The Strategies to Reduce Injuries and Develop Confidence in Elders (STRIDE) study produced breakthrough findings that suggest fall prevention among older adults is more challenging than the authors of previous research found.

In the study, nurse case managers met with at-risk people to perform a structured assessment of fall risk factors and implement changes, says Nancy Latham, PhD, clinical research director in the division of men’s health, aging, and metabolism at Brigham and Women’s Hospital, and instructor at Harvard Medical School. Latham was one of the STRIDE study researchers.

No Significant Reduction

Investigators followed participants over an average of three years to determine whether people who received an intervention experienced fewer fall-related injuries than those who did not receive an intervention.1

The findings surprised investigators, revealing the multifactorial intervention was not significantly more effective than enhanced usual care in reducing serious fall injuries. Investigators theorized this might be due to a lower adherence to the intervention plan than occurred in previous efficacy trials. Also, participants were referred to existing services at local health or community centers, but the trial investigators provided no additional resources. No one routinely monitored whether participants stuck to their exercise plan.1

The STRIDE study did show a significant reduction in self-reported fall injuries — just not in serious fall injuries, Latham says.

“They could have a bruise or scrape, but not necessarily a fracture,” she explains. “Those were fall-related injuries, and we did have a significant reduction in those, but we didn’t have a reduction in our primary outcome of the most serious of fall-related injuries.”

While the data were not what researchers expected, there still is reason to expect positive results from fall prevention programs, Latham notes.

“We do think fall prevention services are extremely important,” she adds. “To have a larger impact that could prevent more serious fall injuries, it could be that fall care managers perhaps need to have a higher intensity of meeting with people.”

In the STRIDE program, fall care managers met with participants only twice in the first year and annually after that. The participants enrolled in the study were age 70 years or older and were part of a primary care practice. People in long-term care facilities were not enrolled because their risk factors are different from the population studied, Latham says.

Participants had to answer yes to at least one of these three risk factors:

  • Two or more falls in the past year;
  • Fall injury in the past year;
  • Fear of falling when engaged in mobility activities.

The fall care manager also evaluated participants on the seven most common risk factors:

  • Problems with strength, gait, and balance;
  • Postural hypotension (lightheaded when standing up too quickly);
  • Vision problems;
  • Improper footwear;
  • Taking medication that can increase risk of falling;
  • Safety hazards in the home;
  • Osteoporosis.

“The fall care manager evaluated them for those risk factors, and then worked with the patient and the primary care doctor to prioritize which of those risk factors they wanted to start to address,” Latham says. “We had a structured assessment for them. For each of these risk factors, we developed treatment algorithms to guide them through. If they have this problem with their balance, then that person might be appropriate to refer to physical therapy, or another person could be referred to a community-based exercise program.”

REFERENCE

  1. Bhasin S, Gill TM, Reuben DB, et al. A randomized trial of a multifactorial strategy to prevent serious fall injuries. N Engl J Med 2020;383:129-140.