A multi-centre cluster randomised controlled trial to evaluate the Guide to Action Care Home fall prevention programme in care homes for older people.(FinCH)
Recipient organisationUniversity of NottinghamSource-published name: The University of Nottingham
Funding£1.8M
PeriodMay 2016 — Aug 2020
In plain English
AI plain-English summary
Care home staff will use a 15-minute checklist to assess each resident’s fall risk and then carry out tailored actions—such as adjusting medication or removing trip hazards—taking up to two hours per person. Falls are the leading cause of injury and hospital admission among older care home residents, yet most homes lack a structured, evidence-based prevention programme. The Guide to Action Care Home (GtACH) process was co-designed with care home and NHS staff to fill this gap, translating NICE guidelines into a practical tool that frontline workers can use without specialist training. If the trial shows GtACH reduces fall rates by at least 33%—the target the study is powered to detect—care homes across the UK could adopt a low-cost, systematic approach to preventing falls. This would mean fewer hip fractures, fewer emergency hospital admissions, and less disruption to residents’ quality of life. The concurrent economic analysis will tell the NHS and social care commissioners whether the programme is cost-effective compared with usual practice. The process evaluation will reveal what helps or hinders implementation, so other homes can replicate it successfully.
View original technical description
Design: Multicentre cluster randomised controlled trial Setting: UK care homes Target population 1. Residents of old age care homes who are not terminally ill or receiving short term respite care. 2. Care homes with robust falls recording, willing to implement the GtACH process and who are not already using a structured falls risk assessment and risk reduction programme. Health technology The intervention is the Guide to Action Care Home (GtACH) systematic process delivered to care home residents by care home staff who have been trained i and are supported. GtACH is a systematic falls risk assessment and action process, co designed by care home and NHS staff, based on NICE clinical guidelines. The assessment takes 15 minutes and actions take up to two hours per resident. The control conditions reflect usual practice. Usual practice requires care home staff to be trained sufficiently to meet legal requirements and to write care plans for each resident but this does not include systematic routine training in fall prevention or the routine use of a systematic falls assessment tool or a falls prevention decision support tool. Residents in both groups will be eligible for usual medical and community services. Measurement of costs and outcome Data will be collected from care home records as this was found reliable in a feasibility study, NHS data, residents and care home staff acting as proxy. Researchers collecting and analysing data will be blinded to treatment allocation. Times are from randomisation. Primary • Rate of falls between three and six months Secondary • Rate of falls at 9 and 12 months At 6 and 12 month - • Fall injuries • Days in hospital • Death • Health and Social service use • Physical activity (PAM-RC) • Functional ability (Barthel Index) • Quality of life (DEMQOL-U-5D, DEMQOL-P-4D), • Health (EQ-5D-5L and EQ-5D-5L proxy) • Medication use Economic study: Within trial cost-effectiveness and utility analyses from NHS and personal social service perspective. The choice to use several health measures reflects the fact that the utility value sets, DEMQOL-U and DEMQOL-P-U, have not been widely used or validated but EQ-5D-5L has successfully been used in care homes. Concurrent process evaluation: To explore implementation of the GtACH process 12 staff focus groups and 30 stakeholder interviews, observations and documentary analysis will be completed. Thematic analysis approaches, constant comparison, progressive focusing of field observations, and memo-writing will be used to construct categories and sub-categories. Sample size: 1308 residents from 66 CHs are required to detect a 33% falls rate reduction in the intervention group. This assumes a falls rate of 2.5 falls per year per resident in the control group, 1:1 allocation, 80% power, a two-sided significance level of 5%, an average cluster size of 20 residents, an intra-cluster coefficient of 0.1 and 16% attrition. 6 sites will each recruit 11 CHs. Randomisation: Variable block randomisation at care home level by Norwich Clinical Trials Unit using a web-based randomisation service. Timetable: 3 years: 6 months set-up; 12 months recruitment; 12 months follow up; 6 months analysis, write-up and dissemination. Team expertise: Falls prevention, care home research and management, multicentre clinical trials, health economics, medical statistics, implementation science, concurrent process analysis
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