PCORI and NIH Announce Major Study of Patient-Centered Approach to Preventing Fall-Related Injuries in Older Adults

Download PDF

WASHINGTON, D.C. (June 4, 2014) – The Patient-Centered Outcomes Research Institute (PCORI) and the National Institute on Aging (NIA) of the National Institutes of Health (NIH) today announced a five-year, $30 million national study of the effectiveness of a multi-pronged strategy that includes deploying nurses or nurse practitioners trained as “falls care managers” to provide older adults with individually tailored, evidence-based care plans to help them avoid falls and related injuries.

The award funded by PCORI and made by NIA as part of a first of its kind partnership between the nonprofit institute and the federal agency will support a uniquely patient-centered approach to reducing rates of fall-related injuries among non-institutionalized older adults. The study will be led by several of the country’s leading geriatric experts and conducted in collaboration with older individuals, family caregivers, and other stakeholder partners who will contribute to all phases of the research. Patients, stakeholders, nurses, and primary care physicians will play key roles as partners in implementing the tailored care approach.

Falls rank among the most common and potentially devastating problems facing the growing population of older adults and their families. Every year, roughly one in three adults over age 65 falls, and as many as 30 percent suffer moderate to severe injuries, which can lead to further declines in health and loss of independence. Rates of fall-related injuries remain stubbornly high despite research pointing to effective interventions. Among other challenges, many older patients are reluctant to disclose previous falls and only a third are screened for this problem during primary care visits.

“We cannot eliminate falls altogether, but we know that many fall-related injuries are preventable through good, evidence-based interventions,” said PCORI Executive Director Joe Selby, MD, MPH. “What’s lacking is evidence on the optimal combination of interventions to meet patients’ individual needs and circumstances and how best to deliver tailored plans. Older adults and their caregivers and healthcare providers are essential partners in the effort to answer these questions.”

“One of the keys to innovative scientific research is the ability to collaborate in creative and dynamic ways,” said NIA Director Richard J. Hodes, M.D. “This unique collaboration between NIH and PCORI builds on the strengths of our respective organizations. We hope this partnership will translate into real strides in preventing falls and their resulting injuries in older people.”

The five-year trial will recruit 6,000 adults age 75 and older who have one or more risk factors for falls. Diverse populations from community-based primary care practices affiliated with 10 healthcare delivery systems located in rural, urban, and suburban communities across the country will be represented.

The trial will test the effectiveness of deploying nurses or nurse practitioners trained as “falls care managers” to develop and deliver evidence-based prevention plans tailored to the specific risks of each individual and to monitor patients’ outcomes in consultation with their primary care providers. The rate of fall-related injuries among study participants receiving this experimental approach will be compared to the injury rate among similar patients who receive only risk assessments and educational material from their primary care physicians.

In the study’s patient-centered approach, the falls care managers will work with older individuals and their caregivers to tailor plans to the patients’ preferences and resources as well as their particular risk factors. In addition, a National Patient and Stakeholder Council and 10 local councils connected to the study sites will provide ongoing advice and feedback on the design and implementation of the study. Council members will include patients who are at risk or have experienced a fall and individuals who have cared for an older friend or family member.

The project will be led by three geriatric experts: Shalender Bhasin, MD, Director of the Research Program in Men’s Health: Aging and Metabolism at Harvard Medical School; Thomas M. Gill, MD, Humana Foundation Professor of Geriatric Medicine and Director of the Yale Program on Aging at Yale University; and David B. Reuben, MD, Chief of the Division of Geriatrics at the University of California at Los Angeles. Each directs one of the 14 Claude D. Pepper Older Americans Independence Centers, which are NIA-funded centers of research expertise on complex geriatric conditions. Representatives of all 14 Pepper Centers will contribute expertise to the study.

The trial will be carried out in two stages, starting with a one-year protocol development and refinement phase. Based their review of phase 1 results, PCORI and NIH will together decide if the study will proceed to the implementation phase in years 2 through 5.

The precedent setting collaboration between PCORI and NIH capitalizes on the non-profit institute’s expertise in fostering patient-centered comparative effectiveness research that engages the end-users of study results throughout the research process and the federal agency’s deep subject expertise in geriatric research that improves the health and wellbeing of older adults.