How To Make Fall Prevention Screening a Routine Part of Clinical Care

Jul 15, 2020 10:00:00 AM / by Crystal Trevors, MBA, MSc - President & CEO

How To Make Fall Prevention Screening and Assessment a Routine Part of Clinical Care

Falls in older adults 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.

CDC Senior Fall Prevention Strategy GraphicPhoto Credit: CDC STEADI Program


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
  • Distribute fall risk screening questionnaires
  • Use electronic medical record to identify patients who are due for fall risk screening
  • Raise awareness about falls
  • Ensure follow-up for at-risk patients

Medical Assistant
  • Conduct fall risk screening
  • Perform vision assessment
  • Enter data into the electronic medical record
  • Notify a provider of any concerns related to assessment
Nurse
  • Perform gait testing
  • Conduct medication reconciliation
  • Check orthostatic blood pressure
  • Perform vision assessment
  • Assess feet and footwear
  • Conduct cognitive assessment
  • Discuss fall prevention strategies with patients and caregivers
  • Discuss suitable fall risk strategies
  • Provide appropriate educational materials
  • Follow up to ensure patients are following their fall risk care plan
Physician
  • Take a careful fall history, including circumstances of previous falls
  • Perform a physical exam, including an observation of gait
  • Review results of fall risk assessments performed by other team members
  • Manage medications that increase fall risk
  • Order appropriate labs and imaging
  • Recommend and provide referrals
  • Discuss fall prevention strategies with patients and caregivers
  • Actively engage patients and caregivers in developing and implementing their own personal fall prevention plan
  • Recommend community exercise or fall prevention programs
Physical Therapists
  • Perform detailed gait and balance testing
  • Design a rehabilitation plan or exercise program to improve mobility and balance
  • Educate patients about community-based fall prevention programs such as Tai Chi classes


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.


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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.

Stepscan Fallrisk Report 2020

How Can Stepscan Help?

Fall Screening and Assessments

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.

To learn more about Stepscan and how it is supporting fall prevention and healthy aging contact us today. A member of our Product Specialist team will be happy to discuss with you.

“Mobility is the litmus test for healthy aging!”

Tags: Research, Rehabilitation, Senior Care

Crystal Trevors, MBA, MSc - President & CEO

Written by Crystal Trevors, MBA, MSc - President & CEO

Crystal is the founder and owner of Stepscan Technologies Inc. She holds a Bachelor of Science from the University of New Brunswick, and a Master of Science in Biology from the University of Prince Edward Island, as well as a Master’s in Business Administration from the University of Guelph. Her business and research interests include corporate performance management and reporting, process improvement and operational efficiencies. Operating Stepscan is a dream come true for her, allowing her to combine her love of biology, research and business, every day.

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