APMA News - September/October 2024 - 11

STEADI Algorithm
STEADI Algorithm for Fall Risk Screening, Assessment, and Intervention among Community-Dwelling Adults 65 years and older
Available Fall Risk
Screening Tools:
START HERE
1
SCREEN for fall risk yearly, or any time patient presents with an acute fall.
* Stay Independent: a 12-question tool [at risk if score ≥ 4]
Important: If score < 4, ask if patient fell in the past year
(If YES  patient is at risk)
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* Three key questions for patients [at risk if YES to any question]
Feels unsteady when standing or walking?
Worries about falling?
Has fallen in past year?
» If YES ask, " How many times? " " Were you injured? "
-
-
-
SCREENED NOT AT RISK
SCREENED AT RISK
PREVENT future risk by recommending
effective prevention strategies.
* Educate patient on fall prevention
* Assess vitamin D intake
If deficient, recommend daily
vitamin D supplement
-
* Refer to community exercise or fall
prevention program
* Reassess yearly, or any time patient
presents with an acute fall
Evaluate gait, strength, & balance
Common assessments:
*Timed Up & Go
*30-Second Chair Stand
*4-Stage
Balance Test
Identify medications that increase fall risk
(e.g., Beers Criteria)
Ask about potential home hazards
(e.g., throw rugs, slippery tub floor)
Measure orthostatic blood pressure
(Lying and standing positions)
Check visual acuity
Common assessment tool:
* Snellen eye test
Assess feet/footwear
Assess vitamin D intake
Identify comorbidities
(e.g., depression, osteoporosis)
Poor gait, strength, & balance observed
* Refer for physical therapy
* Refer to evidence-based exercise or fall prevention program (e.g., Tai Chi)
Medication(s) likely to increase fall risk
* Optimize medications by stopping, switching, or reducing dosage of medications that increase fall risk
Home hazards likely
* Refer to occupational therapist to evaluate home safety
Orthostatic hypotension observed
* Stop, switch, or reduce the dose of medications that
increase fall risk
* Educate about importance of exercises (e.g., foot pumps)
Visual impairment observed
* Refer to ophthalmologist/optometrist
* Stop, switch, or reduce the dose of medication
affecting vision (e.g., anticholinergics)
Feet/footwear issues identified
* Provide education on shoe fit, traction,
insoles, and heel height
Vitamin D deficiency observed or likely
* Recommend daily vitamin D supplement
Comorbidities documented
* Optimize treatment of conditions identified
* Be mindful of medications that increase fall risk
* Establish appropriate blood pressure goal
* Encourage adequate hydration
* Consider compression stockings
* Consider benefits of cataract surgery
* Provide education on depth perception
and single vs. multifocal lenses
* Refer to podiatrist
2
ASSESS patient's modifiable
risk factors and fall history.
Common ways to assess fall risk
factors are listed below:
3 INTERVENE to reduce identified risk factors using effective strategies.
Reduce identified fall risk
* Discuss patient and provider health goals
Below are common interventions used to reduce fall risk:
* Develop an individualized patient care plan (see below)
Centers for Disease
Control and Prevention
National Center for Injury
Prevention and Control
FOLLOW UP with patient in 30-90 days.
Discuss ways to improve patient receptiveness to the care plan and address barrier(s)
experience modest to moderate improvements
in pain, fatigue, stiffness, strength, and balance.
Also interesting and being studied in Iowa
through Iowa State University and the Iowa Hub
is clinician use of a community-care hub model
to bidirectionally refer to evidence-based interventions.
This way, clinicians can easily refer to
and patients can access evidence-based community
arthritis and falls prevention resources
with documentation upon completion.
Future of Falls Prevention
What additional resources or tools
would you recommend to podiatrists
who want to expand their practice's
focus on falls prevention?
The first and most important step is to be
completely familiar with the CDC STEADI
initiative. September is falls prevention month
and the National Council on Aging has updated
resources with the theme of Awareness to
Action. Focusing on the falls prevention and
arthritis-appropriate evidence-based interventions
available in your community will positively
impact your community's health and falls
prevention efforts. Documenting and tracking
Physical Activity as a Vital Sign is the future of
evidence-based physical activity interventions
for falls prevention. Falls prevention resources
are available on APMA.org.
Reference
1
H.B. Menz, M.E. Morris, S.R. Lord, " Foot and Ankle
Risk Factors for Falls in Older People: A Prospective
Study, " J Gerontol A Biol Sci Med Sci 61, no. 8
(2006): 866-70. doi: 10.1093/gerona/61.8.866.
PMID: 16912106.
APMA.ORG
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11
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APMA News - September/October 2024

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