Fall rates in care home residents are 5 times more frequent than in community dwelling adults. Major mortality and morbidity are associated with falls, with some bone damage and deaths being irreversible consequences.

Hip fractures alone cost over 1 billion pounds per year; set to double by 2050. Community falls prevention interventions reduce falls by 30%, but care home literature to date has reported no conclusive reduction in falls. Since compliance and adherence to fall prevention methods may be lower in cognitively impaired groups, the high prevalence of cognitive impairment in care home residents (84%) may explain the lower success. When devising a fall prevention intervention for use in the care home setting length of stay, target group and careful selection of content is needed.

In 2012 researchers at Nottingham University commenced a 2 year phase II RfPB feasibility study to investigate feasibility, acceptability, tolerability and integrity parameters related to the design and grant application for a multi-centre definitive cluster randomised controlled trial to answer the question: Does the Guide to Action in Care Homes (GtACH) fall prevention intervention reduce falls in care homes?   six care homes (with 52 residents) took part, both residential and nursing, three were in the ‘intervention group’ and three ‘control group’.  Those within the ‘intervention group’ received training from Clinical Falls Specialists on the Guide to Action Care Home (GtACH) fall prevention intervention. The GtACH is a multifactorial programme designed to assess risk of falling on an individual basis to enable the implementation of personalised fall prevention orientated changes. To better suit staff rotations and the busy care home environment staff are trained in groups of 4-8 in 1 hour sessions. Data were collected from care records, self-report, care staff reports and accelerometers from 6 care homes and care home staff were interviewed surrounding their perspective of GtACH use.

Clinical Studies Officer; Nadia Frowd proved instrumental in the recruitment of both care homes and residents.

The eligibility criteria were:

Inclusion criteria

• Care home resident
• Aged 65 years or over
• Fallen in last year

 Exclusion criteria         

• Bedbound, moved with a hoist
• Known to be unsuitable for inclusion in research, for reasons such as previously
• expressed views about research by patients or the relatives of incapable patients
• Residents without capacity to consent for whom no consultee can be identified

 Summary of findings:

• 22 out of 145 care homes responded to letter invite – but when the researchers rang those who had not responded to find out why, they were actually very interested therefore both letter and telephone invite are important methods of care home recruitment
• For the FICH study inclusion was restricted to  residents in the care homes who had already fallen to take part – in the future we would invite all residents to take part
• Interviews with care home staff showed they favoured training sessions on the use of the Guide to Action Tool to be in small groups and the training should be around 1 hour in length
• Care homes documented risks and actions on GtACH forms when an interactive sessions was arranged to discuss its’ use. Care homes also requested greater explanation of terms, refresher training and greater leadership involvement from senior authority (i.e. Manager and Fall link nurse).
• We found that staff who had attended the training did become more aware of all the risk factors associated with falling and that they took actions to reduce that risk where possible
• We found that falls are systematically and routinely recorded in care home records sufficient detail to be considered as an appropriate primary outcome measure

Submission to the NIHR Health Technology Assessment programme is a two stage process. We submitted our proposal for a multi-centre definitive effectiveness trial; FinCH (Falls in Care Homes) in December 2013 and were selected to be fast-tracked as part of an internal pilot scheme to improve efficiency of application processing. The outline proposal was accepted in March 2014 and we are now acting on reviewers comments and justifications of complete breakdown of costs for full application submission due May 2014 end. We will know by August 2014 as to whether the study will be funded. The anticipated start date is currently February 2015. If funded the study should determine the clinical and cost effectiveness of the GtACH in a larger more representative sample. An embedded concurrent mixed methods process evaluation will be completed to identify implementation facilitators and barriers.

Watch a shortfilm about the study here

Visit the study Facebook page here

For more information contact:

ttp://www.nottingham.ac.uk/research/groups/healthofolderpeople/projects/index.aspx

Professor Pip Logan: Pip.logan@nottingham.ac.uk

Gemma Walker: Gemma.walker@nottingham.ac.uk