How To Make Fall Prevention Screening and Assessment a Routine Part of Clinical Care
Falls in older are a significant and growing public health problem. According to the Centers for Disease Control and Prevention (CDC), injury death rates from falls nearly doubled between 2000 and 2013, from an average of 29.6 to 56.7 per 100,000 population. The direct medical costs of falls in the United States are projected to increase to $100 Billion by 2030.
STEADI: A Resource for Fall Prevention Implementation
In response to this growing problem, combined with low provider uptake of falls screening and interventions, the CDC developed the STEADI program- Stopping Elderly Accidents, Deaths and Injuries. Launched in 2013, the program is based on the clinical practice guidelines for prevention of falls in older adults proposed by the American and British Geriatrics Society in 2010.
The STEADI initiative emphasizes three key elements in fall prevention:
1) screening patients for fall risk,
2) assessing modifiable risk factors, and
3) intervening to reduce risk through clinical and community strategies.
STEADI places a heavy emphasis on providing fall screening and prevention in primary care settings because this is where older adults receive the majority of their care.
The CDC’s suggested workflow incorporates every member of a clinic team as shown in this abbreviated table:
|Team Member||Suggested Tasks|
|Front Office Staff|
Physical Therapists play an important role in falls risk management, as demonstrated in the above STEADI workflow table. They regularly assess gait and balance as a part of establishing a treatment plan, and several of the recommended interventions from the STEADI workflow are administered by physical therapists.
Interventions that are encouraged through STEADI include referrals to physical therapy or to a fall prevention exercise program. Patients may also be prescribed a mobility aid, or if they are using a mobility aid incorrectly, they may be referred to a physical therapist for instruction.
Other Resources to Facilitate Implementation Fall Prevention and Assessment
The APTA has a large collection of resources related to falls and balance disorders on a dedicated page of its website.
In 2015, the APTA also released a clinical guidance statement that makes recommendations about the management of falls in community-dwelling older adults, which is another valuable resource.
The exercise interventions recommended by physical therapists for patients at risk of falling vary according to the needs of the individual. One exercise program favored by many physical therapists is the Otago Exercise Program, an evidence-based intervention which consists of 17 strength and balance exercises designed for frail older adults.
How Can Stepscan Help?
According to the workflow of the STEADI initiative, fall assessments are to be conducted on any patient whose screening results indicate that they are at risk for falls. The goal of the screening is to determine if a patient is at risk for falling, whereas the goal of the assessment is to determine why the patient is at risk for falls.
Stepscan's technology is a unique mobility assessment tool that can be used for both fall screening and assessment purposes. By capturing objective measures of gait and balance and analyzing the irregularities in the findings, the technology is able to quickly and reliably identify high risk fallers during screening. Further to this, Stepscan® gait and plantar pressure analysis software reports measure all the critical parameters of gait and balance allowing baseline measures, level of impairment, and potential treatment options to be determined.