Centers for Disease Control and Prevention National Center for Injury Prevention and Control
As a healthcare provider, you are already aware that falls are a serious threat to the health and well-being of your older patients.
More than one out of four people 65 and older fall each year, and over 3 million are treated in emergency departments annually for fall injuries.
The CDC’s STEADI initiative offers a coordinated approach to implementing the American and British Geriatrics Societies’ clinical practice guideline for fall prevention. STEADI consists of three core elements: Screen, Assess, and Intervene to reduce fall risk.
The STEADI Algorithm for Fall Risk Screening, Assessment, and Intervention outlines how to implement these three elements.
Information about falls
Case studies
Conversation starters
Screening tools
Standardized gait and balance assessment tests (with instructional videos)
CDC’s STEADI tools and resources can help you screen, assess, and intervene to reduce
Educational materials for providers, patients, and caregivers
Online continuing education
Information on medications linked to falls
Clinical decision support for electronic health record systems
Algorithm for Fall Risk Screening, Assessment, and Intervention
RESOURCE
You play an important role in caring for older adults, and you can help reduce these devastating injuries.
Additional tools and resources include:
your patient’s fall risk. For more information, visit www.cdc.gov/steadi.
Stopping Elderly Accidents, 2019 Deaths & Injuries
http://www.cdc.gov/steadi
http://www.cdc.gov/steadi
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STEADI Algorithm for Fall Risk Screening, Assessment, and Intervention among Community-Dwelling Adults 65 years and older
Available Fall Risk Screening Tools:
SCREEN for fall risk yearly, or any time patient presents with an acute fall. START HERE
• 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) • 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?” 1 SCREENED NOT AT RISK SCREENED AT RISK ASSESS patient’s modifiable risk factors and fall history. 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 2 Common ways to assess fall risk factors are listed below: Measure orthostatic blood pressure (Lying and standing positions) Ask about potential home hazards (e.g., throw rugs, slippery tub floor) Identify medications that increase fall risk (e.g., Beers Criteria) Evaluate gait, strength, & balance Common assessments: • Timed Up & Go • 30-Second Chair Stand • 4-Stage Balance Test Check visual acuity Common assessment tool: • Snellen eye test Assess vitamin D intake Assess feet/footwear Identify comorbidities (e.g., depression, osteoporosis) Centers for Disease Control and Prevention National Center for Injury Prevention and Control INTERVENE to reduce identified risk factors using effective strategies. 3 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 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) Orthostatic hypotension observed • Stop, switch, or reduce the dose of medications that increase fall risk • Educate about importance of exercises (e.g., foot pumps) Home hazards likely • Refer to occupational therapist to evaluate home safety • Establish appropriate blood pressure goal • Encourage adequate hydration • Consider compression stockings Visual impairment observed • Refer to ophthalmologist/optometrist • Stop, switch, or reduce the dose of medication affecting vision (e.g., anticholinergics) • Consider benefits of cataract surgery • Provide education on depth perception and single vs. multifocal lenses Feet/footwear issues identified • Provide education on shoe fit, traction, insoles, and heel height Comorbidities documented • Optimize treatment of conditions identified Vitamin D deficiency observed or likely • Recommend daily vitamin D supplement • Refer to podiatrist • Be mindful of medications that increase fall risk FOLLOW UP with patient in 30-90 days. Discuss ways to improve patient receptiveness to the care plan and address barrier(s) - - - - - https://www.americangeriatrics.org/publications-tools https://www.cdc.gov/steadi/pdf/STEADI-Assessment-TUG-508.pdf https://www.cdc.gov/steadi/pdf/STEADI-Assessment-30Sec-508.pdf https://www.cdc.gov/steadi/pdf/STEADI-Brochure-StayIndependent-508.pdf https://www.cdc.gov/steadi/pdf/STEADI-Assessment-4Stage-508.pdf https://www.cdc.gov/steadi/pdf/STEADI-Assessment-4Stage-508.pdf RESOURCE Algorithm for Fall Risk Screening, Assessment, and Intervention Additional tools and resources include: 1 SCREEN for fall risk yearly, or any time patient presents with an acute fall. 2 ASSESS patient’s modifiable risk factors and fall history. Evaluate gait, strength, & balance Identify medications that increase fall risk Ask about potential home hazards Measure orthostatic blood pressure Check visual acuity Assess feet/footwear Assess vitamin D intake Identify comorbidities 3 INTERVENE to reduce identified risk factors using effective strategies. Reduce identified fall risk Poor gait, strength, & balance observed Medication(s) likely to increase fall risk Home hazards likely Orthostatic hypotension observed Visual impairment observed Feet/footwear issues identified Vitamin D deficiency observed or likely Comorbidities documented