Older Adult)
- Sex
- All
- Accepts Healthy Volunteers
- No
Inclusion Criteria
- •Community-dwelling adult (non-institutionalized) 65 years-old or older presenting to ED after a fall
- •Able to communicate in English
- •Fall not due to syncope or external force (i.e., struck by car or assault)
- •Fall not due to serious illness (i.e. stroke, acute myocardial infarction)
- •Will be discharged to home, assisted living, or rehabilitation at completion of ED visit (i.e., not admitted)
- •Legally authorized representative present to give informed consent if patient has cognitive impairment on Six Item Screener (score of less than four)
Exclusion Criteria
- •Unable to give informed consent due to intoxication or altered mental status
- •Presence of injuries that prevent mobilization (i.e., pelvic or lower extremity fractures)
Outcomes
Primary Outcomes
Feasibility of Implementing Intervention in Emergency Department
Time Frame: 12 Months
Assess the feasibility of implementing this intervention in an ED setting. We will report enrollment, reasons for accepting or declining enrollment, and drop-out from the study using the CONSORT approach. We will compare the demographic characteristics of the GAPcare participants in both arms using Chi-square or Fisher's exact test for categorical variables and Student's t-test or Wilcoxon's test for continuous variables, as appropriate. We will use Wilcoxon's test to compare the median ED length of stay between participants of both study arms.
Secondary Outcomes
- Feedback(21-24 Months)
- Initial efficacy(12 Months)
Investigators
Elizabeth Goldberg
Assistant Professor of Emergency Medicine
Rhode Island Hospital