EHR-Integrated Home Exercise Program Modestly Reduces Falls in At-Risk Older Adults

Older adults identified as being at risk for falls experienced a modest reduction in medically recorded falls when their primary care clinics adopted a streamlined tool for prescribing home-based strength and balance exercises, according to a clinical trial published October 16 in JAMA Network Open. The program requires roughly 10 minutes per session and no specialized equipment.

The eSTEPS trial enrolled 11,945 adults aged 65 and older who screened positive for fall risk across 22 primary care practices within a single health system. Practices equipped with the prescribing tool recorded a fall rate of 19.3 per 100 patient-years, compared to 21.2 in practices delivering usual care—a 9% relative reduction.

For families concerned about aging relatives, the findings highlight a practical discussion to raise at the next checkup: whether a structured home exercise plan, a physical therapy referral, or a combination of both is appropriate.

Inside the eSTEPS Trial

Researchers from Brigham and Women’s Hospital, Harvard Medical School, the University of Texas Medical Branch, and Mass General Brigham integrated a non-interruptive alert into the electronic health record (EHR). When a patient screened positive on a three-question fall-risk assessment, the clinician received a prompt alongside an order set for tailored exercises; the option to refer to physical therapy remained available.

The exercises were adapted from the Otago Exercise Programme, an evidence-based regimen of leg-strengthening and balance movements. The protocol offered four difficulty levels, defaulting to beginner or seated variations. Patients received support materials including handouts, visit summaries, patient portal messages, a dedicated website, and a mobile application with instructional videos.

The trial ran from June 2023 to May 2025, with 12 to 23 months of follow-up. The average participant age was 77, and approximately two-thirds were women. The study is registered on ClinicalTrials.gov (NCT04993781).

The authors concluded that “falls and fall-related injuries were modestly reduced in older adults in primary care.”

Modest Gains with Important Limitations

Fall-related injuries also decreased, falling to 15.7 per 100 patient-years versus 16.7 in the control group. The injury benefit was most pronounced in patients aged 76 and older. Hospitalizations showed a slight decline in a post-hoc analysis, while mortality rates did not differ between groups.

The researchers calculated a number needed to treat of approximately 29 patients covered for two years to prevent one fall. Safety monitoring revealed no serious adverse events attributable to the intervention. Roughly 78% of clinicians in intervention practices utilized the tool to prescribe exercises at least once. Physical therapy referral rates remained similar across both arms (approximately 56% vs. 57%), indicating the home program supplemented rather than replaced standard therapy.

Several caveats apply. Only about 22% of eligible patients in intervention practices actually received an exercise prescription, and adherence to the exercises was not tracked. Falls were captured via medical record diagnosis codes, potentially missing unreported events. The trial was confined to a single health system, and baseline imbalances existed: intervention practices served more Black patients and patients with lower median incomes. Before adjusting for these differences, only self-reported falls showed a statistically significant reduction.

The study was funded by the National Institute on Aging. One author disclosed equity in health technology companies, and several reported NIH grant support.

Falls Remain a Leading Threat to Independence

Falls are the leading cause of injury-related death among adults 65 and older, accounting for over 43,000 deaths in 2024, per the CDC’s older adult fall prevention data. That same year, falls resulted in approximately 4.5 million emergency department visits.

A fall can precipitate fractures, head trauma, or a loss of confidence that curtails mobility and social engagement. Fear of falling often reduces activity, leading to muscle deconditioning that further elevates risk.

Risk factors include lower-body weakness, balance deficits, certain medications (such as sedatives), vision impairment, foot pain, and home hazards like loose rugs and inadequate lighting. Many of these factors are modifiable. The CDC’s STEADI (Stopping Elderly Accidents, Deaths, and Injuries) initiative provides clinicians with screening tools and intervention frameworks.

Starting a Safe Home Program

Older adults and caregivers should request a fall risk assessment during a primary care visit, particularly after a fall, a near-miss, or new onset unsteadiness. Key questions include whether a home strength and balance program is suitable, which difficulty level to start with, and whether a physical therapy evaluation should precede independent exercise.

Medicare’s Annual Wellness Visit offers a dedicated opportunity to address fall concerns, and Medicare covers physical therapy when medically necessary. Many local Area Agencies on Aging offer low-cost community programs, such as tai chi and balance classes.

Caregivers can assist by scheduling consistent exercise times, supervising standing movements, and ensuring a sturdy chair or counter is within reach. Sessions should start gradually; participants should stop immediately if they experience chest pain, dizziness, or shortness of breath. Individuals with cardiac conditions, recent surgery, or severe joint issues should obtain clinical clearance before beginning.

Environmental modifications are equally critical: remove tripping hazards, install night lights and grab bars, and request a pharmacist review of medications that may cause dizziness. Never discontinue a prescribed medication without medical guidance. Urgent care is warranted for any fall involving a head strike, inability to rise, new confusion, or if the patient takes anticoagulants.

Key Questions Answered

What did the eSTEPS trial find? Primary care practices with the ability to prescribe a home strength and balance program recorded a 9% lower fall rate among at-risk older adults compared to practices providing usual care.

What exercises were used? Brief, equipment-free movements adapted from the Otago Exercise Programme, offered at four levels—including seated options—requiring approximately 10 minutes per session.

How significant was the benefit? Modest. Roughly 29 patients needed to be covered for two years to prevent one fall, and only about 22% of patients in intervention practices received a prescription.

Were the exercises safe? Yes. Safety monitoring identified no serious adverse events linked to the program.

How can families request a program? Ask for a fall risk screening at a primary care visit and inquire about home exercises, physical therapy, or community-based balance classes.

When does a fall require urgent care? Following a head injury, if the person cannot get up, if new confusion develops, or after any fall in an individual taking blood thinners.

Source link