Staying 'STEADI' in Arkansas Lessons learned and recommendations on communitybased fall risk screening, assessment, and fall prevention Jennifer Vincenzo, PT, MPH, PhD, GCS, CHES University of Arkansas for Medical Sciences jlvincenzo@uams.edu Susan Kane Patton, PhD, MHSA, APRN University of Arkansas, Fayetteville skpatton@uark.edu Disclosure Jennifer Vincenzo received partial funding for her research from the Geriatric Workforce Enhancement Award through the University of Arkansas for Medical Science (HRSA, DHHS 2016) Session Learning Objectives List the key screening questions for fall risk in older adults Access materials for professionals and older adults on the STEADI website • Develop a plan for implementation of fall risk screening specific to their community CONTENT Falls Background and introduction to the STEADI Research in Press Our experience with the STEADI As a physical therapist, nurse, and educators Discussion implementation Every second an older adult suffers a fall Falls are the leading cause of injury and death among older Americans Falls cost Medicare more than $31 billion/year Arkansas • Ranks LAST in America’s Health Rankings for Falls • HIGHEST rate in nation at 34.3% • High rate of physical inactivity – 37.4% - ranks 47/50 RISK FACTORS MULTIFACTORIAL Origin of the STEADI • American Geriatrics Society/British Geriatrics Society CPG (AGS/BGS 2010; Stevens & Phelan, 2013) • Fall Risk Questionnaire (FRQ; Rubenstein et al., 2011) • Originally designed for PCPs to identify and manage fall risk • Physical therapists and nurses use it to conduct community screenings/fall risk assessments Research in press • Using STEADI in Level Trauma hospital-based setting resulted in: • Decreased LOS • Increased rates of d/c home • Decreased readmission rates with falls • Only on https://www.cdc.gov/steadi/stories/hospital.html OUR experience How Steady is the STEADI? © Nithman/Vincenzo, 2018 Physical therapy instructors and students • Since 2015 • PT students at UAMS have been conducting yearly fall risk screenings with the STEADI in retirement homes • Education by online modules • Practice important! • Teams • Pharmacy students one year • Advertisement of open fall risk screenings Issues from our perspective Nursing instructors and students • Research question: Does completion of an online falls prevention course with opportunity to practice skills increase self-efficacy in fall risk assessment and management among undergraduate and graduate nursing students? • Convenience sample of students enrolled in six sections of a senior level clinical course in the Bachelor of Science program and a graduate level health assessment course in the Doctor of Nursing Practice program Final sample of 63 students Qualitative Results: Learning to a falls risk assessment Increasing self-efficacy through mastery Learning through observation The power of positive reinforcement Issues from our perspective • Addressing ageism • Contributions of online vs face-to-face approaches • IPE • Longitudinal studies Program Impact • 14 clinicians (physical therapists and nurses) have been educated on and conducted screenings • 193 physical therapy and nursing students have been educated on and conducted screenings • 217 older adults in Northwest Arkansas have been screened for falls Future impact/plans • Multidisciplinary falls risk screenings • Community Fall Prevention Day TO IMPLEMENTATION • Considerations of adherence to referrals/recommendations to prevent falls • Ensure screenings and assessments are being conducted properly • follow the directions • Don’t just refer/recommend – provide the resources and address barriers! CDC Estimates on impact of implementation • For every 5,000 health care providers who adopt STEADI • Over years, million patients may be screened • million falls could be prevented • Estimated $3.5 billion savings in medical costs • (Centers for Disease Control and Prevention, 2016) TO IMPLEMENTATION • Good learning experience for students • Emphasize importance of fall prevention • Interprofessional screenings/assessments • Good community event • You not need to be a health care provider to conduct most of the aspects of the falls risk screening/assessment skpatton@uark.edu jlvincenzo@uams.edu References 1) Burns ER, Stevens JA, Lee R The direct costs of fatal and non-fatal falls among older adults—United States J Safety Res 2016;58: 99-103 2) Panel on Prevention of Falls in Older Persons - American Geriatrics Society and British Geriatrics Society Summary of the Updated American Geriatrics Society/British Geriatrics Society clinical practice guideline for prevention of falls in older persons J Am Geriatr Soc 2011;59(1):148-157 3) Centers for Disease Control and Prevention STEADI Toolkit for Healthcare Providers 2013; https://www.cdc.gov/steadi/index.html Accessed March 16, 2016 4) Spagnuolo DL, Jurgensen SP, Iwama AM, Dourado VZ Walking for the assessment of balance in healthy subjects older than 40 years Gerontology 2010;56(5):467-473 5) Panzer VP, Wakefield DB, Hall CB, Wolfson LI Mobility assessment: sensitivity and specificity of measurement sets in older adults Arch Phys Med Rehabil 2011;92(6):905-912 6) Parker SJ, Jessel S, Richardson JE, Reid MC Older adults are mobile too! Identifying the barriers and facilitators to older adults' use of mHealth for pain management BMC Geriatr 2013;13:43 7) Avin KG, Hanke TA, Kirk-Sanchez N, McDonough C, Shubert TE, Hardage J, Hartley G Management of falls in community-dwelling older adults: clinical guidance statement from the Academy of Geriatric Physical Therapy of the American Physical Therapy Association Phys Ther 2015;95(6):815-834 8) Stevens JA, Phelan EA Development of STEADI - a fall prevention resource for health care providers Health Promot Pract 2013;14(5): 706-714 9) Phelan EA, Mahoney JE, Voit JC, Stevens JA Assessment and management of fall risk in primary care settings Med Clin North Am 2015;99(2):281-293 10) Lohman MC, Crow RS, DiMilia PR, Nicklett EJ, Bruce ML, Batsis JA Operationalisation and validation of the STEADI fall risk algorithm in a nationally representative sample J Epidemiol Community Health 2017;0:1–7 11) Stevens JA, Smith ML, Parker EM, Jiamng L, Floyd FD Implimenting a Clinically Based Fall Prevention Program Amer Journal Lifestyle Med 2017; e-plublished https://doi.org/10.1177/1559827617716085 12) Park SH Tools for assessing fall risk in the elderly: a systematic review and meta-analysis Aging Clin Exp Res 2018; 30:1–16 DOI 10.1007/s40520-017-0749-0