Addressing Older Adults Resistance to Engage in Fall Prevention: EMS and PCP Integration as a Solution for Rural Michigan

Research Objectives: Living FREE offers a free community-based fall prevention program targeting post-fall rural older adults from the ER without injuries, focusing on education and physical training. Despite being free, it has limited engagement from those referred. Our primary objective was to evaluate motivation and assess reasons for failure to engage. A secondary objective included assessing the impact of involving primary care physicians (PCPs) and Emergency Medical Services (EMS) staff to improve engagement. We hypothesized that integrating PCPs and EMS who are seen in the community as trusted partners would boost engagement.

Design: Living FREE enrolls post-fall older adults, with no injury reported, and no medical reason for a fall, from ER referrals to assess and mitigate future fall risk through personalized interventions developed after behavioral interviews, home assessments and include lifestyle support and comorbidity management.

Setting: Rural central Michigan, leveraging ER referrals to prevent recurrent falls.

Participants: Post-fall older adults with no injury or medical cause for falls that reported to the ER.

Interventions: To improve engagement, the following two secondary interventions are planned (a) EMS staff will provide an educational pamphlet, short survey, and encouragement to call and (b) at discharge from ER with patient’s consent Living FREE will be sent their PCPs contact so they will be part of the conversation.

Main Outcome Measures: Our primary outcome measures will focus on engagement in this phase. Participants were categorized as: non-engagers, non-responders, actively engaged, and initially ineligible due to medical issues. The reasons for non-engagement will be recorded.

Results: From September 2021 to November 2023, of the 923 referrals, we observed that 32% (296) did not engage, 52% (479) did not respond, 7% (65) actively engaged, and 9% (83) were ineligible due to medical issues. Of those actively engaged, 9 filled out the follow-up survey addressing their progress. Follow-up via phone call yielded one response at 2 months, one at 3 months, and two at 6 months for 4 individual responses post-intervention. Participants reasons for non-engagement were (1) belittling the reason for fall, (2) not understanding that falls are preventable, (3) thinking that in the absence of injury no further intervention is needed. The study is ongoing for the secondary measures to improve engagement.

Conclusions: Our low engagement highlights the need for strategy change. We have implemented community-based partners EMS staff and PCPs to generate trust in the program and decipher causes for engagement resistance. We will report the change in engagement due to this secondary intervention.

Author(s) Disclosures: None.