UPMC part of study on falls among elderly

Research will take data from 10 hospitals across U.S.

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The University of Pittsburgh will participate in a national study on preventing falls among the elderly, one of the leading causes of injury and death in the age group.

The study will follow people age 75 and older who have been identified as being at risk of falling. Of the 6,000 participants nationwide, about 600 will be UPMC patients.

"This is the Manhattan Project of fall injury prevention," Shalender Bahsin said at a teleconference Wednesday. The endocrinologist is one of the leaders of the study, and works at the Brigham and Women's Hospital in Boston. Nine other hospitals in addition to UPMC will participate in the study, which is funded by the National Institutes of Health and the Patient-Centered Outcomes Research Institute in Washington.

One older adult falls every 29 minutes, according to the study's organizers.

This $30 million, five-year study is innovative in a number of ways, researchers said. Over the last 20 years, a number of studies have clearly identified factors that put an elderly person at risk of falling. There has also been research on methods of fall-prevention, but little of that has been applied to the treatment of elderly patients, the researchers said.

This study will differ from previous research by making the patients partners, they said.

"The patients have concerns you don't know," said Neil Resnick, head of geriatrics at UPMC and one of the organizers of the study.

Some participants in the study will receive specialized intervention and be assigned a "falls care manager," a registered nurse or nurse practitioner who will tailor care to the patients' needs. But even those who will receive standard care will benefit from participating in the study, Dr. Resnick said.

Already, patients and patient advocates have influenced the study design. They encouraged nurses and doctors to check that participants have followed up on referrals. They also pinpointed occupational therapy as a good tool for those patients with low vision and other sensory impairments.

This study is especially important for Pittsburgh because of the city's large elderly population. According to the American Community Survey, 19.3 percent of Pittsburgh's population is 60 or older.

"If you look at the percentage of those over 75, or over 85, we are also the highest of the high," said Dr. Resnick, who identified Pittsburgh as the city with the second-oldest population in the U.S. He explained that even those elderly Pittsburghers who retire elsewhere often return after age 75 because of Pittsburgh's high quality hospitals.

Dr. Resnick said that 10 years ago, the UPMC's Claude D. Pepper Older Americans Independence Center was chosen as the only institute to receive federal funding specifically for the study of balance and mobility among the elderly. Much of the evidence being used in the current study came out of that project.

They found, for example, that predictors of falling are more complicated than they might seem. A patient may be perfectly capable of walking down a hospital hallway, but when asked to do simple addition or read a poster at the same time, their mobility disintegrates.

They also found that the speed of a person's gait is the single biggest predictor of falling. And it can be tested while patients make their way from the waiting room into the doctor's office.

Trying to integrate this research into the everyday lives of doctors and patients will prove difficult, even within the limited realm of the study, Dr. Resnick said.

"We have spent the last two days arguing over the phone about the next steps," he said. "The study was launched [Wednesday], but the first patient will not be enrolled for over a year."

Eric Boodman: eboodman@post-gazette.com or 412-263-3772. First Published June 4, 2014 2:28 PM

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