Abstract
<sec> <title>BACKGROUND</title> <p>Falls are the leading cause of trauma-related hospitalization in older US adults. Conventional personal emergency response systems (PERS) suffer from low wear-time, stigma, and dispatcher-based all-or-none escalation, and rarely include prevention. We evaluated a virtual fall-management program pairing a consumer smartwatch PERS, 24/7 emergency-medical-technician (EMT) triage, and a multifactorial prevention curriculum in older adults at high fall risk.</p> </sec> <sec> <title>OBJECTIVE</title> <p>To evaluate the feasibility, acceptability, and engagement of an integrated digital fall-management program in a vulnerable population of older adults at elevated fall risk, and to explore its association with serious fall events and health care utilization in a matched-cohort quality-improvement evaluation.</p> </sec> <sec> <title>METHODS</title> <p>Propensity-score–matched, hypothesis-generating quality-improvement evaluation. Patients ≥65 at elevated fall risk in Medicare Advantage (MA), enrolled August 2021–June 2022, were matched 1:1 (n = 304 each) to Medicare Shared Savings Program (MSSP) controls. Participants received an Apple Watch with fall detection, a 24/7 EMT triage service, and a multifactorial prevention program. The primary endpoint was time to a first serious fall event (fall-related inpatient [IP] or skilled-nursing-facility/long-term-care [SNF/LTC] admission). Feasibility, engagement, and acceptability were assessed within the enrolled cohort (n = 396).</p> </sec> <sec> <title>RESULTS</title> <p>The program was delivered, sustained, and highly accepted: home-safety task completion was 83.8%, 58.6% participated in medication review, and the Net Promoter Score was 86 (95% survey response among completers). Over mean follow-up of 11.7 months, serious fall events fell ≈55% (20 vs 44), with time to first event prolonged (Cox HR 0.47; 95% CI, 0.24–0.90; P = .024). All-cause IP admissions fell 35% (IRR 0.65; P = .003); fall-related and all-cause SNF/LTC were reduced (IRR 0.31, P = .014; IRR 0.45, P = .003). As designed, fall-related ED visits rose (IRR 1.53; P = .07).</p> </sec> <sec> <title>CONCLUSIONS</title> <p>An integrated digital fall-management program was feasible, sustained, and highly acceptable in a vulnerable, older population that current models leave unmanaged. Exploratory comparisons with a traditional-Medicare cohort suggested fewer serious falls, hospitalizations, and post-acute placements; because the arms reflect different Medicare products and opt-in enrollment, these associations are hypothesis-generating and motivate a randomized trial.</p> </sec>