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How to STEADI your patients: Using outcomes measures to assess fall risk and refer to
Physical TherapyBy: Allyson Armstrong, DPT
Board Certified Geriatric Clinical Specialist
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INTRODUCTION:
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OBJECTIVES
• Today we will be discussing the CDC’s STEADI screening tool
• STEADI Tool • Screen • Assess• Intervene and Refer
• Role of Physical Therapy in fall prevention and fall risk assessment
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PHYSICAL THERAPY
• Trained in the use of differential diagnosis for causes of balance impairments.
• Experts in the areas of evidence based functional training for geriatric patients
• Multiple avenues: outpatient, home health, inpatient rehab, acute care
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THE NERDY STUFF:
** NO SINGLE TEST/ MEASURE DEMONSTRATED STRONG POST TEST PROBABILITY FOR FALL RISK**
• Best history questions
• Best self-report measures
• 5 performance based measures
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Research shows the most effective questions to ask to screen for falls :
1. Have you fallen in the last year?
2. Are you concerned about falling?
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THE NERDIEST STUFF:
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Who has heard of the STEADI toolkit
created by the CDC?
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STEADI = Stopping Elderly Accidents, Deaths & Injuries
• A coordinated approach to implementing the American and British Geriatrics Societies’ Clinical Practice Guideline for fall prevention.
• STEADI consists of three core elements:1. Screen patients for fall risk2. Assess modifiable risk factors3. Intervene to reduce risk by using effective clinical and
community strategies
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Resources available to you:
• Screening and Assessment (Focus of today’s presentation) • Algorithm
• Patient Resources: • Pocket guide: preventing falls in older patients
• Provider Resources: • Fall Facts • Medication Management• Wall Chart: integrating fall prevention into practice
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Step 1: Screen using the algorithm on any patients >65
• Using the “Stay Independent” Brochure:
OR
• Ask these questions: • Fell in the past year? ( how many times? Were you injured?)
• Feels unsteady when standing or walking?
• Worries about falling?
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STAY INDEPENDENT QUESTIONNAIRE
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Step 2: Assess
• If the patient scores >/= 4 on the “Stay Independent” Brochure
OR
• Answers YES to any of the questions = “FALL RISK”
Then move on to Assessment phase
• If NO than patient is deemed “NOT a fall risk”
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How many times have you fallen in the last year?
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Step 2: Assess if deemed “fall risk”
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Step 2: Assess if deemed “fall risk”
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Timed Up & Go / TUG (Recommended) https://www.youtube.com/watch?v=BA7Y_oLElGY
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Timed Up & Go / TUG (Recommended) • ** REQUIRES the patient to be ambulatory** • SET UP:
• Patient sits in chair with back and arms• Measure line 3 meters/10 feet away on the floor
• START: On the word “GO”, patient walks quickly around obstacle placed on line and returns to chair.
• STOP: As patient sits • ASSESS: >12 seconds to complete the TUG is at risk for falling • What does the TUG test?
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Why TUG?
• Takes very little time and supplies or time (<3 minutes!)
• Designed for the geriatric population (65+) and well studied in sub populations
• It’s reliable, and can predict fall risk
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30–Second Chair Stand (Optional) • SET UP:
• 17 inch chair without arm rests
• Stop watch
• Sit in the middle of chair, arms crossed over chest, feet flat.
• START: On “Go” rise for full stand and back down, repeating as quickly as possible.
• STOP: After 30 seconds • ½ a stand counts
• ASSESS: Below average score based on age indicates increased fall risk• What does this test?
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30–Second Chair Stand (Optional)
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4–Stage Balance Test (Optional) • SET-UP:
• Stopwatch, flat surface • TEST: 4 standing balance positions that get progressively more difficulty.
• Describe and demonstrate then help pt assume position with no assistive devices. 1. Romberg (feet side by side) 2. Semi-tandem3. Tandem 4. Single leg
• If patient cannot hold a position for 10 seconds without moving their feet or needing support go on to the next position.
• ASSESS: If patient cannot hold tandem for 10 seconds they are at an increase risk for falling
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Step 3: Intervene
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Step 4: Follow Up• If patient is a high fall risk there is A LOT of interventions.• Follow up in 30 days to assess medication changes • See if patient is participating in physical therapy. Reinforce
home exercise program.
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What happens at Physical Therapy should not stay at Physical Therapy…..
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Patient Resources
• Stepping on
• Silver sneakers
• Otago
• Tai Chi
• Others??
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Putting it all together
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In Conclusion
• Screen your patients for falls with the stay independent brochure or by asking 2 easy questions
• Perform the TUG with patients
• Refer to Physical Therapy for balance, gait assessments and falls.
• Learn about community resources such as “Stepping On”
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Questions??
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References1. Lusardi, Michelle M., et al. “Determining Risk of Falls in Community Dwelling
Older Adults.” Journal of Geriatric Physical Therapy, vol. 40, no. 1, 2017, pp. 1–36., doi:10.1519/jpt.0000000000000099.
2. “Materials for Healthcare Providers | STEADI - Older Adult Fall Prevention | CDC Injury Center.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, www.cdc.gov/steadi/materials.html.
3. “Predicting the Probability for Falls in Community- Dwelling Older Adults Using the Timed Up & Go Test.” Physical Therapy, 2000, doi: 10.1093/ptj/80.9.896.