Laird Harrison

October 01, 2013

A simple program to educate family practice residents can significantly increase their ability to prevent falls in elderly patients, a new study shows.

After instruction, the fall-assessment scores of second-year residents increased from 42% to 78%, and of third-year residents increased from 55% to 85%.

"The primary goal was to get the residents interested in working with their patients, but it had the added benefit of helping those patients," said Michael Rosenblatt, DO, MPH, associate program director at the Scripps Mercy Chula Vista Family Medicine Residency in California.

Dr. Rosenblatt presented the findings at the American Academy of Family Physicians 2013 Scientific Assembly in San Diego.

Previous studies have indicated that 1 in 3 older people falls each year, and 75% of these people fall twice.

Falls take a significant toll, seriously injuring 20% to 30% of older adults every year and directly or indirectly killing 9500, Dr. Rosenblatt reported.

To see if the ability of family physicians to prevent the falls could be improved, Dr. Rosenblatt and his team designed an education program for residents. They enlisted 10 second-year and 7 third-year residents.

It was pretty eye-opening. Some of the patients lived by themselves with all these things that were potential fall risks.

They tested participating residents on their knowledge of falls in elderly people and assigned them to a computer-based learning module. The residents also viewed a DVD from the ACOVE project on assessing care of vulnerable elders. They then visited patients, assessed them and their environments, and developed care plans for them.

The patient assessment included a falls risk-assessment patient survey, the Get-Up and Go Test, and the Tinetti Balance Assessment Tool.

In the Get-Up and Go Test, the physician asks the patient to get up from a chair, walk a short distance, return to the chair, and sit down. In the Tinetti Balance Assessment Tool, the physician rates the patients' ability to sit, stand, walk, and perform related movements.

The residents learned a lot, said Dr. Rosenblatt. "It was pretty eye-opening. Some of the patients lived by themselves with all these things that were potential fall risks. Most residents are never going to get into their patients' houses, but you can do an assessment in your office in 5 or 10 minutes."

Care plans included adjustments to medication, physical therapy, installing rails and handholds, and removing tripping hazards, such as electrical cords and throw rugs.

Dr. Rosenblatt acknowledged that this sample was not large enough to achieve statistical significance. He said he hopes, in the future, to publish findings on whether the intervention actually reduces falls.

Asked to comment, Laurence Rubenstein, MD, MPH, chair of geriatrics at the University of Oklahoma in Oklahoma City, told Medscape Medical News that previous studies have found such measures to be effective.

"If you do all those things, you can probably reduce the risk of falls by 50%," he said. "It's good that they're teaching this."

In a previous study, Dr. Rubenstein and his colleagues surveyed 372 older people and found that fewer than one third had undergone the recommended assessments and interventions for fall prevention (J Am Geriatr Soc. 2004;52:1527-1531).

New efforts to educate physicians are a "step forward" but might not be sufficient to make a dent in the problem. "It takes more than the education of doctors to make big changes in outcomes," Dr. Rubenstein noted. "On an institutional level, you can make changes. You need big programs."

The American Geriatric Society and the British Geriatric Society have issued guidelines calling on physicians to ask patients whether they have fallen in the past year, assess their mobility and balance in general, and design interventions based on these assessments.

Dr. Rosenblatt and Dr. Rubenstein have disclosed no relevant financial relationships.

American Academy of Family Physicians (AAFP) 2013 Scientific Assembly: Poster abstract 103. Presented September 25 - 28, 2013.


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