Improving fall prevention by providing tailored information to elderly patients

The fall prevention outpatient clinic aims at preventing (recurrent) falls of elders (≥ 65 years) that visited the Emergency Department (ED) due to an injurious fall. There are however various problems in the current fall prevention processes such as: (a) patients are currently identified by a nurse visiting the ED which then sends the CTI questionnaire to the patient by post and so many patients do not even fill the questionnaire; (b) Many of those completing the questionnaire and invited to the fall prevention clinic, do actually visit the outpatient fall prevention clinic; (c) the information conveyed to the elders are not individualized. Our aim is to investigate whether providing patient specific risk information to elders when they visit the ED will increase the percentage of actual visits. Our secondary aim is to measure (a) effect on percentage completed questionnaires and (b) difference between perceived and predicted risk of a recurrent fall.

We hypothesize: (a) that providing patient specific risk information to elders when they visit the emergency department will improve their willingness to visit the FOC; and (b) that elders may underestimate their risk for a recurrent fall.

Measurements are automatically calculated/collected by the computer as soon as they become available. We will measure outcomes at the end of the study.

When an elderly patient visits the Emergency Department (ED) due to a fall they will be asked to fill in the CTI (CAREFALL Triage Instrument) questionnaire on a laptop. They will also be asked about their subjective assessment of of the risk of falling in the coming year. Upon completion of the CTI the risk estimate for a recurrent fall will be automatically calculated via a prediction model. Based on the criteria and the existing risk factors the patients will be categorized in one of the following groups and receive a specific message for that group at the end of filling in the questionnaire.

1. Those patients who, based on current policy, will not be invited to the fall outpatient clinic will be merely thanked for filling in the questionnaire.

2. Patients who, based on current policy, will be invited to the fall outpatient clinic will be randomized (sample size 104 patients per group):

(a) In the intervention group the patients will be presented with their probability of recurrent falling within one year (and their relative risk in comparison to elders not having their risk factors). They will also be informed that they will be contacted via a letter from the geriatrician within two weeks (similar to the current process) inviting them to visit the outpatient fall prevention clinic.
(b) In the control group patients will be informed that they will be contacted via a letter within two weeks (similar to the current process) inviting them to the outpatient fall prevention clinic.