Steps Toward Safety: A Guide to Pharmacy Student-Led Fall Prevention.

Over one in four U.S. older adults (age 65+) reports falling each year with fall-related medical costs estimated at $50 billion. The American Geriatrics Society/British Geriatrics Society Clinical Practice Guideline for Prevention of Falls in Older Persons recommends that healthcare providers assess and manage their patients’ fall risk. The Centers for Disease Control and Prevention’s Stopping Elderly Accidents, Deaths, and Injuries (STEADI) initiative helps healthcare providers incorporate these guidelines by providing tools on how to screen, assess, and intervene to reduce risk. Evaluations of fall prevention have focused on the clinical process and outcomes. Understanding clinical activities is important in fall prevention but a better understanding of older adult characteristics that increase fall-risk, and attitudes that may affect their adoption of evidence-based interventions could improve the effectiveness of prevention strategies. The five presentations in this session include: 1. Demographic, health and functional characteristics of older adults with increased fall risk. 2. Caregivers of people with chronic conditions or disability as a group with increased fall risk. 3. The most effective and efficient ways of identifying older adults with increased fall risk. 4. Facilitators and barriers to older adults’ adherence to evidence-based fall interventions. 5. Applying knowledge of older adult attitudes to improving an implementation of STEADI-based fall prevention. Multifactorial fall prevention strategies such as STEADI focus on the clinical aspects of fall prevention but their success depends on understanding and incorporating older adult characteristics and attitudes. The information presented in this session can inform fall prevention strategies and improve health.

Background and ObjectivesFalls are the leading cause of injury-related deaths in older adults. Objectives include describing implementation ofthe Centers for Disease Control and Prevention’s Stopping Elderly Accidents, Deaths, and Injuries (STEADI) initiativeto help primary care providers (PCPs) identify and manage fall risk, and comparing a 12-item and a 3-item fall screeningquestionnaire.Design and MethodsWe systematically incorporated STEADI into routine patient care via team training, electronic health record tools, andtailored clinic workflow. A retrospective chart review of patients aged 65 and older who received STEADI measured fallscreening rates, provider compliance with STEADI (high-risk patients), results from the 12-item questionnaire (StayIndependent), and comparison with a 3-item subset of this questionnaire (three keyquestions).ResultsEighteen of 24 providers (75%) participated, screening 773 (64%) patients over 6 months; 170(22%) were high-risk. Of these, 109 (64%) received STEADI interventions (gait, vision, and feet assessment,orthostatic blood pressure measurement, vitamin D, and medication review). Providers intervened on 85% with gaitimpairment, 97% with orthostatic hypotension, 82% with vision impairment, 90% taking inadequatevitamin D, 75% with foot issues, and 22% on high-risk medications. Using three key questionscompared to the full Stay Independent questionnaire decreased screening burden, but increased the number ofhigh-risk patients.Discussion and ImplicationsWe successfully implemented STEADI, screening two-thirds of eligible patients. Most high-risk patients receivedrecommended assessments and interventions, except medication reduction. Falls remain a substantial public health challenge.Systematic implementation of STEADI could help clinical teams reduce older patient fall risks.

BackgroundPreventing falls and fall-related injuries among older adults is a public health priority. The Stopping Elderly Accidents, Deaths, and Injuries (STEADI) tool was developed to promote fall risk screening and...

ABSTRACTAimTo identify individuals at risk of falls and the factors contributing to their risk, we screened community‐dwelling older adults using the Centers for Disease Control and Prevention's Stopping Elderly Accidents, Deaths, and Injuries (STEADI) Assessments.DesignA descriptive correlational study design.MethodsFall risk screenings with community‐dwelling older adults aged 65 or older were conducted during a virtual interprofessional education event (IPE) for fall risk screening. The screening included demographic questions, perception of fall risks, medication questions and physical assessments (Timed Up and Go test, Single Leg test, 30‐Second Sit to Stand) using the STEADI algorithm. Screening data were collected via Qualtrics, and descriptive data analyses were performed using SPSS.ResultsIn total, 114 community volunteers aged 65 or older were screened for fall risk. Using the STEADI Fall Risk questionnaire, 84 participants (73.7%) exhibited at least one clinically proven risk factor for falls, with 39 (34.2%) having four or more risk factors. The physical assessments identified 37 participants (32.5%) with functional leg weakness, 47 (41.2%) had poor mobility and 32 (28.1%) had poor balance. As a result, the modified STEADI algorithm identified 68 (59.6%) with fall risk and the most frequently discussed SMART objectives were related to physical assessment data issues (34.5%).Patient or Public ContributionOur study confirmed the effectiveness of a multifaceted STEADI assessment in identifying community individuals at risk for falls who may not be detected through the normal standard of care. Educating nurses on performing comprehensive fall risk assessments and creating corresponding action plans with SMART objectives is essential to ensure thorough screening and care of their patients. A collaborative, interprofessional education programme can help train health professional students to gain valuable skills in conducting comprehensive fall risk screenings and developing objectives for future care plans based on those findings.

BackgroundThe Center for Disease Control and Prevention’s Stopping Elderly Accidents, Deaths, and Injuries (STEADI) initiative offers health care providers tools and resources to assist with fall risk screening and multifactorial fall risk assessment and interventions. Its effectiveness has never been evaluated in a randomized trial.ObjectiveThis study aims to describe the protocol for the STEADI Options Randomized Quality Improvement Trial (RQIT), which was designed to evaluate the impact on falls and all-cause health expenditures of a telemedicine-based form of STEADI implemented among older adults aged 65 years and older, within a primary care setting.MethodsSTEADI Options was a pragmatic RQIT implemented within a health system comparing a telemedicine version of the STEADI fall risk assessment to the standard of care (SOC). Before screening, we randomized all eligible patients in participating clinics into the STEADI arm or SOC arm based on their scheduled provider. All received the Stay Independent screener (SIS) to determine fall risk. Patients were considered at risk for falls if they scored 4 or more on the SIS or answered affirmatively to any 1 of the 3 key questions within the SIS. Patients screened at risk for falls and randomized to the STEADI arm were offered a registered nurse (RN)–led STEADI assessment through telemedicine; the RN provided assessment results and recommendations to the providers, who were advised to discuss fall-prevention strategies with their patients. Patients screened at risk for falls and randomized to the SOC arm were asked to participate in study data collection only. Data on recruitment, STEADI assessments, use of recommended prevention services, medications, and fall occurrences were collected using electronic health records and patient surveys. Using staff time diaries and administrative records, the study prospectively collected data on STEADI implementation costs and all-cause outpatient and inpatient charges incurred over the year following enrollment.ResultsThe study enrolled 720 patients (n=307, 42.6% STEADI arm; n=353, 49% SOC arm; and n=60, 8.3% discontinued arm) from September 2020 to December 2021. Follow-up data collection was completed in January 2023. As of February 2024, data analysis is complete, and results are expected to be published by the end of 2025.ConclusionsThe STEADI RQIT evaluates the impact of a telemedicine-based, STEADI-based fall risk assessment on falls and all-cause health expenditures and can provide information on the intervention’s effectiveness and cost-effectiveness.Trial RegistrationClinicalTrials.gov NCT05390736, http://clinicaltrials.gov/ct2/show/NCT05390736International Registered Report Identifier (IRRID)RR1-10.2196/54395

Fall risk assessment in older adults with overactive bladder: based on the Stopping Elderly Accidents, Deaths, and Injuries (STEADI) algorithm.

BackgroundThe Stopping Elderly Accidents, Deaths and Injuries (STEADI) screening algorithm aligns with current fall prevention guidelines and is easy to administer within clinical practice. However, the stratification into low, moderate...

Falls are a growing concern among older adults with estimates that one in four fall each year. Older adults who experience a fall are at higher risk for poor health outcomes that threaten independence and increase risk of death. Impairment in cognitive function is known to be associated with greater fall occurrence; however, cognitive testing is not an integral part of clinical fall risk assessment. The purpose of this study is to examine cognitive performance in relation to fall risk level and its components determined using the Stopping Elderly Accidents, Deaths, and Injuries (STEADI) algorithm. One hundred eight community dwelling older adults (mean age 79(SD 7.3) years, 76% women, and 56% college or higher education) were included. Cognition was assessed with the Montreal Cognitive Assessment (MoCA; >= 26 normal). The STEADI algorithm was used to assess fall risk (low vs. moderate/high) based on the Stay Independent screening (>= 4), impairment in gait (Timed Up and Go (TUG)), strength (30-second chair stand), and balance (4-stage balance), and number of falls (>= 2). Associations between cognition and fall risk and its components were assessed using logistic regression adjusting for age, gender, and education. Normal cognitive status was marginally associated with lower likelihood of moderate/high compared to low fall risk (OR 0.42, 95% CI 0.17-1.04), and with a lower likelihood of TUG impairment (OR 0.22, 95% CI 0.07-0.66). These results suggest cognitive status may contribute important information about older adults’ fall risk and should be considered an integral part of fall risk assessment.

Developing and Testing Implementation Strategies to support the Centers for Disease Control and Prevention's Initiative for Falls Risk Management in Outpatient Physical Therapy: A Protocol

Falls among older adults (age 65 and older) cause roughly 3 million emergency department visits and $50 billion in medical costs annually. The Centers for Disease Control and Prevention (CDC) developed the Stopping Elderly Accidents, Deaths, and Injuries (STEADI) initiative to increase clinical fall prevention. STEADI encourages screening for fall risk annually, assessing modifiable risk factors, and intervening to reduce risk using effective strategies like medication management. Medication management is critical given new data on the increased use of medications linked to falls. In 15 years, opioid use among older adults increased from 15% to 35% and anticonvulsant use tripled from 4% to 14%. To address the issue, CDC partnered with the University of North Carolina who 1) adapted STEADI tools for use in community pharmacies and 2) piloted and assessed their use in 31 North Carolina pharmacies. The adapted tools and processes were branded STEADI-Rx. Community pharmacists following the STEADI-Rx initiative, screen older patients for fall risk in the pharmacy, perform a medication review to identify medications that could increase fall risk, and intervene to reduce risk by sharing information with the patients’ healthcare providers. Providers can then optimize medications to reduce fall risk and improve health. STEADI-Rx tools include 1) a community pharmacy algorithm, outlining how pharmacists can conduct fall risk screening, assessment, and care coordination; 2) a community pharmacy fall risk checklist; and 3) communication materials to help pharmacists share information with patients’ providers. STEADI-Rx was launched in July 2019. More information is available at www.cdc.gov/STEADI.

Falls are a serious threat to older adults' quality of life. Evidence is lacking regarding the influence of diet on fall risk factors. This study aims to assess the relationship between diet, functional measures, and fall risk among older adults participating in a fall-prevention intervention. Cross-sectional analysis of baseline data from 192 participants with an average age of 70.9 years was conducted using Chi-square tests, t-test, Wilcoxon test, and nominal logistic analysis. Based on Dietary Screening Tool (DST) scores, 39.5% of participants were classified as nutritionally being “at-risk,” 46.1% were at “possible-risk,” and 14.4% were “not-at-risk.” Fall risk was assessed using the Stopping Elderly Accidents, Deaths, and Injuries (STEADI) classifications. There were no significant associations between the “not at fall risk” group and “at fall risk” groups in terms of DST total score (p=0.97), protein score (p=0.27), multivitamin use (p=0.73) and DST risk categories (p=0.64). In the correlation analysis, the DST total scores had a positive correlation with total physical activities (r=0.1648, p=0.029), and a negative correlation with body mass index (BMI) (r=-0.1496, p=0.04) and depression (r=-0.1433, p=0.048). In the nominal logistic analysis, neither of the primary predictors, total DST score or DST protein score, showed significance with STEADI fall risk categories. In each model, the Four-Square Step Test (FSST), an indicator of greater risk of future falls, had the closet likelihood ratio test to the statistical trend as the major component associated with STEADI risk categories. A significant relationship between diet, functional measures, and fall risk was not detected.

Older adults in low- and middle-income countries (LMICs) experience a disparate burden of non-communicable diseases (NCDs) and barriers to accessing health care. Unintentional injuries are among the major NCDs, and falls are the second leading cause of these injuries and deaths. Falls were reported in up to 50% of older people living in Asia, including Thailand. There is a lack of community-based multifactorial fall prevention interventions that target both older adults and the primary care systems. We aimed to culturally adapt the CDC’s Stopping Elderly Accidents, Deaths, and Injuries (STEADI) for Thai older adults and explore the feasibility, appropriateness, and acceptability of using STEADI by trained community health workers (CHWs) and care managers (CMs). STEADI consists of three steps: screening, assessing, and intervening. In Step a, CHWs screened fall risk using three key questions and found that all of participants had fall risk, then CHWs screened with a Stay Independent questionnaire (range 0-14) and found that 100% have high fall risk (total scores 9.7± 2.4). In Step b, CMs assessed risk factors and CHWs assessed home hazards. They found that 50% had poor balance, 70% took 4+ medications, 75% fell on the walkway, and 70% had no bathroom modifications. In Step c, individual participants received fall prevention interventions and participants attended all sessions. Our results indicated that STEADI delivered by CHWs and CMs is feasible and acceptable for older adults. The mean scores of acceptability, appropriateness, and feasibility were 19.20,18.80, and 18.60 out of 20 totals, respectively.

The Short Physical Performance Battery (SPPB): A Quick and Useful Tool for Fall Risk Stratification Among Older Primary Care Patients

Falls among older adults are a growing and costly public health problem that often leads to mobility decline and loss of independence. Although clinical frameworks such as the Centers for Disease Control and Prevention's (CDC) Stopping Elderly Accidents, Deaths, and Injuries (STEADI) initiative recommend multifactor screening (gait, balance, strength, fear of falling, and fall history), most wearable fall risk assessment systems rely on a small set of risk factors (typically gait), which creates a gap between clinical practice and automated wearable assessment. This study aims to evaluate the importance of STEADI-based fall risk factors and provide design guidance for clinically compatible wearable fall risk assessment systems. We created a dataset of 24 older adults (10 low fall risk and 14 high fall risk) from a publicly available plantar pressure dataset of 48 participants by retaining only those with consistent fall risk labels based on both the Berg Balance Scale and the Timed Up and Go test. A total of 18 features were extracted to quantify gait, strength, balance, fear of falling, and fall history. Random forest (RF) models were trained with leave-one-subject-out cross-validation to assess fall risk. Importance of STEADI-based factors was assessed by two methods: (1) estimating Shapley Additive Explanations values based on a single RF model trained on all features; and (2) training 5 separate RF models, each on 1 STEADI factor category, and comparing their fall risk classification accuracies. In this secondary analysis, the RF model trained on all features achieved a subject-level accuracy of 87.53% (95% CI 75%-100%). Shapley Additive Explanations analysis identified the right foot flat phase ratio (fear of falling feature) as the highest-ranked feature, followed by maximum right forefoot ground reaction force (strength feature), whereas traditional gait features did not appear in the top 10. The 5 separate RF models trained on individual STEADI-based factor categories showed a similar trend in mean participant-level accuracy: fear of falling, 87.59% (95% CI 75%-100%); strength, 79.18% (95% CI 62.5%-95.83%); balance, 70.5% (95% CI 50%-87.5%); gait 70.81% (95% CI 54.17%-87.5%); and fall history 62.37% (95% CI 50%-75.1%). However, paired comparisons did not show statistically significant differences in accuracy between the gait model and the models trained on other factors. These preliminary results show that commonly overlooked nongait factors are potentially as informative as gait, although clear superiority was not demonstrated in this dataset. The novel foot flat phase ratio ranked higher than all other evaluated features, which showed the value of domain knowledge-informed feature engineering. These preliminary findings indicate that nongait STEADI factors merit consideration in the design of wearable fall risk assessment systems.

<h3>Statement of purpose</h3> Falls among older New Yorkers are the leading cause of injury deaths, hospitalizations, and emergency department visits. Fall injuries among older New Yorkers result in over $2.3 billion in hospital and emergency department charges every year. Those who fall often suffer a downward spiral in physical and mental health, ultimately taking away an individual's independence. <h3>Methods/Approach</h3> The NYS Older Adult Fall Prevention Program supports evidence-based programs in three counties. The evidence-based community programs include <i>Tai Chi for Arthritis,</i><i>Tai Chi: Moving for Better Balance,</i> and <i>Stepping On</i>. An innovative approach has been using the STEADI Toolkit to integrate fall prevention assessment and referral into clinical practice. STEADI (Stopping Elderly Accidents, Deaths, and Injuries) provides primary care providers the tools to assess older adult patients for fall risk and then refer them to evidence-based community programs and resources. The state health department partnered with a variety of state, county, and local organisations to facilitate program implementation and sustainability. <h3>Results</h3> These programs improve quality of life, preserve independence, and reduce health care costs. These programs have reached nearly 1,500 older New Yorkers. At a healthcare system based in Broome County, over 170 physicians across 17 practices spanning four counties now utilise the STEADI Toolkit to conduct fall risk assessments and referrals. Such assessments and referrals are tracked via modified electronic health records. <h3>Conclusions</h3> Evidence-based fall prevention programs can be delivered through a variety of community partners. Referring older adults into these programs via fall risk assessment in the primary care setting enhances program reach. <h3>Significance and contribution to the field</h3> Implementing evidence-based fall prevention programs in community and healthcare settings through state health departments is an effective public health strategy to reach community-dwelling older adults.