Development of a Fall Risk Identification and Management Model for Older Veterans
Project Number1IK2RX005024-01A1
Former Number1I02RX005024-01P1
Contact PI/Project LeaderGARBIN, ALEXANDER JEFFREY
Awardee OrganizationVA EASTERN COLORADO HEALTH CARE SYSTEM
Description
Abstract Text
Falls among older adults pose a significant risk, leading to life-altering injuries and imposing substantial
healthcare costs. There is a pressing need to develop fall prevention models within the Veterans Health
Administration (VHA) considering Veterans are more likely to fall than their age-matched non-Veteran
counterparts, likely secondary to higher rates of functional impairment and comorbidities. Extensive research
has identified numerous fall risk factors across physical, psychological, pharmacological, and environmental
domains. Further, screening tools and interventions have been developed to identify and manage these risk
factors, offering insight on methods to intervene early and prevent falls in older Veterans. Primary care clinics
within the VHA are well-positioned to play a crucial role in preventing falls. These clinics are frequently visited
by older Veterans for routine care and are widely accessible across the country. However, fall risk assessment
is often not included in the standard care provided by VHA primary care clinics, mainly due to barriers like
limited time, competing medical priorities, and a lack of training. Consequently, there is a missed opportunity to
address fall prevention. Therefore, we are developing a personalized multifactorial model called Fall Risk
Identification and Management (FRIM) to prevent falls in older Veterans seen within primary care by
addressing known barriers that have limited the uptake of other fall prevention models. Specifically, the FRIM
model follows a three-stage process: briefly screening for fall risk during routine primary care visits, conducting
telehealth visits to identify specific fall risk factors, and referring Veterans to existing VHA care pathways with
established interventions for managing identified risk factors. The objectives of this CDA-2 are to refine (Aim 1;
Phase 1) and assess the feasibility (Aim 2; Phase 2) of the FRIM model in preparation for a future efficacy trial.
The initial phase, Aim 1, focuses on refining the FRIM model by gathering feedback on each care pathway
from Veterans and clinicians through qualitative interviews following a small field test. Additionally, we will
assess the impact of each care pathway on fall risk factor assessments. This phase aims to enhance the
model based on the integration of perceptions and outcomes. Following the refinement of the FRIM model, Aim
2 entails conducting a randomized controlled feasibility pilot study. This phase will involve the collection of both
qualitative and quantitative data to evaluate the feasibility, acceptability, and candidate efficacy outcomes of the
FRIM model while comparing it to VHA standard of care. Along with the planned research project, Dr. Garbin
has outlined an extensive training plan and assembled an expert mentorship team to develop his skillset
related to clinical trials, qualitative and mixed methods, and scientific leadership. The proposed research for
this CDA-2 holds significant potential for optimizing a model that identifies and manages fall risk, potentially
leading to a substantial reduction in falls among older Veterans. In addition to the study's outcomes, the
comprehensive mentorship received from Dr. Garbin's team and his continued integration into the VHA will lay
the foundation for a Merit Award submission, which will investigate the efficacy of the FRIM model using a
pragmatic randomized controlled trial (RCT). This award will serve as a catalyst for Dr. Garbin's transition into
an independent VA research scientist, dedicated to addressing the pressing issue of falls and enhancing
outcomes for older Veterans across the VHA healthcare system.
Public Health Relevance Statement
Falls are a common occurrence among older adults, and Veterans have an even higher risk of falling
compared to non-Veterans. These falls often lead to severe health consequences, including traumatic brain
injuries, hip fractures, emergency visits, hospitalizations, and even death. It is crucial to prioritize fall prevention
in order to reduce injuries and enable older Veterans to age comfortably at home. Although current fall
prevention programs in the Veterans Health Administration primarily focus on inpatient care and nursing
homes, there is a pressing need to address falls among older Veterans living independently in the community.
The proposed VA-specific Fall Risk Identification and Management (FRIM) model aims to proactively prevent
falls in older Veterans who receive primary care, effectively reducing the occurrence of adverse health events
associated with falls. By placing emphasis on prevention rather than reacting after falls have already
happened, this initiative seeks to significantly enhance the overall well-being of older Veterans.
NIH Spending Category
No NIH Spending Category available.
Project Terms
AccidentsAddressAgeAlgorithmsAttitudeAwardBehavior TherapyCaringCenters for Disease Control and Prevention (U.S.)Cessation of lifeClinicClinicalClinical PsychologyClinical TrialsCollectionCommunitiesCountryDataDedicationsDevelopmentElderlyEligibility DeterminationEmergency SituationEmergency department visitEventExerciseFall preventionFeedbackFoundationsFunctional impairmentFutureGoalsGuidelinesHealthHealth Care CostsHealth Care SystemsHealth Services AdministrationHip FracturesHomeHospitalizationIndependent LivingInjuryInterventionIntervention TrialInterviewLeadershipLifeMeasurementMeasuresMedicalMentorshipMethodsModelingNursing HomesObesityOccupational TherapyOutcomeOutcome AssessmentOutcome StudyParticipantPathway interactionsPerceptionPersonal SatisfactionPharmacy facilityPhasePhysical FunctionPhysical therapyPilot ProjectsPlayPolypharmacyPopulationPositioning AttributePreparationPreventionPrevention programPrimary CareProcessProviderQuestionnairesRandomizedRandomized, Controlled TrialsReactionRecommendationReportingResearchResearch Project GrantsRiskRisk AssessmentRisk FactorsRisk ManagementRoleRuralScientistScreening procedureSecondary toStructureTimeTrainingTraumatic Brain InjuryVeteransVeterans Health AdministrationVisitbrief screeningcatalystcomorbiditycostcost estimatedata warehouseefficacy evaluationefficacy outcomesefficacy trialexperiencefall injuryfall riskfallsfear of fallingfield studyhazardhigh riskimprovedinpatient serviceinsightolder adultpharmacologicprimary care clinicprimary care settingprimary care teamprimary care visitpsychologicrecruitretention rateroutine careskillsstandard carestandard of caretelehealthtooluptake
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