Virtual fall program assessment for frail Canadian community-dwelling older adults: Examining equitable accessibility

ObjectiveIn response to COVID-19, the fall prevention program (FPP) at Sunnybrook Health Sciences Centre was modified to be delivered virtually. We compared patient populations assessed for the FPP virtually versus in-person to explore equitable accessibility. MethodsA retrospective chart review was performed. All patients assessed virtually from the beginning of the COVID-19 pandemic until the end of abstraction (April 25, 2022) were compared to a historic sample of patients assessed in-person beginning in January 2019. Demographics, measures of frailty, co-morbidity, and cognition were abstracted. Wilcoxon Rank Sum tests and Fisher's Exact tests were used for continuous and categorical variables, respectively. ResultsThirty patients were assessed virtually and compared to 30 in-person historic controls. Median age was 80 years (interquartile range 75-85), 82% were female, 70% were university educated, the median Clinical Frailty Score was 5 out of 9, and 87% used >5 medications. Once normalized, frailty scores showed no difference (p = 0.446). The virtual cohort showed significantly higher outdoor walking aid use (p = 0.015), reduced accuracy with clock drawing (p = 0.020), and nonsignificant trends toward using >10 medications, requiring assistance with >3 instrumental activities of daily living (IADLs), and higher treatment attendance. No significant differences were seen for time-to-treat (p = 0.423). ConclusionPatients assessed virtually were similarly frail as the in-person controls but had increased use of walking aids, medications, IADL assistance, and cognitive impairment. In a Canadian context, frail and high socioeconomic status older adults continued to access treatment through virtual FPP assessments during the COVID-19 pandemic highlighting both the benefits of virtual care and potential inequity.

Automated summary

To address the COVID-19 pandemic, the Sunnybrook Health Sciences Centre modified its fall prevention program (FPP) to be delivered virtually. This study compared patients assessed virtually with those assessed in-person to examine equitable accessibility. A retrospective chart review compared virtual patients assessed during the pandemic with historic in-person patients. The study found that virtual patients were similarly frail as in-person controls, but had increased use of walking aids, medications, assistance with instrumental activities of daily living (IADLs), and cognitive impairment.