Individually tailored falls prevention plan found no better than usual care for reducing serious injury

Large PCORI-, NIH-funded trial examined multipronged intervention in real-world settings.

What

Findings reported in the New England Journal of Medicine suggest that a nurse-managed, individually tailored falls prevention plan administered for at least 20 months did not significantly reduce risk of serious fall injuries in older adults aged 70 and over who were at high risk for falls. Each year in the United States, about 3 million adults 65 and older are treated in the emergency department for serious injuries from a fall. To promote the development of effective approaches to prevent these injuries, the Patient-Centered Outcomes Research Institute (PCORI) and National Institutes of Health supported the Strategies to Reduce Injuries and Develop Confidence in Elders (STRIDE) trial.

STRIDE was a multisite, randomized pragmatic trial, meaning it was conducted in a real-world primary care setting. All participants in the study were screened for seven risk factors for fall injuries: walking and balance impairment; hazards for falling in the home environment; troubles with feet or shoes; vision problems; medications that increased fall risk; experiencing low blood pressure when standing up; and having weak bones from osteoporosis and low levels of vitamin D. The Falls Care Managers helped participants in the intervention group identify their risk factors and select which risks to modify. Control group participants received their usual care plus a falls information pamphlet, and were encouraged to discuss fall prevention with their primary care doctors, who also received the risk factor screening results.

The primary outcome of this large-scale trial was the length of time to the first serious fall injury. After a participant reported a serious injury, it was verified by trial sites or health records. The rates of verified serious fall injuries did not differ significantly between the intervention and control groups. For both intervention and control groups, the number of verified first serious fall injuries was lower than expected based on rates previously reported by older persons who matched the trial’s requirements for inclusion.

Spokespeople from NIH’s National Institute on Aging (NIA) can provide important context about this study, including:

Explaining the design of the STRIDE study, including the study’s strengths and limitations
Sharing background about previous smaller studies on falls prevention
Providing context for NIA-funded falls prevention research

When and Who

The following NIA spokespeople are available for interviews by phone or email.

Evan Hadley, M.D., director of NIA’s Division of Geriatrics and Clinical Gerontology (DGCG)
Rosaly Correa-de-Araujo, M.D., M.Sc., Ph.D., a coauthor of the paper and DGCG senior scientific advisor
Sergei Romashkan, M.D., Ph.D., chief of DGCG Clinical Trials Branch and program official for STRIDE

Additional Background

STRIDE assessed the benefit of an evidence-based, multipronged, individually tailored falls prevention intervention implemented by nurses who were trained to be Falls Care Managers. Led by investigators at Brigham and Women’s Hospital, Harvard Medical School, Boston; Yale School of Medicine, New Haven, Connecticut; and David Geffen School of Medicine, University of California, Los Angeles, the study was conducted at 86 primary care practices in 10 U.S. healthcare systems. The large trial enrolled more than 5,000 people who were at least 70 years old and had been injured from a fall, had fallen at least two times in the previous year, or were afraid of falling because of difficulty walking or balancing.

STRIDE was designed after small-scale trials showed that risk factor reduction interventions reduced the rate of falls and fall injuries. STRIDE participants were asked to diminish one to three of seven risk factors. In some cases, important risk factors were not diminished; therefore, a participant’s risk reduction may not have been optimal. Other strategies to achieve risk reduction in health care systems might be more effective, and lessons learned from STRIDE can help inform the design and implementation of future clinical trials in various health care delivery settings.

Grants

This project is part of the Partnership for Fall Injuries Prevention between the NIA and PCORI. The award was made by NIH and funded by PCORI. STRIDE’s investigators were supported in part by NIA (5U01AG048270, P30AG013679, P30AG028748, P30AG021342, P30AG2874106, P30AG024832, P30AG024824, P30AG024827, P30AG021332, U24AG059624, and K07AG043587). The investigators obtained additional support from NIH’s National Center for Advancing Translational Sciences (UL1TR001102, UL1TR000142, UL1TR000114, and KL2TR000113). Additional details about STRIDE are available at ClinicalTrials.gov using the identifier NCT02475850.

Article

Bhasin S et al. A randomized trial of a multifactorial fall injury prevention strategy(link is external). N Engl J Med 2020;383:129-40. DOI: 10.1056/NEJMoa2002183.

About the National Institute on Aging (NIA): The NIA leads the federal government effort conducting and supporting research on aging and the health and well-being of older people. The Institute's broad scientific program seeks to understand the nature of aging and to extend the healthy, active years of life. For more information on research, aging and health, go to the NIA website and stay connected.

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