531 Efficacy of an emergency department initiated falls prevention intervention: A multi-site randomized controlled trial

Objectives/Goals: This study evaluated whether the Geriatric Acute and Post-acute Fall Prevention (GAPcare) intervention reduced fall-related emergency department (ED) visits and hospitalizations within 12 months of the index visit at three EDs and described adherence to pharmacy and physical therapy (PT) recommendations. Methods/Study Population: We enrolled ED patients aged ≥65 years presenting within 7 days of an accidental fall (excluding syncope, assault, or vehicle strike), who were community-dwelling, expected to be discharged, and without fractures preventing PT. We used the six-item screener for cognitive screening. Patients scoring ≤4 assented with proxy consent. Participants were randomized 1:1 to usual care or GAPcare intervention (ED-initiated pharmacy and PT consults). The primary outcome was fall-related ED visits within 12 months. Outcome assessors were blinded. Analyses followed intention-to-treat and adjusted for age, sex, prior falls, comorbidity index, activities of daily living, injury status, site, index ED visit, hospitalization, and assistive device use using negative binomial regression. Results/Anticipated Results: Among 196 patients, 100 received usual care and 96 received the GAPcare intervention. Median age was 78 (IQR 72–84), 68.4% were female, and 83.1% were white. Fall-related ED visits occurred in 30% of both groups (adjusted IRR 0.90, 95% CI 0.53–1.53). Fall-related hospitalizations were significantly lower in the intervention group (11% vs 21%; adjusted IRR 0.45, 95% CI 0.20–0.96), Adherence to pharmacy recommendations was 81%, and PT recommendations was 65%, with frequent medication optimization and assistive device use. Discussion/Significance of Impact: While GAPcare did not reduce fall-related ED visits, it significantly lowered fall-related hospitalizations and showed high adherence to fall prevention recommendations. These findings highlight GAPcare’s feasibility and potential to address fall risk during a critical window.