Department of Rehabilitation VUmc, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands.
Department of Internal Medicine, Section General Internal Medicine Unit Acute Medicine, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands.
PLoS One. 2022 Jun 9;17(6):e0268682. doi: 10.1371/journal.pone.0268682. eCollection 2022.
Falls among older people occur frequently and are a leading cause of Emergency department (ED) admissions, disability, death and rising health care costs. Multifactorial fall prevention programs that are aimed to target the population at risk have shown to effectively reduce the rate of falling and fall-related injuries in community-dwelling older people. However, the participation of and adherence to these programs in real life situation is generally low.
To test the feasibility of a transitionally organized fall prevention assessment with accompanying personalized intervention initiated at the ED.
DESIGN, SETTINGS AND PARTICIPANTS: A process evaluation, of a non-randomized controlled pilot trial for implementing a transitionally organized multifactorial fall prevention intervention, was performed using the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework to gain insight into the barriers and facilitators of implementation. Older fallers (>70yrs) presenting at the ED were selected based on ZIP-code and after obtaining informed consent, data for the evaluation was collected through questionnaires and interviews. Furthermore, feedback was collected from the healthcare providers.
The consent was obtained by 24 (70%) of the patients approached directly at the ED and 17 (26%) of the patients approached later by phone. Adherence to the protocol by the participants, clinical assessors and family practice were all more than 90%. After three months, nine (26%) of the participants had at least one recurrent fall: three (20%) patients in the intervention group and six (32%) in the control group.
ED presentation due to a fall in older persons provides a window of opportunity for optimizing adherence to a multifactorial fall prevention program as willingness to participate was higher when the patients were approached at the ED during their stay. Implementing a transitionally organized multidisciplinary fall prevention program was successful with a high protocol adherence.
NTR NL8142, November 8, 2019.
老年人跌倒频繁发生，是急诊科（ED）入院、残疾、死亡和医疗保健费用上升的主要原因。针对高危人群的多因素跌倒预防计划已被证明能有效降低社区居住的老年人跌倒率和与跌倒相关的伤害。然而，这些计划在现实生活中的参与率和依从率普遍较低。
测试在急诊科进行过渡性组织的跌倒预防评估及随之开展的个性化干预的可行性。
设计、地点和参与者：采用 Reach、Effectiveness、Adoption、Implementation、Maintenance（RE-AIM）框架对一项过渡性组织的多因素跌倒预防干预的非随机对照试验进行了过程评估，以深入了解实施过程中的障碍和促进因素。根据邮政编码，在急诊科就诊的老年跌倒患者（>70 岁）被选中，在获得知情同意后，通过问卷调查和访谈收集评估数据，并从医疗保健提供者处收集反馈。
直接在急诊科接触到的 24 名（70%）患者同意参加，通过电话联系的 17 名（26%）患者同意参加。参与者、临床评估人员和家庭医生对方案的依从性均超过 90%。三个月后，9 名（26%）参与者至少发生了一次复发性跌倒：干预组 3 名（20%）患者，对照组 6 名（32%）患者。
老年人因跌倒而到急诊科就诊为优化多因素跌倒预防计划的依从性提供了机会，因为当患者在住院期间在急诊科就诊时，参与意愿更高。成功实施了过渡性组织的多学科跌倒预防计划，方案依从性高。
NTR NL8142，2019 年 11 月 8 日。
