Barriers and Facilitators to Secondary Falls Prevention After an ED Fall: Findings From the iSeFallED Focus Groups
Abstract
Introduction
Strength and balance training are effective components of falls prevention. However, primary prevention often fails to reach those at highest risk, partly because individuals may not perceive a need to engage in preventive measures. Secondary prevention may overcome this barrier, as a recent severe fall, such as one requiring emergency department (ED) treatment, can heighten the perceived need for action. Nonetheless, implementing falls prevention into standard care poses challenges, such as adoption and adherence. This study aims to explore barriers and facilitators influencing implementation of secondary falls prevention interventions following an ED-treated fall in older people.
Methods
Data collection involves eight focus groups each with five to seven persons participating in the iSeFallED study or their close relatives. The iSeFallED study enrolls adults aged ≥60 years who experienced a fall requiring an ED visit. Participants are classified as having mild or moderate risk for functional decline. Those at moderate risk are referred to a falls clinic and are offered a six-month training intervention, whereas those at mild risk receive an informational brochure on falls prevention and exercises in line with global recommendations. Focus groups are recorded and subsequently transcribed. Data are being analyzed using content analysis following Kuckartz
Results
The first three focus groups (n=16) were conducted in December 2025. Themes such as direct approach, social support within the training and individual training instructions were identified. Additional focus groups are planned until April 2026, providing further insights into the views of participants with lived experience and their relatives.
Discussion
Limiting barriers and enhancing facilitators within interventions may improve attrition and adherence in falls prevention studies. Hence, results from this study can serve to refine falls prevention interventions tailored to the needs of persons who visited the ED due to a fall, facilitating implementation.
Comments
Timing of follow up
Excellent work exploring a key transition point in the falls pathway. It would be interesting to know whether participants express a preference for the timing of follow-up contact after ED discharge, and whether this influenced engagement with prevention services. We sometimes find there is a small window of opportunity; before which, patients may still feel unwell and not up to participating, and after which the motivation to participate can fade.
Timing of follow up
Thank you very much! In our study, participants completed a contact form in the ED and were then given time to consider participation. This period was no longer than six weeks. However, based on our experience, we believe that this window should not be too long, as our experience has been similar to yours. Therefore, we aim to initiate contact within a few days of the fall. Some participants, however, declined participation immediately in the emergency department. For these individuals, a longer decision period might have been beneficial. Overall, I believe that the optimal timing depends on several factors.
Great Work!
Thank you for sharing. This secondar falls preventio approach is so important to break the cycle of falls and readmission. Just wondering whether the participants were ethnically diverse and if there were any nauces between different ethnic group.
Thank you for your comment!…
Thank you for your comment! In this study, we assessed participants’ country of birth. For those not born in Germany, we also assessed the duration of their residence in their country of origin. The majority of participants were born in Germany. However, we did not directly assess ethnic background, and therefore ethnic diversity in our sample can only be interpreted to a limited extent.