Data-Driven Secondary Falls Prevention in the Emergency Department: SeFallED and iSeFallED

Background: Older adults presenting to the emergency department (ED) after a fall who are discharged home are at increased risk of subsequent falls and functional decline. Although they represent a substantial proportion of ED visits, this population is highly heterogeneous with respect to health status, preferences, and risk profiles. This heterogeneity complicates the allocation of appropriate secondary prevention strategies, particularly under constraints of limited healthcare resources. Data-driven risk stratification followed by targeted secondary prevention may help optimize care delivery.

Methods: Adults aged ≥60 years presenting to the ED after a fall and not admitted to inpatient care were recruited. In the SeFallED study, participants underwent multidimensional geriatric assessments at 4 weeks, and 6, 12, and 24 months post-ED visit. A generalized linear model assessed the predictive value of 12 variables for functional ability. Building on these findings, the follow-up study iSeFallED applies the risk stratification algorithm in a pragmatic implementation study. Participants receive targeted interventions based on risk level, including six months of exercise training, educational materials, or medication review, and are followed for 12 months with assessments at baseline, 6, and 12 months.

Results: In SeFallED, 335 participants (mean age 75 ± 9 years) were included. Significant predictors of functional decline were age, prior falls, care dependency, concerns about falling, cognitive status, educational level, subjective health status and walking aids. In iSeFallED, 129 participants (mean age 73 ± 8 years) have been recruited to date; 40 were classified as low risk and received educational materials, while 89 were classified as moderate or higher risk and allocated to home-based (n=18), university-based (n=42), or community sports club-based exercise programs.

Conclusions: Preliminary results from iSeFallED demonstrate the feasibility of ED-based risk stratification and assignment to personalized secondary prevention pathways. Together, SeFallED and iSeFallED illustrate a scalable, evidence-based approach to stratified falls prevention in emergency care settings.