Injuries from falling cause a significant number of deaths among older Iowans, and the University of Iowa has partnered with a Des Moines–based subsidiary of Mercy Health Network on a project to reduce the number of falls.

The UI College of Public Health, UI College of Pharmacy, and the Mercy Accountable Care Organization (ACO) are part of the nationwide STRIDE study, a five-year research project that seeks to reduce fall-related injuries among older adults. According to the Iowa Department of Public Health, Iowa’s death rate from falls among people older than 65 is 9.4 per 1,000, higher than the U.S. average of 7.8 per 100,000. Medical costs of treating older Iowans who injure themselves in a fall is $135 million per year. 

“Every year, about 30 percent of adults over age 65 suffer an injury from a fall, and about 30 percent of those result in injuries severe enough to lead to declines in health and loss of confidence,” says Robert Wallace, professor of epidemiology in the UI College of Public Health, who is leading the study. “This patient-centered group research study is to determine how we can best prevent falls by reaching out to seniors directly in a primary care setting.” 

The UI/Mercy ACO partnership is one of 10 research sites to receive a portion of the $30 million STRIDE grant, awarded by the National Institutes on Aging. Wallace says UI partnered with the Mercy ACO and Mercy Clinics because of their special interest in falls, and their clinics reach several rural as well as urban communities throughout central Iowa, providing care to a large number of older patients. Both of those factors met the STRIDE study’s priorities, he says. 

The study involves more than 5,400 adults nationally who are at risk of falling, about 360 of whom are Iowans who see their doctors in Mercy Clinics. Some of the patients are assigned to a nurse falls care manager, who screens them individually and identifies their risks for falling. The falls care manager assesses a variety of factors that suggest increased falls risk, including:

• Examination for foot injuries
• The use of strength, gait, and balance exercises
• Consulting a pharmacist and/or primary care physician to determine if a patient’s medications may increase falls risk, such as by causing dizziness, muscle weakness, or other side effects
• Determining the success of using Vitamin D to strengthen bones that might be weakened by osteoporosis
• Home inspections to look for hazards that might increase the likelihood of a fall
• Conducting a vision screening examination
• Encouraging patients to wear shoes that better stabilize the feet and ankles, instead of sandals or flip flops
• Blood pressure testing to determine if the patient has orthostatic hypotension, a condition where standing up too quickly can lead to fainting or dizziness

The falls care manager then prepares a report on risk factors for falling, which is sent to the patient’s primary care provider. Together with the falls care manager, they develop an overall falls prevention and management plan.    

“For instance, if a patient has fallen in the past, possibly sustaining an injury, the physician and the health system will treat the injury and then work with the patient to improve fall prevention strategies for the future,” says Wallace.

Carri Casteel, associate professor of occupational and environmental health and director of the Occupational Injury Prevention Program, says the plan is focused particularly on avoiding falls that lead to head and hip injuries, which are especially dangerous for older adults. 

After the falls prevention program is in place, researchers from the UI/Mercy team, along with other injury prevention centers, follow up with study participants and gather data on their fall rates, including the occurrence of serious injuries or fatalities from those falls. Once the five-year study period ends in 2019, the researchers will analyze the data to determine which strategies and combination of strategies were most effective.

“There are several falls prevention interventions that are known to work individually. What we’re testing is whether the systematic delivery of a package of interventions can have an important preventive effect for older people,” says Wallace.

The researchers expect the final study results to be available in late 2019 or early 2020. They hope the data can be used for developing additional fall prevention programs, as well as developing new studies to improve the overall health of older adults.