Closing the Care Gap for Seniors After Falls

Original source: https://www.mcknights.com/news/study-finds-major-care-gap-for-seniors-visiting-eds-after-falls/

This briefing summarizes a recent multicenter study highlighting a critical disconnect between recommended care guidelines and actual clinical practice for older adults presenting to emergency departments (EDs) following falls. s.

I. Significant Gap in Recommended Care vs. Actual Practice:

The core finding of the study is a substantial "care gap" for elderly patients experiencing falls. Despite national guidelines advocating for comprehensive assessments, only a small fraction of these vulnerable individuals receive the recommended therapeutic evaluations.

• "A new multicenter study reveals a significant gap between recommended care and actual practice for older adults’ emergency department visits following falls."
• "Researchers analyzed 945 patients aged 65 and older who presented with fall-related complaints at five hospitals… between 2020 and 2022."
• "The study found that only 16% of elderly emergency patients received physical or occupational therapy evaluations, despite national guidelines recommending comprehensive assessments for this vulnerable population."
• This represents a "substantial underutilization of therapy services."

II. High Impact and Effectiveness of Therapy Consultations (When Implemented):

Despite their underutilization, the study unequivocally demonstrates the high impact and effectiveness of physical and occupational therapy evaluations when they do occur.

• "However, when therapy consultations did occur, they proved highly effective."
• "According to the research, 76% of physical therapy evaluations and 78% of occupational therapy evaluations resulted in meaningful changes to patient care plans."
• These "meaningful changes" included a range of crucial interventions such as:
• Recommendations for different living arrangements
• Referrals for home health therapy
• New medical equipment (e.g., walkers, safety devices)
• Strategies for better symptom management

III. High Medical Complexity of the Patient Population:

The study population underscores the vulnerability and complex needs of older adults who experience falls, further emphasizing the necessity of comprehensive care.

• "The patient population studied demonstrated high medical complexity, with 28% having dementia and 67% requiring hospital admission."
• Among those screened for various geriatric conditions (cognitive impairment, delirium, fall risk, functional problems), a large majority tested positive for at least one issue: "74% tested positive for at least one issue."

IV. Inconsistent Implementation Across Hospitals:

The study revealed a wide disparity in the rate of therapy consultations among the participating hospitals, suggesting a lack of standardized implementation of care guidelines.

• "Physical and occupational therapy consultation rates varied dramatically between hospitals, ranging from less than 1% to nearly 40% of eligible patients receiving therapy evaluations."
• This variation "suggests inconsistent implementation of established care guidelines across different emergency departments."

V. Conclusion: High Impact, Significant Underutilization:

The study's authors draw a clear conclusion: while ED therapy evaluations are highly impactful for older adults who fall, their real-world clinical utilization remains strikingly low.

• "The study authors concluded that ED therapy evaluations for older adults with falls are highly impactful when implemented but remain significantly underutilized in real-world clinical practice."