STRIDE study tests ways to prevent injuries from falls

Every year about one in three adults age 65 and older takes a fall, and 20 to 30% of those who fall suffer significant injuries such as head trauma or a broken hip. A new study shows how difficult it is to prevent these injuries, even with help from primary care providers.

Doctors at Yale, Harvard, and the University of California-Los Angeles recently presented findings of the Strategies to Reduce Injuries and Develop Confidence in Elders (STRIDE) Study, a comprehensive effort to test the effectiveness of a nurse-delivered strategy to prevent injuries from falling. It is based on a trial conducted at 86 primary care clinical practices, representing 10 health care systems in the U.S.

The study appears in the New England Journal of Medicine.

The trial included 5,451 people age 70 and older who were at risk of fall injuries. A "falls care manager" worked with the patients and their physicians to identify risk factors for falls and fall-related injuries. The falls care managers also created care plans to reduce these risk factors.

The Yale Program on Aging coordinated recruitment and assessment aspects of the STRIDE Study. Yale screened all participants across the country and conducted follow-up interviews every four months for up to 44 months.

 "We designed the intervention so it could be easily incorporated into a real-world health system," said  Dr. Thomas M. Gill , Yale’s Humana Foundation Professor of Geriatric Medicine and joint principal investigator of the study.

The STRIDE intervention reduced the rate of first adjudicated serious fall injury - injuries confirmed by medical records or Medicare/Medicaid claims data - by nearly 10%. The researchers said the reduction was not statistically significant and was lower than expected.

The STRIDE approach produced a similar reduction in the rate of self-reported injuries, which the researchers said was statistically significant.

 "It’s hard to change human behaviors, which this approach requires, but it is important work," Gill said. "We know that falls - and injuries that occur as a result of falls - are often a defining event in the life of an older person."

The researchers said larger reductions in serious fall injuries might be achieved by more aggressive efforts to discontinue medications that increase the risk of falling and to increase the use of osteoporosis medications. Greater access and adherence to exercise programs might also reduce fall injuries, the researchers said.

Peter Peduzzi , professor of biostatistics at the Yale School of Public Health and director of the Yale Center for Analytical Sciences, led the data coordinating center for STRIDE.

Joint principal investigators of the study were Gill, Dr. Shalender Bhasin of Harvard, and Dr. David B. Reuben of UCLA.

Visit the website for general information about the STRIDE Study.

Jim Shelton

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