Expanding the Reach of a Fall Prevention Intervention for Older Adult Emergency Department Patients through Telehealth: A Trial Protocol

Audrey Keleman^1,2Megan Bounds³William Mundo³Jonathan Gomez Picazo³Meredith Mealer²Sunny Linnebur⁴Bucky Ferozan⁵Julie Dunn⁶Jennifer Stevens-Lapsley^1,2Elizabeth Goldberg^3*

• ¹Geriatric Research, Education, and Clinical Center, VA Eastern Colorado Health Care System, Aurora, United States
• ²Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, United States
• ³Department of Emergency Medicine, University of Colorado Anschutz Medical Campus, Aurora, United States
• ⁴Department of Clinical Pharmacy, University of Colorado Anschutz Medical Campus, Aurora, United States
• ⁵Department of Emergency Medicine, UCHealth Northern Colorado, Fort Collins, United States
• ⁶Trauma Center, UCHealth Medical Center of the Rockies, Loveland, United States

Background: Falls are a leading cause of emergency department (ED) visits among older adults, yet many patients are discharged without a clear understanding of their fall risk factors or access to timely prevention services. The Geriatric Acute and Post-Acute Fall Prevention (GAPcare) intervention has demonstrated efficacy in reducing fall-related ED revisits by addressing these factors during the ED visit. Still, its reliance on in-person specialists limits scalability to smaller and lower-resourced EDs. Methods: This study outlines a protocol for adapting GAPcare into a telehealth-enabled model (e-GAPcare) using a two-phase implementation science approach. Phase 1 engages ED staff, patients, and caregivers in structured workgroups to guide the adaptation of telehealth while preserving core intervention components. Phase 2 involves a single-arm trial at one ED with 40 older adults presenting after a fall, evaluating feasibility and acceptability. The intervention includes remote consultations with a pharmacist and physical therapist, tailored assessments to address individual fall risk factors, and a standardized checklist integrated into discharge planning that is shared with primary care clinicians. Outcomes: Data will be collected through surveys and electronic health records over a 6-month follow-up period. Trial outcomes include usability, care transition quality, healthcare utilization, and uptake of recommendations. Conclusion: By leveraging hospital-based telehealth infrastructure and eliciting end-user perspectives on needed adaptations, e-GAPcare aims to extend the reach of evidence-based fall prevention programs to smaller EDs or those that lack in-person pharmacists and physical therapists.