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J Am Geriatr Soc. 2017 Dec;65(12):2733-2739. doi: 10.1111/jgs.15121. Epub 2017 Oct 17.

The Strategies to Reduce Injuries and Develop Confidence in Elders Intervention: Falls Risk Factor Assessment and Management, Patient Engagement, and Nurse Co-management.

Author information

1
Division of Geriatrics, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California.
2
Center for Patient Safety, Research and Practice, Brigham and Women's Hospital, Boston, Massachusetts.
3
Department of Medicine, School of Medicine, University of Michigan, Ann Arbor, Michigan.
4
School of Medicine, Yale University, New Haven, Connecticut.
5
New England Geriatric Research, Education and Clinical Center, Veterans Affairs Boston Healthcare System, Boston, Massachusetts.
6
Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts.
7
Saint Alphonsus Health System, Boise, Idaho.
8
Department of Neurology, School of Medicine, Wake Forest University, Wake Forest Baptist Health, Winston-Salem, North Carolina.
9
Men's Health, Aging, and Metabolism Unit, Brigham and Women's Hospital-Harvard Medical School, Boston, Massachusetts.
10
Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.
11
Boston University, Boston, Massachusetts.
12
School of Nursing, University of Minnesota, Minneapolis, Minnesota.

Abstract

In response to the epidemic of falls and serious falls-related injuries in older persons, in 2014, the Patient Centered Outcomes Research Institute (PCORI) and the National Institute on Aging funded a pragmatic trial, Strategies to Reduce Injuries and Develop confidence in Elders (STRIDE) to compare the effects of a multifactorial intervention with those of an enhanced usual care intervention. The STRIDE multifactorial intervention consists of five major components that registered nurses deliver in the role of falls care managers, co-managing fall risk in partnership with patients and their primary care providers (PCPs). The components include a standardized assessment of eight modifiable risk factors (medications; postural hypotension; feet and footwear; vision; vitamin D; osteoporosis; home safety; strength, gait, and balance impairment) and the use of protocols and algorithms to generate recommended management of risk factors; explanation of assessment results to the patient (and caregiver when appropriate) using basic motivational interviewing techniques to elicit patient priorities, preferences, and readiness to participate in treatments; co-creation of individualized falls care plans that patients' PCPs review, modify, and approve; implementation of the falls care plan; and ongoing monitoring of response, regularly scheduled re-assessments of fall risk, and revisions of the falls care plan. Custom-designed falls care management software facilitates risk factor assessment, the identification of recommended interventions, clinic note generation, and longitudinal care management. The trial testing the effectiveness of the STRIDE intervention is in progress, with results expected in late 2019.

KEYWORDS:

cluster-randomized clinical trial; falls; injuries; prevention

PMID:
29044479
PMCID:
PMC5729112
DOI:
10.1111/jgs.15121
[Indexed for MEDLINE]
Free PMC Article

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