Mitigating fall risk: A community fall reduction program

doi:10.1016/j.gerinurse.2017.08.014

Geriatric Nursing

Volume 39, Issue 2, March–April 2018, Pages 199-203

https://doi.org/10.1016/j.gerinurse.2017.08.014 Get rights and content

Abstract

One fourth of all American’s over 65 years of age fall each year. Falls are a common and often devastating event that can pose a serious health risk for older adults. Healthcare providers are often unable to spend the time required to assist older adults with fall risk issues. Without a team approach to fall prevention the system remains focused on fragmented levels of health promotion and risk prevention. The specific aim of this project was to engage older adults from the community in a fall risk assessment program, using the Stopping Elderly Accidents, Deaths & Injuries (STEADI) program, and provide feedback on individual participants’ risks that participants could share with their primary care physician. Older adults who attended the risk screening were taking medications that are known to increase falls. They mentioned that their health care providers do not screen for falls and appreciated a community based screening.

Section snippets

Background

In a review of the literature,¹⁵ found that the most common risk factors for falls in older adults included impaired balance and gait, polypharmacy, and a history of previous falls. Other factors from this literature review that often influence fall risk include age, female gender, visual impairment, cognitive decline, and environmental factors.

There is now strong evidence that structured fall-preventive programs for the elderly, especially for those older adults with high-risk for falls, are

Discussion

Older adults who attended the risk screening appreciated the benefit of fall risk screening for themselves and others in the community. They stated that their health care provider did not screen for falls and did not have the equipment, time or office space to do so. However, were very interested in taking the evaluation received at the fall risk event back to their primary care provider and having a discussion about fall risk and fall safety. Several of the community participants were taking

Conclusions

The purpose of this project was to form an interdisciplinary team of healthcare providers to work with community dwelling elders to evaluate individual fall risk. The group used the STEADI fall risk assessment and prevention program to evaluate fall risk in these elders and provide them with a fall risk assessment sheet to take to their primary care provider.

The interdisciplinary team of students worked together and shared discipline specific knowledge in this fall evaluation. In this manner,

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Cited by (9)

A Longitudinal Fall Prevention Study for Older Adults
2019, Journal for Nurse Practitioners
Citation Excerpt :
Many were taking medications that put them at risk for falls. The researchers provided recommendations to reduce PIMs by discussing their fall risk and medication profile with their primary care providers.22 Even though the research evidence shows that fall prevention programs are effective,23 the practice of recommending strategies to reduce falls by primary care providers is not consistent.
Falls among the older adult population are a health concern that can be addressed by nurse practitioners in primary care settings. The purpose of the study was to improve gait and balance through exercise, reduction of polypharmacy and potentially inappropriate medication, education about medications, and removal of potential hazards in the home environment. Over 12 months, participants had a significant improvement in the fourth position of the 4-Stage Balance test and the 30-Second Chair Stand. They also had a reduced number of falls. Nurse practitioners can replicate the study using the STEADI Kit from the Centers for Disease Control and Prevention.
How steady is the STEADI? Inferential analysis of the CDC fall risk toolkit
2019, Archives of Gerontology and Geriatrics
Citation Excerpt :
Therefore, screenings performed in other places, such as the community, and by other providers such as physical therapists, may help reach a greater number of older adults and may improve the sustainability of fall risk identification initiatives (Ory & Smith, 2015). Physical therapists, as movement system experts and direct access healthcare providers, have been using the STEADI toolkit for fall risk screening and falls prevention initiatives within their communities (Reinoso, McCaffrey, & Taylor, 2017). However, the utility and validity of the STEADI algorithm has not been investigated with community-based fall risk screenings or when conducted by physical therapists.
The CDC developed the STEADI toolkit to assist providers with incorporating fall risk screening, assessment of modifiable risk factors, and implementing evidence-based treatment strategies. The purpose of this study was two-fold: analyze the STEADI algorithm for strengths/weaknesses based upon inferential data and provide recommendations for additional research and possible limitations of the STEADI toolkit from a physical therapy perspective.
This investigation employed a quantitative, cross-sectional cohort design collating data from community-dwelling and retirement-facility seniors (n = 77) from two regions of the U.S. Data is reported based upon descriptive statistics, correlation, and validity of the STEADI algorithm, its subcomponent tests, and self-reported fall data. All participants completed the Stay Independent Brochure (SIB) and the algorithm's mobility, balance, and lower extremity strength tests regardless of risk categorization.
Sensitivity of the STEADI with discriminating fallers and predicting future falls was better among community-dwellers (73–80%) versus the retirement facility-dwellers (56–62%). The STEADI demonstrated high false negative rates among those categorized as low risk as 57% community-dwellers and 24% facility-dwellers fell in the prior 12 months and several fell within 6 months following participation. Results suggest that it is important to conduct more than one mobility or balance screening test, and indicate that elevated STEADI risk classification was not associated with advancing age.
Outcomes from this study suggest that cut-off scores and the selection of functional fall screening tests, as well as the relative weights and scoring of items on the SIB/3KQ be reevaluated to maximize discriminate and predictive validity of the algorithm.
Effect of intradialytic exercise on fall occurrences in older patients undergoing hemodialysis: a single-center non-randomized study
2023, Renal Replacement Therapy
Accidental Fall Death in McLean County: Examining Variables in Community-Dwelling Older Adults
2022, Journal of Gerontological Nursing
Physical Therapists as Partners for Community Fall Risk Screenings and Referrals to Community Programs
2021, Frontiers in Public Health
Older Adults’ Perspectives on Fall Risk: Linking Results to the ICF
2021, Journal of Applied Gerontology

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Feature ArticleMitigating fall risk: A community fall reduction program

Abstract

Section snippets

Background

Discussion

Conclusions

Aging, complexity and critical illness

J Gerontol Nurs

Health, functioning and disability in older adults – present status and future implications

Lancet

The aging of the global population: the changing epidemiology of disease and spinal disorders

Neurosurgery

Projections of the Size and Composition of the U.S. Population: 2014 to 2060

An aging nation: The older population in the United States. Population Estimates and Projections

Census Briefs. The Older Population: 2010 Issued November 2011

Prevention of falls in the elderly – a review

Osteoporos Int

Geriatric syndromes: clinical, research and policy implications of a core geriatric concept

J Am Geriatr Soc

Current Gerontology and Geriatrics Research

Feature Article
Mitigating fall risk: A community fall reduction program