Nursing Home Prevention of Injury in Dementia (NH PRIDE)

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Abstract: Injurious falls are common, morbid, and costly for nursing home (NH) residents, particularly those with Alzheimer’s Disease and Related Dementias (ADRD). Our long-term goal is to reduce injurious falls in NH residents. The current proposal will develop an Injury Liason Service (ILS) intervention designed to promote deprescribing of psychoactive and cardiometabolic drugs AND encourage osteoporosis treatment. The intervention will address common barriers to fall prevention encountered in NH studies including fragmented communication. The following specific aims are proposed: 1) Develop an ILS care model designed to prevent injurious falls in NH residents using a) an automated risk calculator to identify high risk residents, b) centralized care coordination by an Injury Liaison Nurse, and c) videoconferencing with NH staff; 2) Test the ILS’ implementation-effectiveness in four NH facilities in residents with and without ADRD; and 3) Develop the protocol and resources for a phase 2 efficacy trial of the ILS model in 2-3 NH chains. The central hypothesis is that the ILS model will reduce injurious falls by changing care delivery through deprescribing and increased osteoporosis treatment. We hypothesize that implementation barriers are greater for residents with ADRD, and that it will require iterative intervention modifications to achieve adherence in this population. We will use experience-based co-design principles in Aim 1 to convene key stakeholders to transform the components of the intervention into a single, pragmatic care model that could be disseminated across NH systems. In Aim 2, we will implement the care model in four NH facilities. This will require programming the prediction model within the EMRs to identify high risk residents. A centralized ILS nurse will enact deprescribing recommendations and osteoporosis treatment among high risk residents (n~80) from a remote location. Videoconferencing will be used to facilitate education and communication. We will measure implementation success using post intervention measures of acceptability, demand, fidelity, and practicality. Effectiveness will be measured using process measures (e.g., medication dose reduction) using a pre-post design, and safety will be assessed using both pre-post measures from the Minimum Data Set (MDS) and chart review, stratified by ADRD status. In addition, we will validate the planned primary outcome for a future pragmatic trial, injurious falls ascertained from the MDS, with chart review. In Aim 3, we will develop the protocol and all materials needed for conducting an embedded pragmatic clinical trial of the ILS within 2-3 NH chains. The research team has considerable experience with NH research, including implementation science. At the completion of this study, we will have developed a robust care model that can be readily deployed by NH systems and evaluated for its impact on injurious falls in ADRD residents. We will be ideally positioned to conduct a pragmatic clinical trial embedded in NH systems to test the efficacy of the ILS. In addition to addressing injurious falls, this model has the potential to be modified for other complex geriatric syndromes in NH residents with ADRD.