An Ambitious Attempt to Keep Older Americans From Falling

One-third of Americans over age 65 fall each year. It’s the leading cause of injuries, including fatal ones, among seniors and it costs the health care system $30 billion a year, according to the Centers for Disease Control. And the problem has gotten worse: The CDC reports that the rate at which older Americans die from falling has increased sharply.

That increase comes despite years of research into why people fall and how to prevent it. This week, the National Institutes of Health announced a new study—”the Manhattan Project of trials in fall-injury prevention,” according to Dr. Shalender Bhasin, one of the study’s lead investigators and director of an NIH-funded center to promote independence for older Americans.

What makes this study different from others is its scale and complexity. Researchers will track 6,000 elderly patients at risk for falling at 80 clinics across the country. Half the clinics will tailor specific interventions to the patients’ needs, led by a designated “falls care manager,” while the other half will continue their customary treatment approach.

The managers, usually nurses or nurse practitioners, will evaluate patients’ risk and create a specific plan to avoid falls. They might rethink a patients’ medication mix if it causes dizziness, or encourage exercise or physical therapy to improve strength and balance. They might prescribe new glasses, suggest safety improvements in the home, or address some combination of these and other approaches.

“When people fall, there are multiple factors that contribute to their fall risk,” Bhasin says. The study will also test how well hospitals systems and clinics can put fall-prevention techniques in place. “If we can’t implement it in clinical practice, then it’s all theoretical,” Bhasin says. “That’s been the problem with many of the previous studies.” The trial will be funded with $30 million over five years from the Patient-Centered Outcomes Research Institute established by the Affordable Care Act.

Researchers picked a combination of rural and urban sites to recruit patients, from Mount Sinai Health System in New York to Essentia Health in Duluth, Minn. The goal is to get results that will be meaningful across settings: “If it works in Boston but doesn’t work in Timbuktu, then it’s not going to have a major public health impact,” Bhasin says.

Patients in the trial will be at least 75 years old and will be tracked for as long as three years. They’ll be evaluated on whether they suffer serious fall injuries, as well as on the total number of falls. Researchers will also look at broader measures of functioning and wellness, including levels of anxiety and depression, because falls and the fear of falling can have wide consequences. “Many will stop going out of the house and become confined to the four walls of their homes, and it has great impact on their well-being and quality of life,” Bhasin says.

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