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Contact the study team using the details below to take part. If there are no contact details below please ask your doctor in the first instance.

Contact Information:

Prof Pip Logan
+44 115 8230235
pip.logan@nottingham.ac.uk


Mrs Gail Arnold
+44 115 8230239
gail.arnold@nottingham.ac.uk


Study Location:

Nottingham Healthcare NHS Trust
The Resource Trust HQ Duncan Macmillan House
Nottingham
NG3 6AA


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Finch: Falls in care homes study

Not Recruiting

Open to: All Genders

Age: Senior

Medical Conditions

Falls prevention in care home residents


This information is provided directly by researchers and we recognise that it isn't always easy to understand. We are working with researchers to improve the accessibility of this information.




Background and study aims
Falls are one of the leading causes of death and injury in people over the age of 65. Studies have shown that care home residents fall five times more often than elderly frail people living in their own homes. Of those residents who fall nearly 1 in 10 suffer a broken bone, 1 in 5 is admitted to hospital and 1 in 5 will die within the year as a result of this injury. These people suffer pain, immobility and fear of further falls with high personal and financial costs. Currently hip fractures cost £1.4 billion per annum and the number of fractures is set to double by 2050 and so it is vital to find a way to reduce the high level of falls in care homes. The physical environment and the decline in residents’ memories have prevented this from being achieved through the traditional falls prevention programmes. The Guide to Action Care Home (GtACH) falls prevention is a unique process which involves falls prevention experts, usually employed by the NHS, training care home staff in small groups to systematically assess residents fall risk and then provide actions to reduce falls risks. Previous studies have shown that care homes are keen to take part in studies looking at GtACH, staff are willing to attend GtACH training, GtACH processes can be implemented with residents and fall rates can be reliably established from care home records. However, it is still not known whether the GtACH process can reduce falls rates in care home residents and what the casts would be for the NHS. The aim of this study is to compare the number of falls in care homes where staff are trained to use the GtACH process with homes that are providing usual care.

Who can participate?
Long-term care residents of care homes which are registered to look after the elderly and those with dementia.

What does the study involve?
If a care home resident decides they would like to take part in the research a researcher makes arrangements to visit the care home and explain the study and make sure the resident understands what is involved. The resident is given an information sheet to keep and is asked to sign a consent form. The consent allows the researcher to:
1. Collect information from the care home records about their current health, any previous falls they may have had and how they manage each day.
2. Notify the residents GP (or other health care practitioner) of their participation in the FinCH study and to allow clarification of medication data from GP records where necessary.
3. Observe care home staff assessing residents for the new treatment and delivering actions arising from the assessment. The assessment may be repeated every 3 months, or more often if a participant has a fall.
Once all data from everyone who wishes to participate in the care home has been collected, the participating care homes are randomly allocated to receive either the new treatment or usual care. If the care home is allocated to receive the new treatment, care home staff are trained to carry out a personal assessment and suggest changes that may prevent residents having falls in the future. At 3, 6, 9 and 12 months after the care home has been allocated to the new treatment or care as usual, the researcher visits each participant to complete some questionnaires and collect information from the care home records about the participants current health, any falls they have had in the previous three months and how they manage each day.

What are the possible benefits and risks of participating?
There are no direct benefits or risks to participants taking part in this study.

Where is the study run from?
Sixty six care homes across Nottingham City, Nottinghamshire County, Sheffield, Leicester, Derby and Norwich (UK)

When is the study starting and how long is it expected to run for?
January 2014 to September 2020

Who is funding the study?
National Institute for Health Research (UK)

Training care home staff to deliver the Guide to Action to reduce falls which is an evidence based falls prevention intervention will reduce the rate of falls in care home residents and be cost effective.


Multi-centre single blinded cluster randomised controlled trial

Start dates may differ between countries and research sites. The research team are responsible for keeping the information up-to-date.  

The recruitment start and end dates are as follows:

01 Nov 2016

31 Oct 2017

Publications

2021 Results article in https://pubmed.ncbi.nlm.nih.gov/34876412/ (added 20/12/2021)

Interventional

Intervention Type : Other
Intervention Description : Care homes will be randomised on a 1:1 basis to one either: intervention (which will be GtACH fall prevention programme) or control (which will be usual care). Randomisation of homes to allocation will occur after all participants have given consent and all baseline data have been collected. The research assistant who gathered the baseline information will confirm to the site Falls Lead (not individual care home falls champion) that the care home is ready to be randomised. The Falls Lead will use a remote, internet-based randomisation system to obtain the allocation for each home, and will inform the Falls Champion within the care home of the allocated intervention arm. This is to maintain the blinding of the research assistants to home allocation: the site Falls Lead will necessarily be unblinded.

Intervention arm: The intervention is the Guide to Action Care Home (GtACH) process delivered to care home residents by care home staff who have been trained and are supported. GtACH is a systematic falls risk assessment and action process, co-designed by care home and NHS staff, based on NICE clinical guidelines. The intervention involves care home staff completing the GtACH Tool with residents in a private area of the care home. The results will be discussed with family, friends and other care home staff. Completed GtACH documentation will be placed in the residents care records and updated when necessary according to the re-assessment schedule outlined below. The actions might require changes within the care home, changes to residents’ personal care, referral to other services, or purchase of equipment. The actions will be written in the GtACH documentation. The assessment takes 15 minutes and actions take up to 2 hours per resident. The GtACH will be completed within 4 weeks of randomisation for all trial participants in the care home. Actions will be started immediately after the identification of risk. As part of GtACH training, re-assessment is undertaken if the participant develops a new medical or cognitive condition, if they fall, or every 3-6 months if there are no other changes.

Control arm: Participants receive usual care, where usual care is defined as the absence of a systematic and coordinated falls prevention process.

The study duration will be 36 months. Care Home participation will be for a duration of 13 months per care home (1 month prior to randomisation and 12 months post randomisation), Resident/Consultee participant will be for a duration of 13 months per resident/consultee (1 month prior to randomisation and 12 month from date of randomisation of care home). The Process evaluation duration (resident/consultee/staff) will be 4-6 months immediately post-randomisation (limited to 6 care homes randomised to GtACH intervention).


You can take part if:


Care Home inclusion criteria: 1. Long stay with old age and/or dementia registration2. 10 or more potentially eligible residents3. Routinely record falls in resident personal records and on incident sheets4. Consent of care home manager to comply with the protocol and identify a care home fall champion

Resident inclusion criteria:All long term care home residents.

Staff Inclusion Criteria (Process Evaluation Only)1. Employed by a Care Home participating in FINCH and selected for participation in the Process Evaluation2. Employed in a caring role




You may not be able to take part if:

Care Home exclusion criteria:1. Participated in GtACH pilot/feasibility studies2. Homes exclusively providing care for those with learning difficulties or substance dependency3. Homes with contracts under suspension with health or social providers, or that are currently subject to safeguarding investigations or homes under CQC special measures4. Homes with a significant proportion of beds taken up by health-service commissioned intermediate-care services 5. Trained and routinely using a systematic falls prevention programme

Resident exclusion criteria1. Residents on short-term care (e.g. respite), 2. Residents identified to be in the last few days of life

Staff Exclusion Criteria (Process Evaluation Only)3. Have a significant proportion of time caring for residents in health-service commissioned intermediate-care services funded beds


Below are the locations for where you can take part in the trial. Please note that not all sites may be open.

  • Nottingham Healthcare NHS Trust
    The Resource Trust HQ Duncan Macmillan House
    Nottingham
    NG3 6AA
  • Nottinghamshire City PCT
    1 Standard Court Park Row
    Nottingham
    NG1 6GN
  • Norfolk Community Health and Care NHS Trust
    Elliot House 130 Ber Street
    Norwich
    NR1 3FR
  • Derby Hospitals NHS Foundation Trust
    Derby City General Hospital Uttoxeter Road
    Derby
    DE22 3NE
  • Derbyshire Community Health Serves NHS Trust
    Newholme Hospital Baslow Road
    Bakewell
    DE45 1AD
  • Airedire NHS Foundation Trust
    Airedale General Hospital Skipton Road
    Steeton
    BD20 6TD
  • Leicester City PCT
    St. Johns House 30 East Street
    Leicester
    LE1 6NB
  • Leicestershire County and Rutland PCT
    Lakeside House 4 Smith Way Grove Park Enderby
    Leicester
    LE19 1SS


The study is sponsored by University if Nottingham and funded by National Institute for Health Research .



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for Trial ID: ISRCTN34353836

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