Award Title: Do Safe and Well Visits delivered by the Fire and Rescue service reduce falls among older people? (FIREFLI)
Funder: Department of Health and Social Care

Abstract: Aims of the research _x000D_
The Fire and Rescue Services (FRS) routinely carry out approximately 670,000 Safe and Well Visits (SWV) each year in people’s homes.  The aim of the SWV is to reduce fire risks, support independent living, improve quality of life and help prevent avoidable hospital admissions and excess winter deaths.   A  part of the SWV is looking at ways to prevent falls. We want to find out if these SWV are effective at reducing falls, improve quality of life in older people and if the visits are good value for money.    _x000D_
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Background to the research _x000D_
About a third of people over the age of 65 and half of those over 80 will fall each year. Most of these falls, happen at home. Falling may cause people to lose confidence, feel as if they have lost their independence and become withdrawn.  About a fifth of falls require medical attention.  There were around 210,000 falls-related emergency hospital admissions in England in 2016.  It costs the NHS a lot of money to treat falls; about £2.3 billion a year. The problem is likely to get worse as people are living longer. We know that interventions to improve home safety appear to be effective at reducing falls, especially in people at higher risk of falling and when the visit is carried out by an occupational therapist.  What we don’t know is whether SWV undertaken by members of the Fire and Rescue Service will reduce falls._x000D_
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Design and methods used_x000D_
To find out if SWV reduce the number of falls people have and improve their quality of life, we will run a randomised controlled trial.  We will recruit 1156 people aged 70 years and over from lists of people held on FRS databases.  We will allocate half of the people to receive a SWV from the FRS at the start of the study, which will last about an hour.  The other half will receive the SWV after 12 months when they have finished the study. Everyone will receive a falls prevention leaflet from Age UK and their usual care from their GP and/or other health care professionals.  They will be asked to fill in a monthly falls calendar for 12 months and three postal questionnaires over a 12 month period to collect information about falls, quality of life, how often they’ve used NHS services and if they are doing any activities which makes them more likely to have a fire in their home.  A statistician and health economist will analyse the data to find out if the SWVs reduce falls and if they are good value for money.  We also want to find out if the SWV are acceptable to older people and the FRS.  We will explore this through a series of indepth interviews._x000D_
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Patient and public involvement (PPI)_x000D_
We will work with a group of older members of the public and ask for their help with the study.  We will seek their advice about the best way to ask people to take part and stay in the study.  We will ask them to read and give feedback on the paperwork used in the trial and to ask them the best way to let everyone know about the results of our study. _x000D_
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Dissemination_x000D_
Once we have completed the trial, we will work with the PPI group, the FRS taking part in the study and Age UK to make sure our results can be used by as many people as possible. We will send participants a summary of our findings, present the results at conferences and publish the results. We will share these findings with other FRS and other relevant people.

Lay Abstract: DESIGN: A pragmatic individually randomised controlled trial using equal randomisation, with a qualitative and economic evaluation._x000D_
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AIM: To determine whether Safe and Well Visits (SWV) delivered by the Fire and Rescue Service (FRS) will lead to a reduction in falls and an improvement in health-related quality of life among older people living in the community._x000D_
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SETTING: Participants’ homes._x000D_
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TARGET POPULATION: Men and women aged 70 years and over who live in the community, residing in areas covered by Humberside and Kent FRS.  _x000D_
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INCLUSION CRITERIA: Men and women aged 70 years and over; community dwelling in areas covered by Humberside and Kent FRS. _x000D_
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EXCLUSION CRITERIA: People who live in residential/nursing homes; are bed bound; are unable to give informed consent and do not have a consultee living with them who can provide outcome data; have had an OT visit within the past 12 months; a SWV within the past 3 years or who are passed to the FRS as an urgent referral and therefore require a SWV within 12 months._x000D_
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INTERVENTION: SWV delivered by Humberside and Kent FRS, usual care from healthcare professionals and falls prevention leaflet._x000D_
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CONTROL:Usual care from healthcare professionals, falls prevention leaflet.    _x000D_
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PRIMARY OUTCOMES:the number of falls per participant over the 12 months from randomisation and the EQ-5D-5L (EuroQol).  _x000D_
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SECONDARY OUTCOMES: time to first fall; proportion of participants reporting at least 1 fall and multiple falls (2 or more falls); fear of falling; fall related injuries and costs; loneliness (UCLA 3-item); fire risk taking behaviours; uptake of flu jab, smoking status;  attendances to participants’ homes by the FRS.  _x000D_
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SAMPLE SIZE: We will recruit 1156 participants and randomise them 1:1 (i.e., 578 to control and 578 to intervention).  This allows for 10% attrition and provides 90% power (using 2-sided significance at the 2.5% level) to show a difference in the percentage of participants who experience at least one fall in the 12 months following randomisation from 35% in the control group to 25% in the intervention group. Assuming an attrition rate of 20%, 1156 participants would give us 90% power to detect an effect size of 0.23 in the second primary outcome of EQ-5D-5L._x000D_
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PROCESS EVALUATION: A mixed methods process evaluation will include: (1). Observations of those delivering the SWV to assess if key falls prevention components are included. (2) Completion of an intervention delivery inventory to record the exact elements of the intervention delivered.  (3) Participant questionnaires will record adherence with the intervention. (4) Qualitative interviews with trial participants will explore acceptability and how suggested changes are incorporated into everyday life; interviews with those delivering the intervention will explore their experiences and challenges of delivering SWV; interviews with service leads will explore current provision and incorporating trial findings into service development.  _x000D_
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PROJECT TIMETABLE AND RECRUITMENT: Project duration 36 months starting 01.02.20.  Set up 01.02.20 to 31.07.20 (month 1-6); recruitment and randomisation July 2020 to July 2021 (months 6-18) randomisation will be 22 participants per week; follow up until the end July 2022 (months 19-30); analysis and report writing will be completed by January 2023 (months 31-36)._x000D_
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DISSEMINATION: summary results to participants; academic publications; conference presentations; briefing documents

Research Activity Codes: 3.1 PRIMARY PREVENTION INTERVENTIONS TO MODIFY BEHAVIOURS OR PROMOTE WELL-BEING
Health Categories: INJURIES AND ACCIDENTS