Front-loading of assessment and interventions by a multidisciplinary team for patients admitted to the Geriatric Faller Protocol (GFP) results in fewer short-term adverse outcomes and hospital admissions, according to a Singapore study.
“[F]ront-loading multidisciplinary assessments under GFP enabled timely care planning and addressed medical, functional and social needs, reducing treatment delays and supporting appropriate decisions such as outpatient referrals and rehabilitation,” said the researchers, who retrospectively reviewed the clinical records of patients under GFP for 6 months.
The collected data of patients were categorized as follows: (a) sociodemographics and clinical profile, (b) medication profile, (c) injury profile, (d) non-pharmaceutical interventions, (e) pharmaceutical interventions, and (f) intervention outcome measures.
One hundred fifteen patients were admitted to GFP, of whom 101 were included in the final analysis (median age 81 years, 70.3 percent female). Of the participants, 79.2 percent had a Clinical Frailty Scale of between 4 and 7. [Singapore Med J 2026;67:224-231]
Nearly three in five patients (67.3 percent) avoided acute hospital admission, while five reattended the Department of Emergency Medicine within 30 days, of which two were related to falls. Notably, falls were the main reason for emergency presentation (94.1 percent), with more than half resulting in head or facial injuries.
“The findings align with those of the local Emergency Department Interventions for Frailty study, which demonstrated that early geriatric assessment in emergency department can reduce admissions without increasing adverse outcomes,” the researchers said. [J Am Med Dir Assoc 2021;22:923-928.e5]
“It also underscores the importance of interdisciplinary collaboration in fall prevention programmes, consistent with previous research,” they added. [BMJ 2008;336:130-133]
Another study suggested the inclusion of a “fall nurse specialist” to promote adherence to fall prevention guidelines. [BMC Health Serv Res 2008;8:105]
Similarly, pharmacists can help in preventing falls by providing medication reviews and therapy optimization. Previous studies have shown that pharmacist interventions improved health outcomes in geriatric patients. [Ther Clin Risk Manag 2014;10:437-448; Integr Pharm Res Pract 2015;4:101-111]
Polypharmacy
Furthermore, 75 percent of patients in the current study had polypharmacy (median number of medications, 9), and more than half (57.4 percent) self-managed their medications.
This finding is consistent with that of earlier studies, which found that older patients are prone to polypharmacy and its complications, such as increased fall risk and functional decline. [BMJ 2024;385:e074892; Clin Pharmacol Ther 2009;85:86-88]
In addition, suboptimal medication regimens accompanied by inappropriate medication use, polypharmacy, or under-prescribing also put patients at increased risk of harm. [Ther Adv Drug Saf 2022;13:204209]
“In this study, anticholinergic agents were the most frequent contributors to drug-related problems, posing concerns due to the heightened anticholinergic burden in older adults,” the researchers said. [J Am Med Dir Assoc 2021;22:56-64]
“These medications can cause peripheral effects such as dry eyes, dry mouth, constipation, and urinary retention, as well as central effects such as drowsiness and impaired concentration, all of which increase fall risk,” they added.
GFP is a multidisciplinary team consisting of geriatricians, emergency physicians, geriatric-trained emergency nurses, pharmacists, physiotherapists, occupational therapists, and medical social workers, according to the researchers.
“This team delivers frailty-centred care through comprehensive assessment of geriatric syndromes, functional status, multimorbidity, psychosocial needs, and polypharmacy,” they said.