Telehealth Model Could Reduce Repeat ED Visits Due to Falls in Older Adults

Each year, 3 million older adults visit the emergency department (ED) after a fall. Over the next 6 months, those adults are at 30% greater risk of returning to the ED due to falling again compared to other adults of the same age.¹

Fall prevention is a major concern due to high recurrence and burdensome complications such as hip fractures.¹ Current interventions include screening and referrals to outpatient services, which are beneficial but may not be as effective as intended if patients cannot access these services soon after discharge. To remedy this issue, the Geriatric Acute and Post-Acute Fall Prevention (GAPcare) service provides recommended outpatient physical therapy (PT) and pharmacy resources while the patient is still in the ED.²

EDs that implement GAPcare have had high patient and caregiver satisfaction rates and reduced the number of 6-month fall-related ED visits by 66%. However, this service involves visits by a pharmacist and physical therapist, limiting implementation to large EDs with the manpower to allow individual visits for each patient by both departments.

A team of researchers from Duke University addressed the implementation of GAPcare into smaller EDs and published their findings in Frontiers in Public Health. They propose implementing GAPcare as a telehealth-based model (e-GAPcare), alleviating the strain on resources for small EDs.²

Researchers created and tested their protocol in 2 parts. The first included interviewing ED staff, patients, and caregivers to adapt the concept for real-world use. Then, they tested their program in a 40-patient single-arm trial at an ED, which included older adults presenting after a fall. These patients received remote consultations with pharmacy and PT to assess factors contributing to fall risk and complete a checklist shared with each patient’s primary care provider.

Researchers followed up with participants for 6 months to evaluate usability, care transition quality, health care utilization, and uptake of recommendations.

The findings highlighted that fall recurrence rates are high due to a lack of patient and caregiver understanding of fall risk and quick access to fall prevention services. The researchers confirmed that GAPcare is an effective ED intervention to reduce recurrent ED visits due to falls, but they added that so far it is limited to large institutions with in-person PT and pharmacy services. It may be effective for smaller EDs to leverage telehealth to implement e-GAPcare with reduced strain on resources as compared to traditional GAPcare.

The researchers plan to use their successes and improvements made with the protocol from the initial study to move forward with a randomized control trial of e-GAPcare on a larger scale. Look out for the results of a larger e-GAPcare randomized controlled trial in the future for an in-depth evaluation.

REFERENCES

1. Older adult fall prevention: facts about falls. CDC. May 9, 2024. Accessed January 5, 2026. https://www.cdc.gov/falls/data-research/facts-stats/index.html

2. Keleman A, Bounds M, Mundo W, et al. Expanding the reach of a fall prevention intervention for older adult emergency department patients through telehealth: a trial protocol. Front Public Health. 2025;13:1720938. doi:10.3389/fpubh.2025.1720938