Recruitment strategies for a fall prevention program: if we build it, will they really come?

Background: More than one third of adults over the age of 65 suffer a fall each year, facing morbidity and mortality. Modifiable risk factors for falls have been identified, but specific recruitment strategies for prevention programs have not been evaluated. The purpose of this observational study was to evaluate recruitment strategies for a fall prevention program.

Methods: Participants were recruited during an 11-month period at a Level I trauma center. Participants were eligible if >65 years old, living independently, and had a fall. Recruitment modalities included (1) emergency medical services, (2) emergency department (ED), (3) primary care providers, and (4) media exposure leading to self-referral. Data were collected on baseline rate of fall victims seen in the ED, demographics, medical history, and source of referral.

Results: There were 91 individuals referred, with 61 (67%) enrolled. Enrollment rates were higher among patients referred by self or primary care providers than among those referred by emergency medical services or the ED. There were no significant differences in demographics or medical history among the eligible but not referred ED population, the referred population, and the enrolled population. Reasons for not enrolling included inappropriate referral (33%), no response (17%), other illness (13%), and patients thinking that they do not need the services (37%).

Conclusions: These recruitment strategies were successful in enrolling a representative population of patients at risk for recurrent falls, but could be improved to capture more potential participants. Source of referral has a significant effect on rate of enrollment. We outline challenges and solutions to recruitment.