Creating integrated care pathways to improve fall risk assessment and follow-up among frail elderly in home care services

Abstract

Falls among the elderly are common. Approximately 50% of elderly living at home fall every year with disability and loss of healthy life years as consequences. Up to 40% of admissions to nursing homes happen in the aftermath of falls. Fall injuries are the sixth-largest factor contributing to living with disability in Norway, even more than the health loss due to cardiovascular disease. As studies show in Norway, a third of the elderly experience a fall every year, and the risk of falling increases after the age of 75. The City of Oslo has recently implemented a care pathway for elderly patients with an increased risk of falling. The main aim of the intervention is to better integrate hospitals and primary care services so the primary care services can monitor the patients at risk and implement measures that prevent new falls. In this study, we aim to understand that how much the new care pathway increases awareness and focus on fall risk prevention in the home services. We also study whether the intervention has improved the information flow to and from the municipal care services for the elderly either at risk of falls or having had falls. For sake of this research, data collection has been conducted by means of an online survey that was sent to health care workers at home care services in 14 boroughs of Oslo. we got 221 responses from the home care services. the results indicated that almost 60% of respondents in control boroughs and 67% in intervention boroughs receive fall reports from the emergency medical services (P=0.24). However, the intervention boroughs received more fall reports from the emergency medical services during 2019 and 2020. Only three statistically significant differences at 5% significance level were found in healthcare workers' knowledge of fall prevention interventions. The actual findings, however, were consistent in their direction, indicating that the healthcare workers in the intervention boroughs are more familiar with checklists and fall prevention follow-up. Also, the information flow from home care services to GPs seems more consistent and regular compared with information flow from the GPs to the home care services.