Stopping Elderly Accidents Research Articles

Factors associated with fall risk increasing drug use in older black and white men and women: the Health ABC Study

BackgroundMost older adults use medications that may increase falls, often defined as fall risk increasing drugs or “FRIDs”. Two definitions for FRIDs, the Centers for Disease Control and Prevention’s (CDC) Stopping Elderly Accidents, Deaths & Injuries (STEADI-Rx) and Swedish National Board of Health and Welfare (SNBHW) definitions, are widely accepted, though include different FRIDs in their definitions. Whether factors associated with FRID use in older adults differ by definition is unknown.MethodsWe hypothesized that factors for FRID use will vary by FRID definition in 1,352 community-dwelling older Black and White adults with medication information in the Health, Aging and Body Composition Study (Health ABC; 2007–08 clinic visit; 83.4 ± 2.8 years; 54.1% women; 65.1% White). Multivariable logistic regression and multivariable negative binomial regression, progressively entering groups of covariates (demographics, lifestyle/behavior factors, and multimorbidity), modeled FRID use (yes/no) and count.ResultsOf 87.0% participants using SNBHW FRIDs, 82.9% used cardiac medications, with lower use of all other FRIDs (range:1.1-12.4%). Of 86.6% participants using STEADI-Rx FRIDs, 80.5% used cardiac medications, with lower use of all other FRIDs (range:1.1-16.1%). Participants with FRID use by either definition were more likely to have chronic health conditions, a hospitalization in the prior year, higher non-FRIDs medication counts, higher Center for Epidemiologic Studies Depression Scale (CES-D) scores, and less physical activity (all p < 0.05). Participants with STEADI-Rx FRID use had poorer vision and higher Modified Mini-Mental State (3MS) scores. In multivariable logistic regression for SNBHW use, hypertension, body mass index (BMI), 3MS scores, and non-FRID count were positively associated with FRID use and poorer vision and Digit Symbol Substitution Test (DSST) scores were negatively associated. In addition to SNBHW factors, higher CES-D scores were associated with STEADI-Rx FRID use. In multivariable negative binomial regression, hypertension, higher BMI, CES-D scores, and non-FRID count were associated with higher FRID count and sleep problems with lower FRID count for both definitions. Higher 3MS and lower DSST scores were associated with higher STEADI-Rx FRID count. Women had lower SNBHW FRID count after adjustments.ConclusionsRisk factors for FRID use in older adults differ slightly by STEADI-Rx and SNBHW FRIDs definition, but are largely similar.

Fall Prevention Model at a Local Nonprofit Equipment Exchange Program Utilizing the STEADI: A Compilation of Two Pilot Studies

Abstract Date Presented 03/23/24 Collective research to determine the predictive validity of the Stopping Elderly Accidents, Deaths &amp; Injuries (STEADI), parallel-forms reliability between the 3-item and 12-item STEADI, and the efficacy of pamphlets in the education of individuals using a nonprofit equipment exchange program. Primary Author and Speaker: Karen Probst

Healthcare Professionals' Insights Regarding the Applicability of the STEADI Falls Prevention Program Among Neurology Patients: A Qualitative Study.

Falls are common among hospitalized patients especially those with neurological health conditions. This highlights the need to implement evidence-based, comprehensive fall prevention programs. However, certain barriers hinder successful implementation of fall prevention programs in hospitals. The aim of this study was to explore the insights of healthcare professionals regarding the implementation of an interdisciplinary falls prevention program among patients with neurological health conditions. A qualitative, descriptive design was used to conduct this study. Healthcare providers at two neurology units from two hospitals were invited to attend interdisciplinary workshops on fall prevention using the Stopping Elderly Accidents, Deaths, and Injuries (STEADI) program. Reflective journals were used to collect the data. A total of 23 healthcare providers returned their completed journals and thematic analysis was performed to extract the main themes. Thematic analysis revealed a total of four main themes: (1) The STEADI program provides an interdisciplinary approach to identifying fall risks, (2) The STEADI program improves patient safety and facilitates recovery, (3) The STEADI program fails to accommodate all neurology patients, and (4) Time and space constraints hinder success. Responses to the reflective journals revealed that the participants were able to identify the advantages of using the STEADI program for both healthcare professionals and patients with neurological conditions. The comprehensive and evidence-based approach, coupled with its interdisciplinary nature, was highly appraised by the participants.

Evidence-Based Strategies for Injury Prevention and Exercise Prescription in Elderly Communities: The Physical Therapist's Perspective

Injury prevention and exercise prescription are critical components of healthcare for older adults. Physical therapists play a critical role in fall risk screening, assessment, and prevention in elderly communities. By incorporating STEADI (Stopping Elderly Accidents, Deaths, and Injuries) and other evidence-based tools and resources, physical therapists can help identify and address fall risk factors, link older adults with community-based programs and resources, and reduce the incidence of falls and related injuries in this population. Evidence-based interventions for fall prevention include exercise interventions that are tailored and include a combination of exercise types, considering individual abilities and preferences. Exercise programs can reduce falls in older people living in residential aged care facilities, but exercise has little or no lasting effect on falls after the end of a program. Physical therapists should consider the patient's fall risk, functional limitations, and comorbidities when prescribing exercises for balance and falls prevention. Physical therapists can help elderly communities implement evidence-based strategies for injury prevention and exercise prescription by adopting a person-centered approach, challenging ageist stereotypes, using sound outcome measures, prioritizing physical activity, and collaborating with other healthcare professionals. By doing so, physical therapists can promote the health, independence, and well-being of older adults, and help them lead active, fulfilling lives. A combination of strength, balance, and functional training exercises, as well as other evidence-based strategies, can significantly reduce the risk of falls in elderly communities. Physical therapists and healthcare providers should consider these interventions when developing fall prevention programs for older adults. Exercise interventions for preventing falls in elderly communities should be implemented regularly, with a frequency of at least three sessions per week, and for a duration of up to 12 months. Keywords: Elderly communities, injury prevention, exercise prescription in elderly, falls prevention, aging

Manhattan Vision Screening and Follow-up Study (NYC-SIGHT): a nested cross-sectional assessment of falls risk within a cluster randomised trial

BackgroundTo investigate the feasibility of using the Stopping Elderly Accidents, Deaths and Injuries (STEADI) Falls Risk Tool Kit during community-based eye health screenings to assess falls risk of participants enrolled...

The Effect of the Stopping Elderly Accidents, Deaths, and Injuries Program on Falls Prevention in Neurosurgical Patients.

BACKGROUND: Despite the negative consequences of falls among neurosurgery patients in acute care settings, there is a lack of high-quality evidence for successful fall prevention programs. This study was conducted to evaluate the effectiveness of the Stopping Elderly Accidents, Deaths, and Injuries (STEADI) program on falling prevention compared with routine falling protocol in neurosurgical patients in Jordan. METHODS: A prospective quasi-experimental design was used in this study. The sample comprised 70 neurosurgical patients from a major university-affiliated hospital in Jordan. The study sample was assigned into a control group (35 patients) and an intervention group (35 patients). A demographics questionnaire, and different fall risk screening tools and tests were used in this study as recommended by the STEADI program. RESULTS: Multivariate analysis of variance results showed a significant effect ( P = .001) of the STEADI program on the linear combination of outcome measures. Independent samples t tests further confirmed the program's effectiveness, with statistically significant mean differences in most outcome measures between the intervention and control groups post intervention. After implementing the study intervention, participants in the intervention group had a statistically significant lower risk for falls. CONCLUSION: The findings indicate potential effectiveness in improving neurosurgery patients' outcomes and reducing the risk of falls. Implementing the study recommendations can enhance patient safety and promote evidence-based fall prevention interventions in neurosurgery patients.

Reducing falls among residents of retirement homes: A DNP project.

Falls among older adults (OAs) living in retirement homes (RHs) in Canada are a major public health concern due to high morbidity and mortality as well as significant healthcare expenditures. This quality improvement (QI) initiative, conducted for the author's Doctor of Nursing Practice (DNP) project, aimed to decrease fall rates and ED transfers related to falls among OAs in six RHs across the Greater Toronto Area in Ontario, Canada through a multipart intervention with two primary goals. First, the project aimed to facilitate RH NPs' implementation of a comprehensive fall risk assessment and fall prevention strategy in their practice by incorporating the Stopping Elderly Accidents, Deaths & Injuries (STEADI) toolkit into their armamentarium. Second, it sought to enhance the knowledge of the RHs' registered practical nurses (RPNs), personal support workers (PSWs), and unregulated care providers (UCPs) in assessing fall risk and incorporating fall prevention strategies in their daily practice. By improving NP, RPN, PSW, and UCP knowledge and increasing (by 20%) RPN, PSW, and UCP use of fall prevention strategies, this QI initiative successfully reduced fall rates in the RHs by 40.4%, with no falls requiring transfer to the ED, in the postintervention period. The results of this project highlight the need for an interdisciplinary approach to fall risk reduction in RHs that includes implementation of multifactorial intervention strategies as well as effective organizational policies and procedures for maximum impact.

Telemedicine-Based Risk Program to Prevent Falls Among Older Adults: Protocol for a Randomized Quality Improvement Trial.

The 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. This 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. STEADI 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. The 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. The 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. ClinicalTrials.gov NCT05390736, http://clinicaltrials.gov/ct2/show/NCT05390736. RR1-10.2196/54395.

Prevalence and risk factors for falls among the community dwelling older adults of Thrissur: A pilot study.

According to World Health Organization (WHO) statistics, every year 28-35% of people over 65 years and 32-42% of people over 70 years experience falls. Given that many falls are preventable, can occur in any population, and can result in significant morbidity and mortality, falls are receiving more attention as a major global issue. The objectives of this study were as follows: 1. To measure the prevalence of falls among the elderly living in the Thrissur Taluk Health Centre. 2. To identify the risk factors associated with falls in the elderly using the Centre for Disease Control and Prevention, Stopping Elderly Accidents, Deaths and Injuries (CDCs STEADI) 2019 scale and the Timed Up and Go (TUG) scale. 3. To find the association between the risk factors and the prevalence of fall among older people. A cross-sectional study was conducted to find the prevalence of fall among the elderly in Thrissur Taluk Health Centers. CDCs STEADI 2019 fall risk assessment tool was used to assess the risk factors associated with the elderly. TUG test was used to determine gait, balance, strength, and posture. In our study, we discovered a prevalence of 41 percent of falls among the community-dwelling older adults of Thrissur. This study has shown that the risk of fall was higher among the female elderly population. 88% are found to be at high risk of fall, and 65% of the population were worried about fall. This study found out a high prevalence of falls among community dwelling older adults.A future study with a larger sample size would be more helpful to confirm the impact of different variables in relation to the risk of fall among the elderly.

Comparing Sensitivity, Specificity, and Accuracy of Fall Risk Assessments in Community-Dwelling Older Adults.

The US Centers for Disease Control and Prevention (CDC) has implemented the Stopping Elderly Accidents, Deaths, and Injuries (STEADI) initiative. This initiative provides an algorithm for fall risk screening. However, the algorithm has the potential to overcategorize individuals as high risk for falling upon initial screening, which may burden clinicians with the task of recategorizing individuals after follow-up testing. Therefore, this study aimed to compare the accuracy, sensitivity, and specificity of fall risk appraisal between the STEADI, Short Fall-Efficacy Scale International (FES-I), and portable balance system (BTrackS) assessments in community-dwelling older adults. This cross-sectional analysis included 122 community-dwelling older adults, comprising 94 women and 28 men. Center-of-pressure postural sway was assessed using the BTrackS, fear of falling was assessed using the Short FES-I questionnaire, and all participants completed the STEADI checklist. Each assessment categorized participants as either high or low fall risk and fall risk appraisal was compared between groups using McNemar tests. The STEADI checklist (high risk: n = 62; low risk: n = 60) significantly differed in fall risk appraisal compared to the BTrackS (high risk: n = 44; low risk: n = 78; p = 0.014) and the Short FES-I (high risk: n = 42; low risk: n = 80; p = 0.002). Compared to the BTrackS, the STEADI checklist had a specificity of 62.8%, sensitivity of 70.5%, and accuracy of 65.6%. Compared to the Short FES-I, the STEADI checklist had a specificity of 67.5%, sensitivity of 81.0%, and accuracy of 72.1%. The STEADI checklist appears to overcategorize individuals as high fall risk more frequently than direct assessments of postural sway and fear of falling. Further research is needed to examine potential improvements in accuracy when combining the STEADI checklist with direct assessments of postural sway and/or fear of falling.

Integrating Fall Prevention Strategies into EMS Services to Reduce Falls and Associated Healthcare Costs for Older Adults.

The purpose of this study is to detail the implementation of fall prevention initiatives through emergency medical services (EMS) and associated outcomes. Paramedics with MedStar Mobile Healthcare utilized the Stopping Elderly Accidents, Deaths, and Injuries (STEADI) fall prevention model to screen and direct intervention through 9-1-1 emergency response, High Utilization Group (HUG), and 30-day Hospital Readmission Avoidance (HRA) programs. Outcomes from 9-1-1 calls measured the number of older adults screened for falls and identified risk factors. The HUG and HRA programs measured change in quality of life with EuroQol-5D, referral service utilization, falls, emergent healthcare utilization, and hospital readmission data. Analysis included costs associated with reduced healthcare usage. Emergency paramedics provided fall risk screening for 50.5% (n=45,090) of adults aged 65 and older and 59.3% were at risk of falls, with 48.1% taking medications known to increase the risk of falls. Services provided through the HUG and HRA programs, along with additional needed referral services, resulted in a 37.2% reduction in fall-related 9-1-1 calls and a 29.5% increase in overall health status related to quality of life. Analysis of the HUG program revealed potential savings of over $1 million with a per-patient enrolled savings of $19,053. The HRA program demonstrated a 16.4% hospital readmission rate, in comparison to a regional average of 30.2%, and a cost-savings of $4.95 million or $15,618 per enrolled patient. Implementation of the STEADI model into EMS services provides an effective and cost-saving model for addressing fall prevention for older adults, provides meaningful and impactful improvement for older adults, and could serve as a model for other EMS programs.

Exploring Communication about Fall Risk and Prevention between Internal Medicine Residents and Geriatric Patients: A Needs Assessment.

In the United States, falls are the leading cause of fatal and nonfatal injuries for geriatric patients. With a growing aging population, medical trainees must gain experience with geriatric assessments, including fall risk and prevention. To the authors' knowledge, no prior studies have explored who most often initiates fall discussions between Internal Medicine (IM) residents and geriatric (age 65 years and older) patients. Our objective was to determine who most often initiates fall discussions between IM residents and geriatric patients and the barriers to having these discussions. This 2023 quantitative needs assessment used surveys distributed to ambulatory geriatric patients, IM residents, and attending physicians within an urban IM resident continuity clinic. We used the Stopping Elderly Accidents, Death & Injuries assessment from the Centers for Disease Control and Prevention to determine patient fall risk. Response rates were 46%, 51%, and 67% for patients, residents, and attendings, respectively. Of the 39 patients who were assessed, 51% were at risk of falling. Eighty-seven percent of patients have had a fall discussion with their residents, and 59% reported these were resident initiated; however, 75% of 28 residents reported initiating fall conversations rarely, and all 4 attendings said that they started these discussions most of the time while staffing patients with residents. Modifiable resident-identified barriers to discussing falls included forgetfulness and lack of knowledge regarding completing a fall risk assessment. Most patients have conversations about falling with their physicians, but discrepancies exist regarding who initiates them. Data from this study suggest that attendings may be instrumental in starting these conversations. Reminder systems and fall risk didactic curricula may increase resident-initiated fall discussions.

MAKING OLDER ADULT FALL PREVENTION A ROUTINE PART OF HEALTHCARE IN TRIBAL CLINICAL SETTINGS

Abstract Over one-third of American Indian and Alaska Native (AI/AN) elders (age 65+) report falling annually. This percentage is higher compared to other race/ethnic groups except for White non-Hispanic older adults. CDC’s Stopping Elderly Accidents, Deaths, and Injuries (STEADI) initiative provides guidance for making elder fall prevention a routine part of clinical care. The presentation will describe a survey of healthcare providers serving AI/AN populations to gauge their readiness to adopt STEADI. Additionally, it will focus on a culturally informed approach to implementing STEADI within tribal settings. The National Network of Public Health Institutes and Seven Directions, A Center for Indigenous Public Health, surveyed a convenient sample of healthcare providers in clinics serving AI/AN patients to assess providers’ knowledge and acceptability of fall prevention best practices, efforts to prevent falls, and receptiveness to receiving fall prevention training and support. The final sample included 94 healthcare providers from 27 clinics. Less than half of those surveyed reported screening elders for fall risk. Only 22% were familiar with STEADI. Most (84%) providers were willing to take part in fall prevention with additional training. Based on these findings CDC is funding two tribes to use an indigenous evaluation approach to improve their tribal health center’s elder fall prevention capacity through evidence-based clinical and clinical-community linked strategies. Results from these activities will be used to outline a best practices guide focused on coordinated care for fall prevention and tailored to the varied environments, governments, cultures, and capacity for public health action in tribal health centers.

Fall Prevention Model at Local Non-Profit Equipment Exchange Program Utilizing the STEADI: a Compilation of Two Pilot Studies

Abstract Individuals picking up gently used durable medical equipment (DME) from a local non-profit equipment exchange program in Erie, Pennsylvania were prompted with the CDC’s Stopping Elderly Accidents, Deaths &amp; Injuries (STEADI) 3-item abbreviated questionnaire and contacted by telephone 6 months later to assess if this survey tool can accurately predict falls. Individuals were also given a STEADI pamphlet upon equipment pickup to educate community members on fall risk. Ninety individuals, who ranged from caregivers to the individual themselves, chose to participate in the follow-up research phone call. Our researchers found that while the abbreviated 3-item STEADI suggested that 80% of community members (in need of DME by way of an equipment exchange program) were predicted to be at risk for a fall, only 22.5% suffered a fall within a six-month follow-up period. This questions the validity of the 3-item abbreviated STEADI, though additional studies are recommended to improve the participant percentage (only 90 out of 255 individuals, or 35%, answered the follow-up call questions) as well as increasing the length of wait time to assess for subsequent fall incident beyond six months. Additionally, only 34% of individuals recalled receiving a pamphlet when picking up equipment, and of those 31 individuals, only 10 of them (32%) remembered what the pamphlet said. This suggests that the simple use of a brochure handout to decrease fall risk amongst community-dwelling adults does not seem to be an effective educational strategy within the Erie, PA community.

A PORTABLE TECHNOLOGY-BASED BALANCE ASSESSMENT PREDICTS FALL RISKS IN LOW-INCOME COMMUNITY-DWELLING OLDER ADULTS

Abstract Despite strong evidence on the association between balance performance and fall risks, there is a need for further studies among racially diverse low-income communities. Sixty-two healthy, low-income community-dwelling older adults (mean 74.11, SD: 6.34, 61-88 years old) in Central Florida were recruited and administered the BTrackS Balance Tracking System (BBS) for measuring balance performance. BBS is a postural sway-based balance performance assessment, where participants were guided to stand still on the BBS plate with hands on hips and eyes closed for about 1-2 minutes. Fall risk was assessed by the Centers for Disease Control and Prevention (CDC)’s twelve-item self-assessment checklist, Stopping Elderly Accidents, Deaths &amp; Injuries (STEADI). About 58% of participants were African Americans, completed high school (54.8%), lived alone (67.7%), and earned just enough financially (54.8%). The simple regression results indicated that the model explained 14.9% of the variance (R2=.149, F (1,60) = 10.47, p =.002). Higher BBS scores (β = .100, p =.002) were significantly associated with higher fall risk scores. As older adults had reduced balance, their fall risks increased. The findings of this study confirmed the benefits of using a combination of a simple fall risk checklist and a portable assessment technology in enhancing the accessibility of balance and fall risk screening. Furthermore, a technology-based balance performance assessment is key in tailoring fall interventions for older adults with poor balance.

BRINGING COMMUNITY-BASED FALLS PREVENTION PROGRAM TO IMPROVE GLOBAL HEALTH (BRIGHT)

Abstract 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.

Feasibility of Implementing Patient-Reported and Physical Performance Measures to Identify and Manage Fall Risk in Older Adults Within a Secondary Fracture Clinic.

The purpose of this study was to assess the feasibility of implementing both electronic and in-person assessments to assess falls risk in an older adult secondary fracture clinic. Electronic data capture feasibility was defined as the proportion of patients that completed the electronic questionnaires prior to their clinic visit. In-clinic feasibility was defined in two ways: (1) the proportion of patients that consented to participate at their clinic visit; (2) time to complete testing. Patients were contacted electronically through their health system portal for electronic consent. Patients were invited to complete consent, the STopping Elderly Accidents, Deaths, and Injuries (STEADI) falls risk assessment tool, and the visual analog scale (VAS) for pain. The Short Physical Performance Battery (SPPB) was performed at the clinic visit. A total of 310 patients were contacted electronically. No patients (0%) provided consent through their health portal. Of the 310 patients, 200 (65%) consented in person (Ineligible: 67 [21%]; Declined: 43 [14%]), resulting in an 82% response rate. In-person data collection took a median of 38.48 (Range: 12.34-54.30) minutes to complete. It was not feasible to contact and collect older adult patient data electronically prior to clinic; but, was feasible to obtain these patient-reported outcomes and physical performance data in person.

Associations among frailty status, hypertension, and fall risk in community-dwelling older adults

ObjectivesFrailty and hypertension often coexist in older adults, which may lead to fall risks. This study aimed to examine the relationship between frailty status, hypertension, and fall risk. MethodsIn this cross-sectional study, a total of 401 older adults were conveniently recruited from communities in Wuxi, China, between September 2022 and November 2022. The fall risk self-assessment checklist from the Stopping Elderly Accidents, Deaths & Injuries (STEADI) Toolkit was used to evaluate their fall risks. The FRAIL scale questionnaire was used to assess frailty status. Participants’ demographic information and comorbidities were collected. Multivariate logistic regression, generalized additive model, and smooth curve fitting were used to analyze the association between frailty, hypertension, and fall risk. ResultsFrailty had a strong association with increased prevalence of fall risk among the participants (OR 8.52, 95% CI 3.21–22.57; P < 0.001). Hypertension significantly increased the fall risk among older adults (OR 1.87, 95% CI 1.11–3.13; P = 0.019). The group with hypertension and frailty had the highest prevalence of fall risk (OR 12.24, 95% CI 3.51–42.65). Smooth curve fitting showed a nonlinear association between frailty and fall risk in hypertension status. In the progress of pre-frailty to frailty status, a higher tendency to fall was found among older adults with hypertension. ConclusionsFrailty status and hypertension independently and jointly influenced the increased prevalence of fall risk. Enhanced frailty and hypertension management may help decrease fall risk among this population.

Association between self-reported falling risk and risk of hospitalization for patients with chronic obstructive pulmonary disease

RationaleThe association between self-report falling risk in persons with COPD and hospitalization has not been previously explored. ObjectiveTo examine whether self-reported risk is associated with hospitalizations in patients with COPD. MethodsA secondary analysis from a prospective observational cohort study of veterans with COPD. Participants completed questions from the Stopping Elderly Accidents, Deaths and Injuries (STEADI) tool kit at either baseline or at the end of the 12-month study. A prospective or cross-sectional analysis examined the association between responses to the STEADI questions and risk of all-cause or COPD hospitalizations. ResultsParticipants (N = 388) had a mean age of 69.6 ± 7.5 years, predominately male (96 %), and 144 (37.1 %) reported having fallen in the last year. More than half reported feeling unsteady with walking (52.6 %) or needing to use their arms to stand up from a chair (61.1 %). A third were concerned about falling (33.3 %). Three questions were associated with all-cause (not COPD) hospitalization in both unadjusted and adjusted cross-sectional analysis (N = 213): “fallen in the past year” (IRR 1.77, 95 % CI 1.10 to 2.86); “unsteady when walking” (IRR 1.88, 95 % CI 1.14 to 3.10); “advised to use a cane or walker” (IRR 1.89, 95 % CI 1.16 to 3.08). ConclusionsThe prevalence of self-reported falling risk was high in this sample of veterans with COPD. The association between falling risk and all-cause hospitalization suggests that non-COPD hospitalizations can negatively impact intrinsic risk factors for falling. Further research is needed to clarify the effects of all-cause hospitalization on falling risk in persons with COPD.

Patient-stimulated fall prevention screening in primary care: analysis of provider coding changes

BackgroundThe Centers for Disease Control and Prevention (CDC) has developed an evidenced based clinical screening tool, Stopping Elderly Accidents, Deaths & Injuries (STEADI) but penetration into routine clinical practice has been slow. To increase screening for falls and fall risk in an internal medicine primary care practice, a patient-centered screening program was integrated into a busy academic clinic.MethodsOver a three month period, Patients were invited to self-screen via a large poster in the waiting room, and complete a STEADI Staying Independent questionnaire, and discuss findings with their healthcare provider. Fall Prevention Booklets were made readily available in clinic exam rooms. Questionnaires and fall prevention booklets, were uniquely numbered, and Epic Slicer-Dicer reports were utilized to evaluate falls screening-related ICD-10 codes determined a priori. Generalized linear modeling calculated difference-in-difference compared with other clinics without this program for rates of coding for fall-related diagnosis codes.ResultsIn three months, 255 questionnaires were taken; only 5 (2%) were returned for later review. 110 booklets were disseminated from clinic exam rooms. The absolute difference-in-difference in ICD-10 coding was 0.7% compared to other clinics in the same practice, and year before. Generalized linear modeling showed a 4.7% increased impact in screening-related ICD-10 codes, which was statistically significant (P = < .0001) without reported disruption to clinical workflows.ConclusionThere are indicators that patient-centered selective screening at a busy academic practice may have resulted in an increase in falls-related ICD-10 coding. Clinical integration of this program was well received.