Falls are the leading cause of injury-related death among older Americans and lead to 3 million emergency department visits every year. About one out of every three adults age 65 or older falls each year. To assess the delivery and implementation of effective strategies for preventing these injuries, the Patient-Centered Outcomes Research Institute (PCORI) and National Institute of Aging of the National Institutes of Health supported the STRIDE Study. As reported online in the New England Journal of Medicine, the STRIDE Study found that a personalized approach to falls risk reduction, in which nurses tailored falls prevention plans for older adults at high risk and administered these plans for at least 20 months, resulted in about an 8% to 10% reduction in serious fall injuries, but this effect was not statistically significant. Potential barriers to care, such as transportation availability and copayments and lack of engagement in reducing some risk factors, such as eliminating medications that increase falls risk, are among possible reasons the paper notes for the lesser effect size seen in the trial.
STRIDE was a multisite, randomized pragmatic trial. It was conducted at 86 primary care sites nationwide and included rural, urban, and suburban sites. The trial enrolled community-dwelling older adults at risk for falling who reflected the general population of older adults across the nation. Nurses trained as Falls Care Managers helped participants in the intervention group to identify their risk factors and select which risk reduction strategies they were willing and able to implement. Control group participants received their usual care plus educational material on falls information and were encouraged to discuss fall prevention with their primary care doctors, who also received the participants' risk factor screening results.
Spokespeople from PCORI can provide important context about this study, including:
- Why there is the need for research assessing the most effective ways to deliver and promote the use of prevention strategies that have been shown to be useful in previous research
- The importance of pragmatic studies for providing evidence about how well healthcare approaches work in everyday situations and circumstances
- Providing background on patient-centered research and the value of engagement of healthcare decision makers in the research process
WHEN AND WHO
The following PCORI spokespeople are available for interviews by phone or email. The embargo lifts on Wednesday, July 8, at 5 p.m. ET.
STRIDE was 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 large trial enrolled more than 5,400 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 conducted after small-scale trials showed that interventions to reduce risk factors can reduce the rate of falls and fall injuries. STRIDE participants were asked to take steps to lessen one to three of seven risk factors using risk reduction strategies shown to be effective in prior research. In some cases, participants did not address important risk factors; therefore, it is possible that some participants' risk reduction may not have been optimal. The findings suggest that in typical clinical care settings, older adults may face difficulties that may affect their ability to select or follow optimal risk reduction interventions. Lessons learned from STRIDE can help inform the design and implementation of future clinical trials of fall injury risk reduction in various healthcare delivery settings.
This project is part of the Partnership for Fall Injuries Prevention between PCORI and NIA. The trial was funded through a funding award from PCORI (MOU-NIH-2013-001) and awarded and administered by NIH. 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.
Bhasin S et al. A randomized trial of a multifactorial fall injury prevention strategy. NEJM. 2020;383:129-140. DOI: 10.1056/NEJMoa2002183.
About PCORI: The Patient-Centered Outcomes Research Institute (PCORI) is an independent nonprofit organization authorized by Congress in 2010. Its mission is to fund research that will provide patients, their caregivers and clinicians with the evidence-based information needed to make better-informed healthcare decisions. PCORI is committed to continually seeking input from a broad range of stakeholders to guide its work.
New England Journal of Medicine