RecruitingNot ApplicableNCT06573983

Fall Risk Identification and Management for Older Veterans

Development of a Fall Risk Identification and Management Model for Older Veterans

Sponsor

VA Office of Research and Development

Enrollment

108 participants

Start Date

Feb 4, 2025

Study Type

INTERVENTIONAL

Conditions

Fall Risk

Summary

Falls are a common occurrence among older adults, and Veterans have an even higher risk of falling compared to non-Veterans. These falls often lead to severe health consequences, including traumatic brain injuries, hip fractures, emergency visits, hospitalizations, and even death. It is crucial to prioritize fall prevention in order to reduce injuries and enable older Veterans to age comfortably at home. Although current fall prevention programs in the Veterans Health Administration primarily focus on inpatient care and nursing homes, there is a pressing need to address falls among older Veterans living independently in the community. The proposed VA-specific Fall Risk Identification and Management (FRIM) model aims to proactively prevent falls in older Veterans who receive primary care, effectively reducing the occurrence of adverse health events associated with falls. By placing emphasis on prevention rather than reacting after falls have already happened, this initiative seeks to significantly enhance the overall well-being of older Veterans.

Eligibility

Min Age: 65 Years

Inclusion Criteria5

Screens positive for increased fall risk within GeriPACT, or generalPACT as needed, (answers "yes" to any of 3 screening questions)
years of age and older
Positive screen on at least two fall risk factor assessments (Aim 1); Positive screen on at least one fall risk factor assessment (Aim 2)
Access to telehealth
Availability of an additional adult (e.g., caregiver or family member) to be present during the physical assessment

Exclusion Criteria7

Life expectancy \<12 months, as determined by PCP
Neurological diagnosis (e.g., cerebral vascular accident, multiple sclerosis, Parkinson's Disease)
Moderate cognitive impairment (\<13 on telephone Montreal Cognitive Assessment (MoCA-BLIND) or \<18 on MoCA Full administered during clinic visit in the previous 3 months)
Unstable condition that precludes safe participation in structured exercise (e.g., recent deep vein thrombosis) if expected fall risk factor is physical, as determined by PCP or chart review
Participation in any intervention components of the FRIM model, with the intention of reducing a FRIM fall risk factor, within the past 2 months
Currently using a wheelchair for mobilization
If it is in the opinion of the study staff that the participant would be at an increased suicide risk due to study procedures

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Interventions

OTHERStrengthening (Physical Therapy, Gerofit)

Individuals with physical fall risk will be referred to strengthening interventions available within the VHA. These may include Physical Therapy or Gerofit (a supervised exercise program).

OTHERCognitive Behavioral Therapy (Clinical Psychology, Occupational Therapy)

Individuals with psychological fall risk will be referred psychological interventions such as cognitive behavioral therapy, which focuses on guided talking. This can be performed by VHA occupational therapists and clinical psychologists.

OTHERMedication Reconciliation (Clinical Pharmacology)

Individuals with pharmacological fall risk will be referred to clinical pharmacology for medication reconciliation. This includes examining the current medication list and deprescribing medications, if appropriate.

OTHERHome Safety Modification (Occupational Therapy)

Individuals with environmental fall risk will be referred to occupational therapy for home safety assessments and modifications. This will involve modifying components within the home to reduce potential fall risk factors.