GAPcare II: The Geriatric Acute & Post-acute Care Coordination Program for Fall Prevention in the Emergency Department

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PROJECT SUMMARY Falls by older adults are often predictable and preventable, yet there is a notable lack of research evaluating interventions to reduce the occurrence of recurrent falls in older adult Emergency Department (ED) patients. Dr. Goldberg’s Beeson K76 project GAPcare II, the Geriatric Acute & Post-acute Care Coordination Program for Fall Prevention in the Emergency Department, addresses this lack of research by further refining and examining the intervention she created in her GEMSSTAR R03 project. In this intervention, patients, caregivers, physical therapists (PTs), pharmacy specialists, and clinicians provide a patient-centric, collaborative approach to fall prevention that bridges the ED visit with outpatient resources. PTs evaluate geriatric patients in the ED immediately after their fall, perform a focused assessment of future fall risk and determine the safety of discharge home. Pharmacists in the ED perform a medication therapy management session aimed at reducing/tapering fall risk increasing medication. ED clinicians, patients and caregivers in turn incorporate the advice offered by these professionals before the patient leaves the ED. In her Beeson K76 GAPcare II project, Dr. Goldberg will build on the lessons learned from the GEMSSTAR R03 work. GAPcare II’s specific aims are to: (1) conduct field testing with geriatric patients with and without cognitive impairment and their caregivers to assess the feasibility, acceptability, and usability of the Apple Watch to objectively measure fall-related outcomes; (2) refine the GAPcare intervention and study protocol based on lessons learned and findings from the GEMSSTAR R03 GAPcare I pilot study and conduct a small open trial of the GAPcare II intervention; and (3) conduct a pilot randomized, controlled trial (RCT) of the GAPcare II (n=200) intervention to obtain initial estimates of efficacy of GAPcare II to decrease recurrent falls at 12 months relative to usual care. This investigation will provide Dr. Goldberg with critical pilot data and expertise to submit a R01 proposal to NIA for a full-scale, multi-center, comprehensive RCT. Dr. Goldberg’s Beeson K76 award overarching aims are to develop and test an ED-based and post-discharge protocol that reduces recurrent falls in older adults and to launch her physician-scientist career as an emerging leader in geriatric emergency medicine. To achieve this goal, Dr. Goldberg will obtain additional training in qualitative research, digital health, longitudinal data analysis, clinical trial methods, and leadership. This expertise will be achieved through advanced coursework, leadership training, and intensive interactions with her mentorship team. Her primary mentors, Dr. Roland Merchant, emergency medicine physician and epidemiologist, and Dr. Vincent Mor, health services researcher and health policy expert, will provide training in epidemiology, health services research, and leading policy initiatives. Her mentorship team also includes experts in qualitative research, digital health, rehabilitation measures, longitudinal data analysis, clinical trial methods, fall prevention and geriatric medication management.