Each year, approximately 3 million older adults visit the emergency department (ED) following a fall. Over the subsequent six months, these individuals face a 30% greater risk of returning to the ED due to another fall compared to peers of the same age. Fall prevention has become a critical public health priority, given the high rate of recurrence and serious complications such as hip fractures, prolonged hospitalizations, and reduced quality of life.
The Gap in Current Fall Prevention Strategies
Existing fall prevention efforts typically focus on screening patients and referring them to outpatient services after discharge. While these interventions offer real value, their effectiveness is often limited when patients cannot access the recommended services promptly following their ED visit. Transportation barriers, waitlists, and lack of follow-through contribute to gaps in care that leave many older adults vulnerable to repeat falls.
To address this challenge, the Geriatric Acute and Post-Acute Fall Prevention program — known as GAPcare — was developed to deliver recommended physical therapy (PT) and pharmacy consultations while the patient is still in the emergency department. EDs that have implemented GAPcare have reported high satisfaction rates among both patients and caregivers, along with a remarkable 66% reduction in fall-related ED visits over a six-month period.
Why GAPcare Is Not Universally Available
Despite its proven effectiveness, GAPcare requires in-person visits from both a pharmacist and a physical therapist for each patient. This model demands significant staffing and infrastructure, making it feasible primarily at large, well-resourced institutions. Smaller emergency departments — which serve a substantial portion of the older adult population — have been largely unable to adopt the program.
Introducing e-GAPcare: A Telehealth Solution
A research team from Duke University tackled this implementation barrier head-on, publishing their findings in Frontiers in Public Health. Their proposed solution, e-GAPcare, adapts the original GAPcare model into a telehealth-based framework, reducing the strain on smaller ED resources while preserving the core benefits of the intervention.
How the e-GAPcare Protocol Was Developed and Tested
The research was conducted in two structured phases. In the first phase, the team conducted interviews with ED staff, patients, and caregivers to understand real-world needs and adapt the telehealth model accordingly. The second phase involved a 40-patient, single-arm pilot trial at an emergency department, enrolling older adults who had presented following a fall.
Participants received remote consultations with both pharmacy and physical therapy professionals. These consultations assessed individual fall risk factors and produced a personalized checklist that was shared directly with each patient’s primary care provider to facilitate smooth care transitions.
Key Findings and Outcomes
Researchers followed participants over six months, tracking fall recurrence, healthcare utilization, care transition quality, and uptake of fall prevention recommendations. The findings confirmed that fall recurrence remains elevated largely because patients and caregivers often lack a clear understanding of fall risk and face delays in accessing prevention services.
The study validated GAPcare as an effective ED-based intervention for reducing repeat fall-related visits. Importantly, it also confirmed that the telehealth-adapted e-GAPcare model shows strong potential for smaller institutions, offering comparable benefits with a significantly reduced resource requirement.
What Comes Next for e-GAPcare
Encouraged by the pilot results, the Duke University research team is moving forward with a larger-scale randomized controlled trial of e-GAPcare. This next phase will provide a more rigorous and comprehensive evaluation of the program’s effectiveness across diverse ED settings. Healthcare professionals and administrators working in fall prevention should watch for the results of this expanded trial, as it may pave the way for widespread adoption of telehealth-based fall prevention in emergency departments nationwide.
