Telephone Coaching Prevents Falls
A new, phone-based falls prevention program called RESPOND has been shown to reduce falls in older people who are sent home from hospital emergency departments.
Researchers at Royal Perth Hospital, The University of Western Australia and Curtin University led the Western Australian arm of the RESPOND study. Melbourne-based studies were conducted by a team at Monash University and The Alfred hospital.
All said they were excited by the results of the initiative, which were recently published in the journal PLOS Medicine, and showed fall rates among people aged 60-plus could be reduced by about 35 per cent if they participated in RESPOND – a patient-centred strategy that aimed to empower and support older people to participate in falls prevention activities. The study also showed a 63% reduction in the rate of fractures in the RESPOND group, when compared to controls.
Professor of geriatric medicine at The University of Western Australia, Leon Flicker, said falling over is the main reason why 60-plus-year-olds visit hospital emergency departments, with falls in older adults accounting for almost 50 per cent of all injury presentations.
“The results from the RESPOND program indicate that taking proactive measures, such as discussing falls prevention over the phone, could help reduce this alarming statistic,” Professor Flicker said.
“The main goal is to respond to the first fall to prevent the second.”
The patient-centred RESPOND program consists of a home-based risk assessment, six months of telephone-based education, coaching, goal setting, risk factor management support and linkages to existing services.
“We specifically designed RESPOND to provide personalised and timely education and support to improve knowledge, confidence, and participation in evidence-based falls prevention activities,” Professor Flicker said.
Within two weeks of a face-to-face session, and with further phone calls over the subsequent six months, the clinician called the participant to review their progress, offer encouragement and troubleshoot issues hampering their ability to implement their fall-prevention plan.
“Previous studies with older adults have identified that negatively-framed falls prevention messages are often perceived as patronising and a threat to independence,” Professor Flicker said.
“RESPOND used positive health messaging to enhance engagement and participation and may be a key component for clinicians to consider in future falls prevention programs.”
Professor Flicker said making personal phone calls was an inexpensive and wide-reaching way to connect with the participants.
Developing a strong partnership between emergency departments and community care was a positive spin-off.
“Emergency departments can be challenging environments in which to deliver falls prevention interventions because the focus is on managing the immediate care needs of a patient,” Professor Flicker said.
“Because older people who experience a fall that leads to an ED attendance are frailer, have multiple health conditions and more severe injuries (when compared with those who do not attend the ED as a result of a fall), we introduced these new interventions to address their complex needs.”
Professor Flicker said patients were actively involved in their care and decisions regarding their treatment, with participants free to choose the modules they perceived most relevant to them. Recommendations provided by ED staff were also reviewed and discussed with participants.
“The fact that almost one in two participants lived alone highlights that many older people who present to the ED with a fall may lack social support,” he said.
“While the RESPOND program did not aim to improve social support, this figure highlights a potential remaining unmet need in many older fallers who present to emergency departments. Now that we have shown this program works it is really important to continue to roll it out.”
Funding: This project was funded under the Australian National Health and Medical Research Council's Partnership Projects funding scheme (project number APP1056802), with financial and in-kind contributions from the following partner organisations: Health Strategy and Networks Branch, Strategic System Policy and Planning, Department of Health, WA*; Aged and Continuing Care Directorate, Department of Health, WA; Royal Perth Hospital*; Curtin University*; The University of Western Australia*; The Royal Perth Hospital Medical Research Foundation; Sir Charles Gairdner Hospital (SCGH) Area Rehabilitation and Aged Care Falls Specialist Program; Injury Control Council of Western Australia (ICCWA); The George Institute for Global Health; The Alfred Hospital*; Monash University*; Integrated Care, Victorian Department of Health. (*Note, authors are employees or have affiliations with these partner organisations.) RM, DA, EB, and EM’s salaries were supported by this grant. AB was funded by an NHMRC Career Development Fellowship (APP1067236). JR was funded by an NHMRC Career Development Fellowship Level 2 (APP1143538). JL was funded by an Early Career Fellowship funded by the NHMRC (APP1052442). SRN was funded by a National Institute for Health Research Career Development Fellowship (CDF-2015-08-030).
