Interdisciplinary Falls Prevention for Seniors

Study Overview
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Brief Summary
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With an aging population, an associated increase in the number of falls and fall injuries, there is a need to examine how health care services, such as home care, can best prevent falls among older people. This project will directly address this area by evaluating the effects and expense of an innovative approach to home care service delivery for older people at-risk for falls.

Detailed Description
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Falls and fall injuries are common-potentially preventable-causes of mortality, morbidity, functional decline, and increased health-care use and cost among community-living seniors over 75 years of age. The knowledge gained from this project will directly address the Canadian Patient Safety Institute's priority areas for research in the Applied Health Services Research Stream by evaluating an innovative approach to reducing adverse events in a community-based (home care) setting. The project will also identify the prevalence, determinants and costs of falls and fall injuries among older people requiring home care services. The design will be a two-armed; single blind randomized controlled trial of 110 older people 75 years and over, at risk for falls receiving hom care in Ontario. Subjects will be randomly allocated to either usual home care (control) or the interdisciplinary team. In the interdisciplinary group, a team of professional home care service providers, with specialized training in falls prevention, will proactively provide a comprehensive, coordinated and evidence based approach to falls prevention. The results will inform policies and practice related to the allocation and delivery of home care services for falls prevention across Canada.

Official Title
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The Comparative Effects and Expenses of a Proactive Nurse-Led, Multifactorial and Interdisciplinary Team Approach to Falls Prevention for Older At-Risk Home Care Clients

Conditions
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Injuries

Intervention / Treatment
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* Other: Falls Prevention


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Must be English speaking 75 years of age and over Newly referred to and eligible for personal support services Living at home in the community Identified as being at risk for falls Exclusion Criteria: Refusal to give informed consent Unable to read/write English and a translator is not available

Ages Eligible for Study
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Minimum Age: 75 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: 1<br>Subjects in the interdisciplinary group received home care services from a team of professional service providers (CCAC Case Manager, Registered Nurse, Occupational Therapist, Physiotherapist, Registered Dietician) with experience and training in falls prevention. The team provided a comprehensive, coordinated and evidence based approach to falls prevention through regular home visits, weekly case conferencing, a single accessible fall prevention plan,and joint client visits. | Other: Falls Prevention<br>* Subjects in the interdisciplinary group will receive home care services from a team of professional service providers (CCAC Case Manager, Public Health Nurse (Registered Nurse), Occupational Therapist, Physiotherapist, Nutritionist) with experience and training in falls prevention. The team will provide a comprehensive, coordinated and evidence based approach to falls prevention through weekly case conferencing, a written interdisciplinary care plan, and joint client visits.<br>* Other names: Interdisciplinary Falls Prevention Team;|
| No Intervention: 2<br>Participants allocated to the control group received standard home care services arranged by the CCAC. These include routine follow-up by the CCAC case manager whose focus is on assessing client's eligibility for in-home health services, arrangement and coordination of professional (i.e. nursing, occupational therapy, physiotherapy, social work, speech-language pathology, nutrition) and non-professional HSS, information and referral to community agencies, and ongoing monitoring and evaluating the plan of care through in-home assessments with clients. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of self-reported falls: Falls surveillance report |  | 10 minutes | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Health-Related Quality of Life and Function: SF-36 Health Survey |  | 15-20 minutes | 
| Gait and Balance: Performance-Oriented Mobility Assessment |  | 10 minutes | 
| Depression: Centre for Epidemiological Studies in Depression Scale |  | 5-10 minutes | 
| Standardized Mini Mental State Examination |  | 20-25 minutes | 
| Confidence in Performing Activities of Daily Living: Modified Falls Efficacy Scale |  | 5-10 minutes | 
| Nutritional risk: Screen II Questionnaire |  | 10-15 minutes | 
| Cost of Use of Health Services: Health and Social Services Utilization Questionnaire |  | 20 minutes | 
| Caregiver burden: Caregiver Strain Index |  | 5-10 minutes | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Falls, Home Care, Aging Population, Clinical Effectiveness, Health Economics