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IIR 94-003 – HSR&D Study

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IIR 94-003
Safe-Grip Fall/Injuries Intervention: A Randomized Trial
Carolee A. DeVito PhD MPH
Miami VA Healthcare System, Miami, FL
Miami, FL
Funding Period: October 1995 - June 2001

BACKGROUND/RATIONALE:
Falls are the leading cause of nonfatal injuries in the United States and the second leading cause of all unintentional injury deaths. Each year fractures of the hip account for about 200,000 hospitalizations among the elderly and falls are contributing factors in 40 percent of admissions to nursing homes. About 30 percent of community-dwelling elderly fall each year, with about 10 percent seeking emergency medical help for a fall injury. Data from CDC-funded study to assess falls among the elderly (SAFE) suggest that as many as 41 percent of elderly patients fall at home in the year following discharge from hospitalization due in part to deconditioning associated with inactivity.

OBJECTIVE(S):
The controlled trial of a physical restoration (PR) intervention (Geriatric Rehabilitation Intensive Program, SAFE-GRIP) is designed to improve physical functional capacity and to reduce the likelihood of falls in the elderly during the period following discharge from hospitalization or inactivity/bed rest.

METHODS:
This is a four year randomized trial of SAFE-GRIP, designed to improve the physical functional capacity, to reduce the likelihood of falls and to decrease the chance of injury from falls. Patients at home or recently discharged to home will be randomly assigned to one of two groups, PR or control, upon receiving medical clearance (time=0). This project will provide mechanisms to establish well-designed innovative physical restoration (PR) protocols for the Miami VAMC and test the effects of these interventions on the rate of falling/sustaining injuries and their sequelae at home. Our anticipated sample was 105 males and 105 females aged 60+ years inactive at home or recently discharged to home from the Miami VAMC and a neighboring community hospital. Study participants will be randomly assigned to one of two groups, PR or control, upon receiving medical clearance. Baseline measures of physical function, health care utilization, ADL/IADL performance and health-related quality of life will be taken following assignment to treatment conditions. These same measures will be taken again at eight weeks following medical clearance, and again at six months. The incidence of falls will be tracked throughout the funding period for each subject. Self-report of the number of falls in the year prior to hospitalization, an assessment of in-home hazards, and an assessment of participants' post-hospitalization medication regimen will be obtained at the baseline assessment and used as covariates in the analysis of outcomes.

FINDINGS/RESULTS:
Over 4,374 subjects were screened for admission into the program, 1,218 passed chart review and 294 passed the physician screen and consented to particpate in the study. The first set of analyses of the data regarding falls is nearing completion. The draft of the first manuscript describing program effects on physical restoration has been completed for internal review, with submission pending final approval by the Associate Chief of Staff for Research at our station. The target publication is The Journal of the Americal Geriatrics Society.

IMPACT:
Data from this study will be useful to the Miami VAMC as well as the VA system of care nationally as it plans for the rational and judicious delivery of services throughout the continuum of care. In this case, rehabilitative services can potentially demonstrate powerful "preventive" effects impacting on utilization of health services, as well as enhancing veterans’ quality of life.

PUBLICATIONS:
None at this time.


DRA: Aging, Older Veterans' Health and Care
DRE: Prevention
Keywords: Falls, Frail elderly, Safety
MeSH Terms: Accidental Falls, Frail Elderly

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