Researchers in Thailand tested a new program called FREED designed to help prevent falls in older adults who visited the emergency room after falling. The program included checking medications, adding vitamin D, physical therapy, and checking homes for hazards. While 216 seniors participated in the study, the program didn’t significantly reduce repeat falls over six months compared to regular care. However, the program was safe and well-liked by patients, suggesting that preventing falls in emergency departments is more complicated than expected and may need different approaches.

The Quick Take

  • What they studied: Whether a special fall-prevention program in the emergency room could stop older adults from falling again within six months
  • Who participated: 216 people aged 60 and older from Bangkok, Thailand who had fallen within the previous week. The average age was 75 years old.
  • Key finding: About 20% of people in the new program had another fall within six months, compared to 25% in regular care—a small difference that wasn’t large enough to prove the program actually works
  • What it means for you: If you’re an older adult who has fallen, this program may be worth trying since it’s safe and helpful, but don’t expect it to completely prevent future falls. Talk to your doctor about combining this with other fall-prevention strategies.

The Research Details

This was a randomized controlled trial, which is considered one of the best ways to test if a treatment works. Researchers randomly assigned 216 older adults who had recently fallen into two groups: one received the FREED intervention, and the other received usual emergency room care. The FREED program included five main parts: checking which medicines they took, reviewing those medicines for safety, giving vitamin D supplements, referring them to physical therapy, and assessing their home for fall hazards. Researchers followed both groups for six months to see who fell again.

The study was conducted in an emergency department in Bangkok, Thailand. Researchers carefully tracked 97% of participants through the entire six-month period, which is excellent follow-up. They analyzed the results two ways: once counting everyone who started the study, and once counting only those who completed the program as planned.

This research approach is important because it helps determine whether a program actually prevents falls or if improvements happen by chance. By randomly assigning people to groups and following them for six months, researchers can see real-world results. Testing this in an emergency department is valuable because that’s where many older adults first seek help after falling.

This study has several strengths: it was randomized (reducing bias), had excellent follow-up rates (97%), and was published in a peer-reviewed journal. However, it was conducted in only one location in Thailand, which may limit how well results apply to other countries or populations. The sample size of 216 was reasonable but not huge, which might have made it harder to detect smaller differences between groups.

What the Results Show

The main finding was that the FREED intervention did not significantly reduce repeat falls. In the intervention group, 20.4% of people fell again within six months, compared to 25.0% in the usual care group. While this looks like a 4.6% improvement, the difference was small enough that it could have happened by chance. Statistically, this means researchers cannot confidently say the program prevents falls.

Both groups showed very slight decreases in their ability to do daily activities (like bathing, dressing, and eating), but there was no meaningful difference between the groups. This suggests that aging and recovery from falls affected both groups similarly.

The good news is that the FREED program was feasible and acceptable to patients. People in the program completed it, attended appointments, and reported satisfaction with the care they received. This means the program is practical and patients are willing to participate.

The study found that the program was well-tolerated with no reported safety concerns. Patients appreciated the comprehensive approach of checking their medications, getting vitamin D, and having their homes assessed. The high follow-up rate (97%) shows that older adults were engaged and willing to participate in the study, suggesting they valued the intervention even if it didn’t prevent all falls.

Previous research has shown that fall-prevention programs work better in community settings and rehabilitation centers than in emergency departments. This study adds to that evidence, suggesting that the emergency department may not be the ideal place to start fall prevention, possibly because patients are stressed, injured, and may not be ready to make changes immediately after a fall. Other studies have found that successful fall prevention often requires longer-term follow-up and multiple interventions working together.

The study was conducted in only one emergency department in Thailand, so results may not apply to other countries or healthcare systems. The six-month follow-up period might not be long enough to see the full benefits of the program. Additionally, the study didn’t track whether people actually followed through with recommendations like physical therapy or home modifications after leaving the emergency room. The program included several components, so it’s unclear which parts (if any) were most helpful. Finally, the study may not have had enough participants to detect smaller but still meaningful differences in fall rates.

The Bottom Line

If you’re an older adult who has fallen, ask your doctor about comprehensive fall-prevention approaches that include medication review, vitamin D supplementation, physical therapy, and home safety checks. However, understand that no single program can eliminate all fall risk. Combine this with other strategies like balance exercises, proper footwear, and removing home hazards. The confidence level for this recommendation is moderate—the program is safe and helpful, but may not be a complete solution on its own.

Older adults (60+) who have recently fallen should care about this research. Healthcare providers in emergency departments should also pay attention, as it suggests they may need different or additional strategies for fall prevention. Family members of older adults should recognize that fall prevention requires ongoing effort beyond a single intervention. People with limited mobility, vision problems, or balance issues should be especially attentive to fall prevention.

If you participate in a fall-prevention program like FREED, you should expect to see benefits over several months, not immediately. The study tracked people for six months, which is a reasonable timeframe. However, some benefits like improved strength from physical therapy may take 8-12 weeks to become noticeable. Be patient and consistent with recommendations.

Want to Apply This Research?

  • Track falls weekly using a simple yes/no log, noting the date, time, location, and what you were doing when each fall occurred. Also track completion of recommended activities like physical therapy sessions and home modifications.
  • Set reminders to take vitamin D supplements daily, schedule and attend physical therapy appointments, and complete one home safety modification per week (like removing tripping hazards or improving lighting).
  • Create a monthly check-in where you review your fall log, assess your confidence in balance and mobility, and track which fall-prevention activities you’ve completed. Share this with your healthcare provider every three months to adjust your plan as needed.

This research describes a clinical trial and should not be considered personal medical advice. The study found that the FREED intervention did not significantly reduce falls compared to usual care. If you have recently fallen or are concerned about fall risk, consult with your healthcare provider to develop a personalized fall-prevention plan. This may include medication review, physical therapy, home modifications, and other interventions tailored to your specific needs and health conditions. Always seek professional medical guidance before starting new supplements, exercises, or health programs.