Expanding the Reach of a Fall Prevention Intervention for Older Adult Emergency Department Patients through Telehealth
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PROJECT SUMMARY The Geriatric Acute and Post-Acute Fall Prevention Intervention (GAPcare) is a promising emergency department (ED) initiated intervention for reducing falls and healthcare visits in older adults; GAPcare reduced 6-month ED visits for falls by 66%, all-cause ED visits by 53%, and hospitalizations by 43%. Because GAPcare begins immediately after a fall occurs, motivation to change behavior is high. However, GAPcare requires in- person pharmacists and physical therapists (PTs), which limits scalability to large EDs, which account for only 43.8% of all ED visits. If we fail to scale this intervention, valuable prevention opportunities will be missed for the 2.8 Million older adults who seek care for falls in EDs each year. Our over-arching goal is to expand the reach of GAPcare by testing a video telehealth GAPcare (e-GAPcare) intervention in a community ED without existing pharmacy and PT services. The rationale for this research is that telehealth for specialist evaluations have already been successfully implemented in EDs, suggesting that GAPcare could be adapted for patients with falls who would benefit from pharmacy and PT consultation, but cannot receive them due to staffing limitations in rural or smaller community EDs. Our long-term goal is to prevent falls in older adults and healthcare visits. The overall objective of this application is to develop and test a telehealth intervention for falls based on our successful GAPcare model. Our central hypothesis is that e-GAPcare will help ED clinicians identify fall risk factors, such as gait, balance, and cognitive impairment and could ameliorate these risk factors through action plans co-created with patients preventing the next fall. GAPcare’s specific aims are to: (1) conduct semi-structured interviews (n=18-24) with content experts in telehealth stratified by practice setting (metro/suburban/rural) to gain insights about the practical considerations; (2) refine the GAPcare intervention and study protocol based on feedback from ED staff, patient and caregivers; and (3) conduct a single arm feasibility study with older adult ED patients (n=40) with a recent fall to determine if they can complete the fall risk assessment and intervention to assess the feasibility and acceptability of e- GAPcare. Dr. Goldberg will obtain initial estimates of efficacy for a larger, multi-center GAPcare III trial. Using phone calls and the electronic health record we will measure subsequent falls, and healthcare visits at 6 months, to inform initial efficacy for our subsequent larger, multi-center GAPcare III trial. Dr. Goldberg’s e-GAPcare overarching aims are to develop and test an ED-based telehealth intervention that reduces recurrent falls and healthcare visits and to launch her physician-scientist career at the intersection of emergency medicine and geriatrics. To achieve this goal, Dr. Goldberg will work with her mentors Drs. Resnik and Ranney to improve her expertise in qualitative research, digital health, longitudinal data analysis, and clinical trial methods. Upon successful completion of the proposed research, we will produce a fully piloted, community- informed telehealth intervention tailored to the unique health needs of older adults with falls.
