Title: A feasibility study to inform the design of a future randomised controlled trial to evaluate a falls prevention intervention in care homes
Funder: Department of Health (England)

Abstract: Background It is estimated that a third of hip fractures in older people in the UK occur in care homes(1). Falls injuries are devastating for residents and costly to the NHS. Rehabilitation reduces falls rates, however these multi-factorial interventions need to be ongoing and rely on patients engaging in their own rehabilitation programme. This is difficult for care home residents as 84% have cognitive impairment. It would seem to be clinically and cost effective for the NHS to train and support care home staff to deliver falls prevention interventions. We have developed, published and tested such an intervention (GtACH)(2) which can be delivered by non professional carers. It includes a falls risk assessment, delivery of evidence-based specific interventions and appropriate referral to services. Aims The ultimate aim is to evaluate whether the GtACH reduces the rate of falls in care homes. However, we are not in a position to complete a large definitive trial until we have collected further information to inform the design of such a study. This feasibility study will answer pertinent questions to enable a definitive large multi-centre trial as below: We will: • Estimate important parameters that are needed to design the main study • Test the feasibility of completing a randomised controlled trial in care homes • Estimate the proportion of care homes and residents that are likely to take part in the definitive study • Explore whether residents will be able to tolerate the intervention • Make sure we can collect valid and reliable data Plan of Investigation A feasibility single-centre cluster randomised controlled study. Six care homes in Nottingham will be recruited with an estimated sample of 68 participants who have fallen. A research assistant (RA) will explain the study, obtain consent and collect baseline data about the home and participants. Homes will be randomised to intervention or control. Staff in intervention homes will be trained by Clinical Falls Specialists to implement the GtACH. The RA will collect outcomes to determine the feasibility, tolerability and acceptability of delivering the intervention, completing the trial and collecting valid and reliable data in this population. Outcomes will be collected from care home records, falls incident books, electronic falls detectors, hospital records and care home staff. Potential Impact The findings from this study will be used to inform the design of a definitive multi-centre cluster-randomised controlled trial of a falls prevention intervention for use by care home staff. The findings will have major implications for residents, NHS staff and care home staff. If successful; residents will fall less, so less sufferring less injuries leading to less hopsital admissions and the NHS will be able to effectively target its input into care homes. Care home staff will be trained to assess and treat people to prevent falls but this increase in work will be offset by the reduction in work caused by fractures, injuries and hospital admissions. If the intervention is not successful, NHS and care home staff will not be trained in its use, resources will be used elsewhere.


Research activity codes: 8.4 RESEARCH DESIGN AND METHODOLOGIES (HEALTH SERVICES)
Health categories: INJURIES AND ACCIDENTS