Family physicians know that their elderly patients are at greater risk of falling and sustaining serious or even fatal injuries. Given that unfortunate reality, physicians and caregivers alike should welcome news that an HHS-funded falls prevention program -- several years in the works and now tested with good results -- is a big step in the right direction and shows promise for keeping seniors safer in home settings.
The Living Independently and Falls-free Together (LIFT) Wellness Program(www.lifeplansinc.com) was developed for community-dwelling seniors and tested in a randomized controlled trial conducted from 2008 to 2012. Results of that study now have been summarized in an article(content.healthaffairs.org) titled "Prevention Program Lowered the Risk of Falls and Decreased Claims for Long-Term Services Among Elder Participants" that was published in the June issue of Health Affairs.
According to a June 8 HHS news release,(www.hhs.gov) the results show that the program reduced falls and the subsequent need for patient care in long-term care facilities.
"While falls are preventable, we need to intervene at the right time in a way that is comprehensive and yet individually tailored," said Richard Frank, Ph.D., HHS assistant secretary for planning and evaluation, in the release.
Frank noted that successfully preventing falls is a big win for all involved: seniors and their families, as well as the health care and long-term care systems. "This study shows that by investing in falls prevention, we can reduce long-term care use and spending," he added.
- New research shows that an HHS-funded falls prevention program helps keep seniors on their feet and lowers fall-related medical costs.
- Study participants assigned to the falls prevention intervention group received a nurse-led clinical assessment, a customized action plan, a follow-up coaching call and a quarterly newsletter with educational tips about fall prevention.
- Researchers said that overall, every $1 invested in the intervention program led to a savings of $1.68 on long-term services and supports for patients.
Risk factors for falling include fear of falling, gait or balance problems, medication use, household clutter and certain health conditions. HHS noted that the program was unique in that it simultaneously addressed all of the known risk factors.
Hitting the High Points
Study participants -- randomly assigned to an intervention group, an active control group or an administrative control group -- were age 75 and older with long-term care insurance provided by one of three major U.S. insurers.
Participants assigned to the intervention group received a
- nurse-led clinical assessment performed in the home,
- customized action plan that documented fall risk factors and recommendations for minimizing risks along with a falls prevention and wellness toolkit,
- follow-up coaching call during which the assessment findings and recommendations were reviewed by nurse, and
- quarterly newsletter that offered additional coaching and educational tips about falls prevention.
In addition, participants' primary care physicians received assessment test results, and patients were encouraged to schedule follow-up appointments with their physicians to review their individualized falls prevention action plan.
Researchers reported that in the first year after the intervention, participants in the LIFT intervention group saw an 11 percent reduction in "risk of falling" compared with participants in the active control group. Also after one year, the relative fall risk for people in the intervention group was 18 percent lower than for those in the active control group.
In addition, one year into the program, 10.9 percent of people in the intervention group reported a fall requiring medical attention compared with 13.6 percent in the active control group.
Furthermore, three years after intervention implementation, participants in the intervention group had 33 percent fewer claims for long-term care services and supports than did people in the administrative control group.
That decrease in claims resulted in dollars saved -- an important point considering that, according to CDC estimates, fall-related medical costs for patients 65 and older totaled some $34 billion in 2013.
The researchers found that gross savings on long-term services and supports for each participant in the intervention group totaled $838 over the three-year intervention period. After deducting the estimated $500 cost per participant to implement the intervention, "we found that the net savings were $338 per participant," wrote the authors. "In other words, every $1 invested in the intervention led to $1.68 in savings on long-term services and supports."
"All told, the intervention saved more money than it cost to deliver," they noted.
Coming to Conclusions
Authors said the LIFT Wellness program demonstrated that a multifactorial falls prevention intervention could, in fact, reduce falls and long-term services and supports claims rates for long-term care policyholders.
They highlighted the success of program components such as customized action plans, physician involvement, education, coaching and ongoing involvement with patients.
"Broad deployment of LIFT by private long-term care insurers as a voluntary program for policyholders could reduce falls and claims incidence rates, provide financial benefit to long-term care insurers, and enhance elders' ability to age in place," the authors concluded.
HHS Report: The Effect of Reducing Falls on Long-Term Care Expenses: Final Design Report(aspe.hhs.gov)