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Keeping Patients on Their Feet: How Fall Prevention Clinics Can Be More Effective
David R Lee1, Lauren K Matsuno2, Joyce H Seo2
1Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA. drlee@mednet.ucla.edu.
Background:
Although fall prevention programs in real-world clinical settings often generate recommendations to reduce fall risk factors, evidence that they improve clinical outcomes remains limited. To better understand this gap, we examined implementation rates of recommendations.
Methods:
This retrospective cohort study evaluated patients who received care at an interdisciplinary (nurse, physical therapist, geriatrician) fall prevention consultation clinic from November 2020 to December 2022. Data were collected on patient demographics, screening assessments (including self-reported falls, fracture risk, visual acuity, cognition, and orthostatic blood pressure), physical therapy evaluations, and implementation of recommendations. Fall- and fracture-related ED visits and hospitalizations in the year before and after the clinic visit were compared.
Results:
Ninety-four patients seen with a mean age of 79 years (SD = 8.4, range 63-101); 71% were women, 60% self-identified as non-Hispanic White, 39% needed help with ≥ 1 activity of daily living, and 62% needed help with ≥ 2 instrumental activities of daily living. Patients screened positive for a self-reported fall in the last year (81%), increased fracture risk (67%), vision impairment (43%), cognitive concerns (27%), and orthostatic hypotension (12%). Implementation of recommendations occurred most often for home (58%) and outpatient (46%) physical therapy, bisphosphonate recommendations or orders (50%), ophthalmology (43%), and medication adjustment recommendations (36%). Referrals to podiatry (30%), clinical pharmacy (29%) for fall risk-increasing drugs, osteoporosis clinic (23%), and memory clinic (12%) were implemented least frequently. There were no statistically significant differences in fall- or fracture-related ED visits (IRR 0.61, 95% CI 0.33-1.15) or hospitalizations (IRR 0.75, 95% CI 0.32-1.72) 1-year pre- and post-clinic evaluation.
Conclusions:
Although this consultative fall prevention clinic generated actionable recommendations, their implementation was sub-optimal. The study identified key areas for process improvement, particularly enhancing adherence to high-impact recommendations such as physical therapy and bone health.
