“It often starts with a fall”

“My approach relies heavily on qualitative methods. Once a strategy is identified, you have to examine the existing culture – the people involved, their values and policies, communication practices, work flow, and technologies used. If you think about it, interventions may be theoretically brilliant and technologically perfect, but unless the providers perceive it as valuable and use it, your intervention will fail.” – Ann E Vandenberg, PhD,  MPH, assistant professor, Division of General Medicine and Geriatrics, Department of Medicine 

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As a gerontologist working in the area of implementation research, Ann Vandenberg, PhD, MPH prides herself on identifying problems and working towards solutions to improve care for older adults. Many of Dr. Vandenberg’s projects directly or indirectly address one cross-cutting problem in the older population: falling.

Dr. Vandenberg’s recent research includes Bed Exit, a pre-implementation study assessing the use of fall prevention technology with fall risk patients in Dutch and U.S. nursing homes. The study found that a commonly installed technology to prevent falls, position monitors, can potentially agitate residents who are at risk of falling, putting them at further risk of falling. She’s also involved in the implementation and dissemination of the ongoing Enhancing Quality of Prescribing Practices for Older Adults in the Emergency Department (EQUiPPED) program, which uses education and computer decision tools to encourage providers to avoid prescribing potentially inappropriate medications for older adults discharged from the Emergency Department. This project also can help decrease the risk of adverse drug events such as falls. Dr. Vandenberg’s pre-implementation work as part of the Instant Functional Outcomes Report for Meaningful Encounters in Dialysis (INFORMED) team developing a functional assessment report to facilitate communication between providers and patients in the dialysis clinic suggested that asking about falls can elicit rich and useful detail providers could use to help patients. The fall section of the report “provoked narrative descriptions with lots of detail about their home, their social support, the activities they were doing when they fell. It’s a rich way of getting data and capturing the context in which these patients were living, instead of just a lab result. Knowing the story of the fall suggests ways to provide support in the home, bolster social support, and maybe add physical therapy to improve balance and strength.”

Dr. Vandenberg’s participation in the  End-of-Life in Assisted Living: Links between Structure, Process, and Outcomes (R01 AG04740803) project involves fieldwork and interviews with assisted living residents, family caregivers, staff, and administrators to gain multiple perspectives on quality of end of life in the assisted living setting. Here too falls are a part of the resident context. “We often find that the story of how someone comes to assisted living or a nursing home is a fall – that’s the beginning. It shrinks your world, you don’t want to leave your house, you don’t get as much exercise, which makes you more unsteady on your feet and more likely to fall again,” says Dr. Vandenberg. A common story, she says, is an older woman who will experience the loss of her husband, manage for a few years in the home where she is living, and then experience a fall that points to underlying vulnerability or frailty. Dr. Vandenberg is now pursuing an interest in implementing discussions of frailty in shared decision making in geriatric care.