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

INTRODUCTION:

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

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

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

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?

THE NERDIEST STUFF:

Who has heard of the STEADI toolkit

created by the CDC?

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

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

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?

STAY INDEPENDENT QUESTIONNAIRE

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”

How many times have you fallen in the last year?

Step 2: Assess if deemed “fall risk”

Step 2: Assess if deemed “fall risk”

Timed Up & Go / TUG (Recommended) https://www.youtube.com/watch?v=BA7Y_oLElGY

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?

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

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?

30–Second Chair Stand (Optional)

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

Step 3: Intervene

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.

What happens at Physical Therapy should not stay at Physical Therapy…..

Patient Resources

• Stepping on

• Silver sneakers

• Otago

• Tai Chi

• Others??

Putting it all together

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”

Questions??

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.