STRIDE Intervention Flops for Seniors' Fall Prevention

In a large randomized trial, older adults at increased risk for fall injuries saw no benefit from a multifactorial intervention delivered in primary care to prevent fall injuries.

The STRIDE trial's primary outcome of first serious fall injury occurred at a rate of 4.9 per 100 person-years for people who received the intervention, versus 5.3 per 100 person-years in controls (HR 0.92; 95% CI 0.80-1.06), reported researchers led by Shalender Bhasin, MBBS, of Brigham and Women's Hospital in Boston.

"The rate of all serious fall injuries, irrespective of when they occurred during the trial, also did not differ significantly between the two groups," the investigators noted in their manuscript, published online in the New England Journal of Medicine.

Notably, adjudication for the primary endpoint required at least two independent sources among participant reports, electronic health records, and claims data. Using patient reports only, the intervention did show a a small but statistically significant benefit: first fall injuries occurred at 25.6 per 100 person-years with the intervention and 28.6 per 100 person-years with controls (HR 0.90, 95% CI 0.83-0.99).

Even so, this benefit was much lower than the hypothesized 20% difference from the control of enhanced usual care.

"Despite evidence from efficacy trials that many falls in older adults can be prevented, the quality of care for the prevention of falls remains low, and age-adjusted mortality attributable to falls has continued to rise," Bhasin's group explained as background for the trial.

Their multifactorial intervention, administered by specially trained nurses, included risk assessment and plans to improve quality of care for each person. Intervention and control groups alike received informational pamphlets about falls and were encouraged to discuss fall prevention with their primary care providers, who had access to a webinar on the topic.

There were lower-than-expected rates of serious fall injury in the trial, which may be related to the stringent adjudication criteria and the increased awareness of fall risk among participants and providers in both study arms, Bhasin and colleagues said.

STRIDE was a pragmatic, cluster-randomized trial conducted at 86 primary care practices in 10 U.S. health care systems. Participants were randomly assigned 1:1 to the intervention or the control. Eligible adults were local residents age 70 or older at risk of falling.

Intervention (n=2,802) and control groups (n=2,649) averaged 80 years of age. Women accounted for 62.0% of participants.

Among the limitations of the trial was its generalizability, according to the authors: "Participants were more educated than the general population, and the trial had modest representation of races and ethnic groups other than whites and of persons with substantial cognitive impairment."

What's more, small independent group practices were not included among study sites, they added.

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