Comprehensive Summary
Sri-on et al. conducted a randomized controlled trial evaluating whether a Falls Reduction for Elderly Emergency Department (FREED) intervention reduced recurrent falls in older adults at 6 months. At a single ED in Thailand, 216 patients were randomized to receive either the FREED intervention or usual care. The FREED intervention included fall risk assessment, medication review, vitamin D supplementation, physical therapy referrals, and home environment evaluation. The primary outcome was the proportion of patients experiencing one or more recurrent falls within 6 months. The study found no significant difference in recurrent falls between groups after 6 months (FREED 32.4% vs. usual care 4.6%, absolute difference: 4.6%, p = 0.42). Both groups experienced similar slight declines in activities of daily living scores.
Outcomes and Implications
Falls are common in older adults, leading to negative health and social effects as well as increased likelihood of recurrent falls. The ED presents a feasible setting for fall prevention interventions, as it captures high-risk patients who may not otherwise engage in preventive care. This study tested a multifactorial fall intervention in an ED in Thailand. While the intervention was feasible and accepted by patients, it did not significantly reduce their risk of subsequent falls at 6 months. The lack of observed benefit may reflect limited patient adherence to post-ED recommendations, insufficient intensity or duration of interventions, and the complexity of addressing multiple fall risk factors in a single ED encounter. The single-center design and modest sample size also limited statistical power to detect smaller but potentially clinically meaningful differences. Thus, while the ED may serve as an entry point for fall prevention, effective programs likely require robust post-discharge follow-up, care coordination with primary care providers, and sustained engagement strategies. Future multicenter trials with longer follow-up and enhanced adherence strategies are needed to determine optimal approaches for ED-initiated fall prevention in older adults.