Integrated Falls and Hip Fractures Prevention in Thai Older Adults (Thai-IFHP), The Falls Surveillance System to Prevent Hip Fractures and Hip Fracture Care to Prevent Re-fracture : A Study Protocol of a Pragmatic Clinical Trial
Year: 2026
Type: preprint
Study design: Study Protocol
Abstract: Background: Falls and fall-related hip fractures are major causes of morbidity, mortality, and loss of independence among older adults, particularly in low- and middle-income countries. In Thailand, prevention and post–hip fracture care remains fragmented across levels of care. Despite evidence supporting multifactorial interventions, scalable, system-integrated models adapted to Southeast Asian settings are limited. This study aims to develop and evaluate an integrated system for fall and hip fracture prevention among Thai older adults. Methods: We will conduct a 12-month pragmatic cluster trial with an embedded cost-effectiveness evaluation across 538 health-promoting hospitals and primary care units in 12 provinces in Thailand, allocated 1:1 to intervention or control clusters. Participants include community-dwelling adults aged ≥70 years, stratified by fall risk, and patients with hip fractures. The program uses an integrated digital platform (“App Paotang”), serving as a digital wallet for government subsidy projects and several other national-level projects, to support data collection and care coordination. Participants in both groups receive fall-risk screening, health education, and home visits, but with different intensities. The intervention group receives community-based exercise (≥1 session/month) and risk-stratified home visits, while the control group receives advice for home-based exercise and uniform home visits every three months. Patients with hip fractures in both groups receive standardized integrated multidisciplinary care from hospitals to communities. Primary outcomes are ≥1 fall and incidence of fall-related hip fractures over 12 months. Secondary outcomes include 30-day mortality and readmission, 1-year recurrent fractures and mortality, health-related quality of life (EQ-5D-5L), timeliness of home visits, and osteoporosis treatment uptake. Analyses will use cluster-adjusted generalized estimating equations and mixed-effects models, with cost-effectiveness evaluated from a societal perspective. Trial registration: The study is registered with the Thai Clinical Trials Registry (TCTR20250905013), registered on 5 September 2025. https://www.thaiclinicaltrials.org/#. Discussion: The Thai-IFHP study evaluates a scalable, digitally enabled model integrating fall and hip fracture prevention across different care levels in multi-province nation-wide. Findings will inform policy and support the development of value-based, integrated care for older adults in Thailand and similar resource-constrained settings.
Source: Research Square
Institutions: Nan Hospital, Mahidol University, Bhumibol Adulyadej Hospital
Language: English
Field: Health Professions
Domain: Health Sciences
Open Access status: green
Funder: Thai Health Promotion Foundation
OpenAlex ID: W7125970577