A nurse-managed, individually tailored falls prevention plan administered for at least 20 months did not significantly reduce risk of serious fall injuries in older adults aged 70 and over who were at high risk for falls, findings from the STRIDE trial, reported recently in the New England Journal of Medicine, suggest.

The Strategies to Reduce Injuries and Develop Confidence in Elders (STRIDE) trial, supported by the Patient-Centered Outcomes Research Institute (PCORI) and the National Institutes of Health, was designed to assess the benefit of an evidence-based, multipronged, individually tailored falls prevention intervention implemented by nurses who were trained to be Falls Care Managers. It was conducted to promote the development of effective approaches to prevent fall-related injuries.

Led by investigators at Brigham and Women’s Hospital, Harvard Medical School, Boston; Yale School of Medicine, New Haven, Conn; and David Geffen School of Medicine, University of California, Los Angeles, the the large multisite, randomized pragmatic trial was conducted at 86 primary care practices in 10 US healthcare systems, a media release from National Institutes of Health explains.

Which Care Plan is Best?

More than 5,000 people who were at least 70 years old and had been injured from a fall, had fallen at least two times in the previous year, or were afraid of falling because of difficulty walking or balancing were enrolled in the study.

All participants were screened for seven risk factors for fall injuries: walking and balance impairment; hazards for falling in the home environment; troubles with feet or shoes; vision problems; medications that increased fall risk; experiencing low blood pressure when standing up; and having weak bones from osteoporosis and low levels of vitamin D.

The Falls Care Managers helped participants in the intervention group identify their risk factors and select which risks to modify. Control group participants received their usual care plus a falls information pamphlet, and were encouraged to discuss fall prevention with their primary care doctors, who also received the risk factor screening results.

The primary outcome of this large-scale trial was the length of time to the first serious fall injury. After a participant reported a serious injury, it was verified by trial sites or health records. The rates of verified serious fall injuries did not differ significantly between the intervention and control groups.

Numbers Lower Than Expected

For both intervention and control groups, the number of verified first serious fall injuries was lower than expected based on rates previously reported by older persons who matched the trial’s requirements for inclusion, the release continues.

STRIDE was designed after small-scale trials showed that risk factor reduction interventions reduced the rate of falls and fall injuries. STRIDE participants were asked to diminish one to three of seven risk factors. In some cases, important risk factors were not diminished; therefore, a participant’s risk reduction may not have been optimal.

Other strategies to achieve risk reduction in health care systems might be more effective, and lessons learned from STRIDE can help inform the design and implementation of future clinical trials in various health care delivery settings, the study concludes.

This project is part of the Partnership for Fall Injuries Prevention between the NIA and PCORI. The award was made by NIH and funded by PCORI.

[Source: National Institutes of Health]

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