Today, I want to talk about a fantastic resource for all clinicians who work with older adults. Before we really get into teaching a patient how to fall, or even working on fall risk reduction, we have to determine if the patient is even a fall risk in the first place. This resource does just that, and it is called the STEADI Initiative. STEADI stands for “Stopping Elderly Accidents, Deaths & Injuries” and was created by the CDC while following the American and British Geriatrics Societies' (A/BGS) clinical fall prevention guidelines. This initiative uses a three-step approach to facilitate positive impacts on reducing elderly fall rates and associated injuries. These three steps consist of screening, assessing, and intervention. Essentially, what you already do with every patient you see. The difference here is that the STEADI Initiative gives you all the information and structure you need to provide your patients the highest level of screening and care.

Screening

 Let’s start with screening.  A fall risk screening is recommended at least twice a year for those over 65 years old by the A/BGS. (1) Screening, within the STEADI Initiative structure, is administered via two main options. The first option is to administer the Stay Independent Brochure while a patient completes intake paperwork or as a take home form. This brochure asks 12 simple questions of which assess overall risk of falling. All questions are asked in the form of a statement with first person language. These questions ask for a “yes/no” answer, as well as give an explanation as to why answering this question matters. Each “yes” is worth 1 point, and each “no” is worth 0 points. If a patient’s score adds up to more than 4 points total, they are at risk for falling. The patient is then prompted to discuss this with their primary care physician or direct access provider during their next appointment. When discussed, the high areas of risk can be pinpointed by the provider based off which questions the patient answered “yes” to. Being able to pinpoint areas of high risk in a patient is crucial to giving the highest level of care.

The second option for screening is to simply ask three questions during the initial evaluation of a patient. This option is much briefer and non-specific but allows a clinician to quickly decide if a deeper look at fall risk is needed for any given patient. These three questions are as follows:

1. “Have you fallen in the past year?”

2. “Do you feel unsteady when standing or walking?”

3. “Are you worried about falling?”

If the patient answers yes to any question, the clinician should take that as a green light to dig deeper and potentially conduct a formal fall risk assessment. (1)

Assessment

Conducting a fall risk assessment is essential if screening indicates any red flags. The assessment fleshes out WHY a patient is a fall risk and gives clinicians direction for interventional strategies. Full fall risk assessments should include blood pressure, medication screening, gait assessment, strength assessment, balance testing, discussion of home hazards, vision assessment, deeper discussion of previous falls, and identifying any comorbidities that may play a role in fall risk. These elements can be split up between the patient’s care team or done by one provider if ample time, scope of practice, and resources are available. (1)

Physical therapists have the knowledge and skill within their scope of practice to conduct all parts of this assessment. All aspects of the assessment are equally important and should be treated as such. If the patient is found to have potential issues in the realm of vision, medications, or blood pressure the clinician should be sure to refer out to the appropriate medical provider to address any potential issue. The bread and butter of a physical therapist’s know-how will lie in assessing the gait, strength, and balance of their patient.  The STEADI Initiative recommends three well known and simple tests to assess these elements. These three tests include the Timed Up and GO (TUG), 30-Second Chair Stand, and the 4-Stage Balance Test. The physical therapist should be judging tests on score and quality of movement. If only limited time is available, the TUG should be performed at very minimum to give an overall picture of patient mobility.

Intervention

Once an assessment is completed and areas of deficit are acknowledged, it is time to plan an intervention strategy to address these deficits. It is important to note that this step is a team effort between the patient and clinician. All patients have different ideas, principles, and beliefs that can affect the intervention strategy, and these must be respected to create a plan that will lead to positive change. Interventions may include referring to a community balance program, attending physical therapy, recommending a mobility aid, or referring out to another appropriate medical provider, as well as numerous other options. Fall prevention is a holistic approach requiring a team effort to address all areas of deficit for best patient outcomes.

As an introduction to the STEADI Initiative, this article only highlights the key big picture principles. STEADI, as a resource, is geared towards all clinicians, not just physical therapists. Although mainly for the older adult, this program can be used for all populations who may be at risk of falling. For more information on the STEADI Initiative be sure to visit the CDC’s website https://www.cdc.gov/steadi/index.html .

References

1. Eckstrom E, Parker E, Shakya I, Lee R. Coordinated care plan to prevent older adult falls. cdc.gov/steadi Web site. https://www.cdc.gov/steadi/pdf/Steadi-Coordinated-Care-Final-4_24_19.pdf. Updated 2019. Accessed May 12, 2020.

Thanks for reading about the STEADI Initiative! Have you encountered this tool in your work or recovery activities? How would you use this tool to help your patients or clients? Comment below and let me know!

Happy falling!

Special thanks to Pam Hale and Siobhan McConnell for editing this article