Falls after Hospital Discharge: A Randomized Clinical Trial of Individualized Multimodal Falls Prevention Education

Abstract

Background: Older people are at high risk of falls after hospital discharge. The study aimed to evaluate the effect of providing individualized falls prevention education in addition to usual care on falls rates in older people after hospital discharge compared to providing a social intervention in addition to usual care. Methods: A randomized clinical trial at three hospitals in Western Australia: Participants followed for 6 months after discharge. Baseline and outcomes measured by assessors masked to group allocation. Participants: Aged 60 years and over, admitted for rehabilitation. Eligibility included: Cognitively able to undertake education (Abbreviated mental test score >7/10). Intervention: Tailored education comprising patient video and workbook, structured discussion and goal setting led by trained therapist. Main outcomes: Falls in the 6 months after discharge; proportion of participants sustaining one or more falls. Results: There were 382 (194 intervention; 188 control) participants (mean age 77.7 [SD 8.7] years). There were 378 falls (fall rate per 1,000 patient-days, 5.9 intervention; 5.9 control) reported by 164 (42.9%) participants in the 6 months following hospital discharge; 188 (49.7%) of these falls were injurious. There were no significant differences in falls rates between intervention and control groups: (adjusted IRR, 1.09; 95% CI [0.78 to 1.52]) or the proportion of participants who fell once or more (adjusted OR, 1.37; 95% CI [0.90 to 2.07]). Conclusions: Providing individualized falls prevention education prior to discharge did not reduce falls at home after discharge. Further research is warranted to investigate how to reduce falls during this high-risk transition period.