Fall Risk Assessment: The STEADI toolkit

Transcription

1 Fall Risk Assessment: The STEADI toolkit Need, development, and use. Becky Turpin, MS Jodi Janczewski, DPT Portions adapted and used with permission from Mindy Renfro, PT, PhD; University of Montana - All Rights Reserved

2 What is the STEADI toolkit? STEADI = Stopping Elderly Accidents, Deaths & Injuries The STEADI toolkit is a simple but comprehensive approach for fall risk assessment and effective fall prevention for older adults. It was developed by the CDC for use by primary care practitioners (PCPs), PT s and anyone who serves older adults.

3 Who should be tested with STEADI? The STEADI toolkit, like the AGS/BGS guidelines, applies ONLY to community-dwelling, independently ambulatory older adults ages 65+. It is NOT intended for institutionalized &/or hospitalized patients. ALL out-patients over the age of 65 should be tested with STEADI annually.

4 Where does the STEADI fit? CDC is launching STEADI to identify fall risks in older adults Once fall risks are identified, they need to be abated Offering and referring to evidence-based fall prevention programs (EBP s) is critical These include the Otago Exercise Program, Stepping On, Matter of Balance and T ai Chi Moving for Better Balance

5 AGS Guidelines for Fall Mgmt. SCREENING AND ASSESSMENT 1. All older individuals should be asked whether they have fallen (in the past year). 2. An older person who reports a fall should be asked about the frequency and circumstances of the fall(s). 3. Older individuals should be asked if they experience difficulties with walking or balance. 4. Older persons who present for medical attention because of a fall, report recurrent falls in the past year, or report difficulties in walking or balance (with or without activity curtailment) should have a multifactorial fall risk assessment. 5. Older persons presenting with a single fall should be evaluated for gait and balance. 6. Older persons who have fallen should have an assessment of gait and balance using one of the available evaluations. 7. Older persons who cannot perform or perform poorly on a standardized gait and balance test should be given a multifactorial fall risk assessment. 8. Older persons who have difficulty or demonstrate unsteadiness during the evaluation of gait and balance require a multifactorial fall risk assessment. 9. Older persons reporting only a single fall and reporting or demonstrating no difficulty or unsteadiness during the evaluation of gait and balance do not require a fall risk assessment. 10. The multifactorial fall risk assessment should be performed by a clinician (or clinicians) with appropriate skills and training. Please visit this link for the full guideline: mendations/prevention_of_falls_summary_of_recommendations

6 Effective Fall Prevention The AGS/BGS guidelines were thorough and helpful, but not user-friendly. The CDC set out to discover how the guidelines could be made more useful to primary care practitioners (PCPs)

7 Initial Interviews 90 min. phone interviews with 18 PCP s regarding the importance of falls to their patients 6 Geriatricians 6 Primary Care Providers 3 Registered Nurses 3 Nurse Practitioners

8 PCP Interview Results about Falls Recognize falls are a threat for their older patients Lack information about standardized assessment methods & evidence-based prevention strategies Tend to be reactive rather than proactive in addressing falls

9 Interview Results (cont) Time was the biggest barrier Need to address multiple health problems Asked for materials that were direct, concise & easy to read Preferred checklists, one-pagers & on-line information

10 Focus Groups formed to Review Nine people in each of 6 groups: Primary care providers (2 groups) Geriatricians Nurses Nurse practitioners Physician assistants STEADI Materials

11 Contents of the STEADI Toolkit I. Provider Resources II. Training Materials III. Patient Education Brochures Let s look at each element Order &/or download STEADI materials at eandrecreationalsafety/fa lls/steadi/index.html

12 Simplified Flow Chart Flow chart summarizes the AGS Fall Prevention Guidelines Each element in the toolkit relates to this chart Adapted from AGS, Clinical Practice Guidelines, 2010

13 Overview of Toolkit Content I. Provider resources II. Training materials III. Patient education Viewing the documents on-line will allow you to follow embedded links to additional resources Now available at

14 I. Provider Resources Fact sheets 3.5 x 5.5 Pocket Guide Chart Integrating Falls Assessment & Interventions Into Practice Assessment tools Management tools

15 Resources: Fact Sheets

16 Pocket Guide

17 Management: Integrating Fall Prevention into Practice Organize each practice so fall risk assessment and management occurs routinely: How does the practice use all members of the office to manage fall risk and prevention? Can the receptionist be useful? How? Where/when should the patient complete the questionnaire? Who/when/why should perform balance tests? What is the role of the PCP and can this be streamlined but effective?

18 Assessment Tools Stay Independent brochure for self-risk assessment contains the patient-completed questionnaire. Instructions for 3 standardized gait & balance tests orthostatic blood pressure measurement Fall Risk Checklist for summarizing risk assessment findings

19 Stay Independent Brochure Please see:

20 Stay Independent Brochure

21 Gait And Balance Test Instructions Instructional videos for these balance tests are available at:

22 Orthostatic Hypotension (OH) As you know, OH can cause falls and is frequently overlooked. Checking OH routinely in all older adults is critical and often overlooked. OH is defined as > 10 mmhg drop in diastolic and/or > 20 mmhg drop in systolic BP

23 Fall Risk Checklist This checklist is intended to put it all together Findings from the patient s assessment can all be summarized and easily reviewed.

24 Management Tools Fall Prevention Referral Form(s) Expedient way to refer to Physical Therapy, Occupational Therapy, Podiatry, Optometry, for a home safety assessment or to see a Physician or Specialist to address the risk factors identified

25 Management Tools Recommended Fall Prevention Classes Worksheet for listing EBFP s available in the community and contact information Should include day/time and costs when information is available. Wisconsin Institute for Healthy Aging (wihealthyaging.org) More classes needed!

26 II. Training Materials Case studies illustrating 3 levels of fall risk Practice patient intervention with the Toolkit Talking about Fall Prevention with Your Patients Are they ready to change? Stages of Change model

27 Case Studies

28 Talking with Patients This 4-page document helps the provider speak with older adults about behavioral change It first describes the model and then gives examples of conversations

29 III. Patient Education Materials 3 CDC brochures What YOU Can Do to Prevent Falls Check for Safety Postural hypotension: What it is & how to manage it Order or download these at

30 Patient Education This handout gives detailed instructions and pictures for the chair rise exercise. This may be a good starting point depending upon a person s comfort with exercise. Suggest individuals place the handout in the living room with the TV remote control and perform during commercials daily.

31 What is the Role of Non-PCPs? Hand out the Stay Independent brochure to older adults Encourage them to complete the questionnaire to check their risk for falling Follow up on risks identified in each area Help to educate and motivate behavioral change in older adults Ask that older adults initiate a conversation about falls with their doctors Educate other practitioners working with you about the STEADI Toolkit and to ask their clients about falls Offer/support EBP s for fall prevention in your area

32 Wrapping Up! Ask ALL older adults about falls Having older adults complete the Stay Independent brochure will start the process for risk assessment Find safe, effective, long-term fitness classes for older adults and try to motivate them to participate regularly. Use and offer EBFPs such as Otago, Stepping On, Matter of Balance, T ai chi: Moving for Better Balance to decrease fall risk. Be proactive in bringing evidence-based fall prevention programs to YOUR area. Spread the word about STEADI, especially to primary care providers so that all older adults have fall risk assessed and can get started on prevention!

33 Next Steps Create the referral and resource pages for your community. Are there EBFP s in your community? Go out and introduce providers to the toolkit Link health systems with community programs

34 Updates on Wisconsin Programs: Otago Exercise Program Training for Physical Therapists to implement the Otago Exercise Program is now available in an online course developed by the Carolina Geriatric Education Center At your own pace you complete the 3-hour course that can be stopped and started at anytime You learn the background & purpose of the Otago Exercise Program, program delivery and program fidelity Registration: Go to AHEC Connect register for an account then sign up for the Otago Exercise Program: Training for Physical Therapists (cost $25)

35 Updates on Wisconsin Programs: LiFE Program Lifestyle integrated Functional Exercise Teaching people to integrate principles of balance and strength training into everyday activities 31% reduction in falls in the LiFE group compared to controls 2 therapists in Wausau have been trained in LiFE and will become master trainers 2 more therapists in Wausau are being trained this month Research is developing a teaching package to train more therapists while upholding the key elements of the program and remaining effective in falls reduction

36 Updates on Wisconsin Programs: WI Fall Prevention Initiative Conference calls the second Thursday of every odd month (1:30pm-3:00pm) Training, peer-to-peer technical assistance, state and national updates Implementation of STEADI September = WI Fall Prevention Awareness Month September 22 = State and National Fall Prevention Awareness Day

37 Thank You! Please feel free to contact us: Becky Turpin Phone: (608) Jodi Janczewski, DPT Phone: (608)