Implementing a Successful Fall Prevention Program for Elderly Veterans

Falls are common among the elderly, occurring in one-quarter to one-third of community-dwelling adults age 65 and older. Research shows that fall prevention programs can reduce future falls, but adoption in routine care has been limited. This article discusses the implementation of a Telecare fall prevention program at the VA Greater Los Angeles Healthcare System (VAGLAHS) that was designed to be sustainable. One of the main goals in designing the program was to include important stakeholders - leadership, Veterans, and healthcare providers. For example, investigators met with VAGLAHS leadership to ascertain whether managers agreed on the importance of fall prevention, strategies for preventing falls, and a broad outline of how these strategies might be accomplished. Investigators also brought together a workgroup that comprised a mix of content experts in fall prevention, as well as clinicians and practitioners of quality improvement.

Findings show that the leadership and workgroup meetings led to the development of a functional program. The Telecare fall prevention program screened its first Veteran in October 2008 and is ongoing. The program uses an existing telephone nurse advice line to: 1) place outgoing calls to Veterans at high risk of falling, 2) assess the Veterans' risk factors, and 3) triage Veterans to the appropriate services. Because Telecare operates via the telephone, it can accept referrals from anywhere in VAGLAHS, thus reaching Veterans in geographically remote areas. The authors suggest that another potential advantage of the Telecare fall prevention program is the opportunity to unburden primary care providers of additional responsibilities by helping assess patients' needs and arranging the appropriate services. In addition to the ongoing evaluation that is part of the Telecare fall prevention program, a research evaluation also is planned.

Ganz D, Yano E, Saliba D, and Shekelle P. Design of a Continuous Quality Improvement Program to Prevent Falls among Community-Dwelling Older Adults in an Integrated Healthcare System. BMC Health Services Research November 16, 2009;9:206.

This study was partly funded by HSR&D, and Dr. Ganz is supported by an HSR&D Career Development Award. All authors are part of HSR&D's Center for the Study of Healthcare Provider Behavior in Sepulveda, CA.