GAPcare: The Geriatric Acute & Post-acute Care Coordination Program for Fall Prevention in the Emergency Department

Therapuetic Areas:Other
Age Range:65 - Any
Start Date:January 25, 2018
End Date:July 31, 2019
Contact:Elizabeth Goldberg, MD, ScM
Phone:(401) 444-7975

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GAPcare (Geriatric Acute & Post-acute Care Coordination Program for Fall Prevention) is an
early stage investigation that enrolls older adults who present to the Emergency Department
after a fall to determine the feasibility of an Emergency Department (ED)-based
multidisciplinary intervention for preventing recurrent falls in older adults.

Falls are the leading cause of fatal and non-fatal injury among older adults. EDs frequently
evaluate older adults after their falls, but the typical evaluation consists of an injury
assessment alone. There is a critical need for an ED-based intervention that addresses
reasons for the fall and provides on-the-spot assessment and guidance to prevent subsequent
falls. Failure to prevent subsequent falls will result in increased morbidity, mortality,
healthcare utilization, loss of independence, and rising health care costs as the population
of older adults increases.

Participants in GAPcare will be older adults (≥65 years-old) who present to the ED for a
fall. We will pursue the following specific aims to test and further refine the GAPcare
intervention: (1) Examine the feasibility of recruitment and retention of eligible patients
into the GAPcare intervention, (2) determine the initial efficacy of the GAPcare intervention
in reducing subsequent falls and healthcare utilization at 6 months. Our long-term goal is to
prevent the early morbidity and mortality of older adults who present to the ED after a fall.
The overall objective of this survey is to gather preliminary data on the feasibility of an
ED based fall prevention project.

Inclusion Criteria:

- Community-dwelling adult (non-institutionalized) 65 years-old or older presenting to
ED after a fall

- Able to communicate in English

- Fall not due to syncope or external force (i.e., struck by car or assault)

- Fall not due to serious illness (i.e. stroke, acute myocardial infarction)

- Will be discharged to home, assisted living, or rehabilitation at completion of ED
visit (i.e., not admitted)

- Legally authorized representative present to give informed consent if patient has
cognitive impairment on Six Item Screener (score of less than four)

Exclusion Criteria:

- Unable to give informed consent due to intoxication or altered mental status

- Presence of injuries that prevent mobilization (i.e., pelvic or lower extremity
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