iSeFallED
iSeFallED
iSeFallED - Tailor-made interventions to preserve function for elderly patients after an index fall with presentation at the emergency center without inpatient admission
(Tailored interventions to prevent functional decline after a Sentinel Fall presenting to the Emergency Department - iSeFallED)
Falls in older adults can have serious health consequences. Particularly serious falls that require a visit to the emergency room, for example, often lead to restrictions in functional ability, independence and quality of life. The prevention of falls is therefore of central importance, not least because the treatment of falls and the consequences of falls generate considerable costs for the healthcare system.
Secondary prevention, i.e. preventive measures that take place after people have already fallen, is particularly important. This is because the need for such measures is often only recognized at this point. However, there are currently no structured aftercare programs for people who present to the emergency room with a fall. The focus here is on treating acute symptoms and the causes of a fall or potential consequences are only given secondary consideration.
The iSeFallED project aims to address the lack of structured programs and expertise for initiating fall prevention measures in various sectors of the German healthcare system, thereby improving the chances of effective and affordable treatments for older people at risk of falling. As part of the project, patients are recruited after a fall in the emergency room and examined for their individual risk of functional limitations using a risk screening based on the findings of the predecessor project "SeFallED". Based on the screening results, patients are divided into different groups in order to enable tailor-made and patient-centered secondary prevention interventions. In addition to providing information material on active and fall-free ageing, special exercise programs that include balance and functional exercises are offered in both individual and group training sessions. These are designed to help patients reduce their personal risk of falling and strengthen them in restoring or maintaining their functionality. Follow-up during home visits, in which a varied and extensive geriatric test battery is carried out, provides evidence for further statements about the functional course of the test subjects, including potential subsequent falls.
The project focuses on analyzing the acceptance, feasibility and effectiveness of the secondary prevention program to be implemented. The involvement of those affected, relatives and other stakeholders plays a central role in this and is implemented in a participatory approach through a project advisory board, among other things. Focus groups will also be conducted to gain insights into the planned interventions. In addition, the establishment of a university outpatient clinic and cooperation with local stakeholders, such as the city sports association and local sports providers, will create a supportive network to establish long-term treatment pathways and implement sustainable secondary prevention strategies. Other focal points of the project are the further development of an algorithm for machine learning and the consideration of socio-economic characteristics.
Predecessor project: SeFallED
SeFallED - Elderly patients after index fall with presentation to the emergency center without inpatient admission: trajectories and needs of this high-risk group as a basis for the development of tailored interventions for elderly people
Falls and fractures are among the five most common causes of loss of independence in Germany. Falls can lead to restrictions in individual functionality, independence, coping with everyday life, social participation and thus quality of life for older people. In addition, the treatment of the consequences of falls causes high costs for the healthcare system. It is therefore important to prevent further falls by reducing the risk of falls.
A particular risk group for not receiving secondary prevention is older people who present to the emergency room after a fall, but for whom the severity of the injury does not require hospitalization.
The aim of the "SeFallED" project is to identify and predict long-term trajectories with regard to independence in performing everyday activities, functional performance, physical activity and the fall risk profile of this risk group. For this purpose, patients are recruited who have been treated as outpatients in the emergency department due to a fall. In addition to a comprehensive geriatric examination, various innovative technologies are used to analyze fall risk factors and individual functional progression. For example, gait analyses are also carried out on a so-called perturbation treadmill , which can be used to test dynamic balance by provoking specific disturbances in gait, which must be counteracted by an appropriate response. In addition, it is investigated whether these targeted disturbances train movement patterns that improve the reaction to such disturbances and thus have an influence on the further course or risk of falling. During the diagnostics, movement data is also recorded by sensors worn on the body. These data sets will be used to record functional performance in daily life using machine learning approaches and to recognize the movement sequences generated under standardized conditions in the laboratory in everyday life using body-worn sensors. Based on the comprehensive findings, a statistical prediction model is being developed.
It is important to the team to involve patients and their caregivers in the research process using a qualitative approach and to identify their needs, preferences and barriers to participation in fall prevention programs. The sum of these results forms the starting point for the selection of existing and development of new intervention measures to prevent falls and minimize the individual risk of falling.
Publications
Voß M, Zieschang T, Schmidt L, Hackbarth M, Koschate J, Stuckenschneider T (2024) Reduced adaptability to balance perturbations in older adults with probable cognitive impairment after a severe fall. PLoS ONE 19(7): e0305067. https://doi.org/10.1371/journal.pone.0305067
Schmidt, L., Zieschang, T., Koschate, J., & Stuckenschneider, T. (2024). Impaired standing balance in older adults with cognitive impairment after a severe fall. gerontology. https://karger.com/ger/article/doi/10.1159/000538598/907059/Impaired-Standing-Balance-in-Older-Adults-with
Stuckenschneider, Tim; Schmidt, Laura; Speckmann, Elisa-Marie; Koschate, Jessica; Zieschang, Tania (2023): Recruiting patients for falls prevention in the emergency department - worth the challenge. In: BMC Geriatrics 23 (1). DOI: 10.1186/s12877-023-04607-5; https://doi.org/10.1186/s12877-023-04607-5
Sandra Hellmers, Elias Krey, Arber Gashi, Jessica Koschate, Laura Schmidt, Tim Stuckenschneider, Andreas Hein, Tania Zieschang (2023) Comparison of machine learning approaches for near-fall-detection with motion sensors. Frontiers in Digital Health https://doi.org/10.3389/fdgth.2023.1223845
Stuckenschneider, T., Koschate, J., Dunker, E. et al. Sentinel fall presenting to the emergency department (SeFallED) - protocol of a complex study including long-term observation of functional trajectories after a fall, exploration of specific fall risk factors, and patients' views on falls prevention. BMC Geriatr 22, 594 (2022). https://doi.org/10.1186/s12877-022-03261-7