Falls are a persistent and serious challenge in many care settings, with implications ranging from reduced quality of life for residents to increased financial strain on healthcare systems. The Decaf Project, spearheaded by Care England, Stow Healthcare, and the University Hospitals of Leicester (UHL) NHS Trust, aims to tackle this issue innovatively. By making decaffeinated beverages the default choice in care homes, this initiative has demonstrated promising results in reducing falls related to toilet trips. Here’s a closer look at this project.

How it began

The project builds on the 2021 “Taste the Difference Challenge” conducted at UHL. The initiative, which encouraged inpatients to switch to decaffeinated drinks, led to a 30% reduction in falls related to toilet trips. The diuretic effects of caffeine—causing increased urinary urgency—were identified as a contributor to these falls. Inspired by these findings, Care England collaborated with Stow Healthcare to test the approach in a care home environment, where residents are particularly vulnerable due to limited mobility and higher rates of incontinence.

Project pioneers

The Decaf Project was implemented across eight care homes operated by Stow Healthcare, encompassing around 350 residents. Starting in June 2023, the trial lasted six months. Residents were encouraged to drink decaffeinated tea and coffee as the default, although caffeinated drinks remained available upon request. A robust data collection framework tracked falls, categorising those related to toilet trips as a separate data set. Pre-trial data (February to May 2023) provided a baseline for comparison.

To ensure informed consent, Stow Healthcare engaged residents, families, and staff through meetings, easy-read materials, and taste-testing activities. These efforts resulted in a high level of participation, with 89% of residents opting into the trial initially, with a further 4% joining along the way, to conclude with an overall participart on 92%.

Did it work?

The trial produced significant findings:

• Reduction in falls: Toilet trip-related falls dropped by 34.72%, while the proportion of total falls declined by 29.21%. This improvement mirrored the hospital-based results of the initial “Taste the Difference Challenge” despite differences in population health dynamics and living environments.
• Resident feedback: Participants largely reported no significant difference in taste between caffeinated and decaffeinated drinks. For some, health benefits were immediately noticeable. One resident shared, “I sleep right through until about 5 a.m. now and am less tired during the day.”
• Staff engagement: Staff also embraced decaf options, noting personal benefits such as improved sleep and concentration.

What could this mean for the future?

The Decaf Project’s results highlight the potential for simple dietary changes to deliver meaningful health benefits in care settings. Reducing falls not only enhances resident safety and wellbeing but also alleviates the burden on healthcare systems. Fragility fractures, often resulting from falls, cost the NHS an estimated £4.4 billion annually.

The findings also underscore the importance of nuanced fall prevention strategies. Toileting-related falls are particularly common in care homes, given the prevalence of incontinence and the challenges residents face in navigating bathrooms safely. By mitigating the urgency caused by caffeine’s diuretic effect, decaffeinated drinks may reduce the likelihood of accidents.

How should care providers approach implementation?

For care providers interested in replicating the success of the Decaf Project, key takeaways include:

• Engage stakeholders early: Clear communication with residents, families, and staff will help to build higher levels of participation.
• Monitor data rigorously: Collecting detailed, consistent data on falls is essential for evaluating the impact of the project.
• Provide choice and transparency: Caffeinated options should remain available to respect individual preferences, whilst also presenting the benefits of the project.

The How-to Guide for Care Providers, developed by project partners, offers practical advice for rolling out similar trials.

Opportunities for future research

While the Decaf Project’s outcomes are compelling, its relatively small sample size suggests the need for larger-scale studies. Future research could explore additional benefits of decaffeination, such as improved sleep patterns, reduced behaviours associated with dementia, or potential impacts on cardiovascular health. Expanding the focus to total falls - not just those related to toilet trips - could further quantify the benefits of decaffeination.

The Decaf Project exemplifies how evidence-based, low-cost interventions can address persistent challenges in care settings. Its success underscores the value of collaboration between care providers, researchers, and healthcare organisations. For care homes seeking to improve resident safety and wellbeing, switching to decaf could be a game-changer.

Stow Healthcare continues to champion this initiative, sharing its findings widely and encouraging care providers nationwide to “give decaf a go.” As the project gains momentum, it has the potential to set a new standard in fall prevention strategies, benefiting residents and healthcare systems alike.

For more information, please visit Stow Healthcare’s Decaf Project Page where you can find a multitude of resources, including the How-to Guide, the full project report, and poster materials.