Falls are among the most frequent reasons older adults seek care in emergency departments, and many of these patients are sent home on the very same day. The point of discharge can be particularly risky, as the underlying causes of a fall are not always fully explored or managed during a brief hospital visit. Emerging evidence now indicates that emergency departments can use this critical window to introduce practical measures that help older adults remain safer once they return home.
These insights come from the GAPcare II trial, titled Emergency Department Visit Outcomes of a Multicentre Randomised Trial of a Fall Prevention Intervention, published in Academic Emergency Medicine. The study examined whether a structured fall-prevention programme could realistically be delivered during emergency department visits for adults aged 65 and over who had experienced an accidental fall within the previous seven days. All participants were expected to be discharged and did not have injuries that severely limited mobility. In total, 852 patients took part in the intervention, which combined assessments by physical therapists with medication reviews conducted by pharmacists.
The research demonstrated that these assessments could be completed during the emergency visit and resulted in tailored recommendations for individual patients. Interventions included advice on mobility support, changes to medication regimens, and referrals for further care after discharge. Participants received consultations at the bedside from both pharmacists and physical therapists, allowing recommendations to be integrated directly into the emergency care process rather than deferred to a later setting.
Pharmacists frequently suggested practical medication-related changes that could reduce fall risk. These included adjusting the timing of medications for 26 per cent of patients, discontinuing medications associated with increased fall risk in 19 per cent of cases, and modifying dosages for a further 18 per cent. Physical therapists focused on functional support and follow-up needs, recommending assistive devices for two-thirds of patients, outpatient therapy services for over a third, and admission to a skilled nursing facility for a quarter of those assessed.
Commenting on the findings, Sarah D. Berry, MD, MPH, emphasised that a fall is rarely an isolated event. Instead, it often signals unresolved health issues or environmental hazards that require attention. She noted that the study illustrates how emergency departments can move beyond simply addressing the immediate injury, helping to identify modifiable risk factors and equipping patients and caregivers with a clearer plan to reduce the likelihood of future falls once they return home.
Although the trial was primarily designed to assess how feasible the programme was to implement, rather than to measure long-term outcomes such as repeat falls or hospitalisations, the results underscore the potential of emergency departments as an important point of intervention. By integrating fall-prevention strategies into routine emergency care, hospitals can play a meaningful role in supporting safer recovery and independence for older adults after discharge.
More information: Elizabeth M. Goldberg et al, Emergency Department Visit Outcomes of a Multicenter Randomized Trial of a Fall Prevention Intervention, Academic Emergency Medicine. DOI: 10.1111/acem.70228
Journal information: Academic Emergency Medicine Provided by Hebrew SeniorLife Hinda and Arthur Marcus Institute for Aging Research
