Dave was joined by Dr. Gwen Bergen with the CDC's National Center for Injury Control and Prevention to talk about the CDC's STEADi program (Stopping Elderly Accidents, Deaths and Injuries) on the AwareGiver Radio Show. Following is a complete transcript. You can also listen to the show at https://api.spreaker.com/v2/episodes/40061574/download.mp3
00:01 David Happe: Welcome to the AwareGiver Radio Show. My name is David Happe and as you guys know, we are here to equip caregivers in hopes of making your jobs easier and your patients' lives a little better. I got a real neat opportunity today and I'm gonna introduce this opportunity to you but we wanted to do a show centred around the CDC's program on stopping elderly accidents, deaths and injuries and I'm gonna tell you a little bit about why that's so important and I'm gonna introduce our special guest for today but each year, more than one in four older adults, ages 65 and older will fall, think about that. The CDC says that falls are not supposed to be an inevitable part of aging. Amongst older Americans, falls are the number one cause of injuries and deaths from injury. This represents 29 million falls, 3 million emergency department ED visits, according to CDC's statistics, that's easy for me to say, 8,000 hospitalisations, 28,000 deaths as the leading cause guys, of fatal and non-fatal injuries amongst older adults. Falls will continue to soar as America's baby boomers start to grow older so this is a super important concept, super important topic.
01:20 DH: So we did what we're supposed to do. We went right to the top for you. I'm going to introduce to you our special guest. Dr. Gwen Bergen has been with the CDC's National Center for Injury Control and Prevention for over 10 years. She's a behavioural scientist on the safety promotion team focusing on understanding risk factors for older adult falls, implementing and evaluating fall prevention, older adult behaviours and attitudes towards fall prevention and older adult mobility issues. We got the perfect expert to come on the AwareGiver Show and talk to us about this. She received her Master's Degree in Public Health from the Emory Rollins School of Public Health and her PhD from the John Hopkins Bloomberg School of Public Health. That was a small intro for all the numerous publications and things that she's done in her expertise in this field but Dr. Bergen, I'm so thankful. Welcome to the AwareGiver Radio Show.
02:18 Dr. Gwen Bergen: Thanks so much for that introduction and I'm really excited about the chance to speak to caregivers because they are so important as they are kind of the immediate contact with older adults and can be some of the best people to identify that an older adult may have a risk for a fall.
02:36 DH: So I brought you on to talk about the CDC's STEADI program. STEADI stands for Stopping Elderly Accidents, Deaths and Injuries. Could you tell us just like... Give us kind of a 50,000-foot view of the STEADI program? How has it started? What's an overview of what the STEADI program is all about?
02:57 DB: As you mentioned Dave, falls are a serious problem for older adults and they lead to injury, death and a loss of independence. The good news is that many of these falls can be prevented and healthcare providers are well-positioned to help their older adult patients by recommending evidence-based interventions to reduce fall risks. Most providers don't discuss falls with their older adult patients for a lot of reasons but especially, they don't get training on fall prevention in medical school and they may not know what to advise so that's why CDC developed the STEADI initiative to help healthcare providers include effective fall prevention in their clinical practice.
03:41 DB: STEADI is based on the American Geriatric and the British Geriatric Society's guideline for the prevention of falls in older persons. The STEADI initiative was developed based on their recommendations and then it was refined using input from healthcare providers and STEADI recommends three core components or three steps to healthcare providers. The first one is to screen their older adult patients once a year by asking a series of questions to see if the older adult is at risk for a fall. The second part is to take those older adults who are at risk and assess them to see what kind of modifiable risk factors they may have and then finally, for each one of the modifiable risk factors identified, to intervene by recommending an evidence-based intervention that will help address that modifiable risk factor and reduce the older person's fall risk.
04:42 DH: I know that one of the program tweaks that you all have deployed as you've kind of refined the STEADI program and made it better and even stronger is it kind of redirected or changed how caregivers can identify patients by putting them through kind of a screening that would result in them being screened as not at risk or screened as at risk for a fall. What are the basics of how a caregiver might take a look at doing that risk assessment to put them in the bucket of screened and not at risk or screened and at risk?
05:20 DB: So the American Geriatric Society guideline recommended screening older adults annually for fall risks. To support that, CDC through the STEADI initiative, provides two different ways to screen older adults. The main one, the most detailed one is the Stay Independent Screener and then the second one are the Three Key Questions and either of these screening tools can be used to identify older adults who are at risk for a fall. Stay Independent is a brochure that is available at the STEADI website, which is www.cdc.gov/STEADI. Caregivers can go through that brochure with their older adult patient and answer yes or no to 12 statements about the person. Each yes answer has a number of points associated with it and if at the end the points total to four or more then that older adult is at risk for a fall. Stay Independent is also something the older adult can actually use on their own to identify if they are at risk for a fall. If the older adult is at risk for a fall, then the next step would be to take that screener in to their healthcare provider and talk about how they might be able to reduce their fall risk.
06:45 DH: Okay so for me as an independent caregiver, I could get on to the STEADI website at the CDC, I could print out that Stay Independent brochure, run through that checklist, see how my patient matches up and if my patient falls into that at risk area, that's the point that I'd wanna seek further intervention or further clarification from a healthcare provider.
07:15 DB: Yes. That's right, that tool will help you classify the person as either not at risk or at risk and since some of the assessments do require medical knowledge, it's best at that point to go to the healthcare provider with the results.
07:30 DH: I'm a complete layman in this regard and when we were talking before, I told you that my interest was kind of family-related 'cause I had a family, an elderly family member that was part of these statistics but you talked about a little terminology that me and just my layman's world don't really fully understand, can you talk to us a little bit more about, you said about identifying modifiable risk factors, can you explain a little bit about what modifiable risk factors might are and what we're looking for specifically?
08:02 DB: Certainly. A modifiable risk factor is one that can be changed. It's a risk factor that you can change and by changing it, you can reduce the risk of having a fall and an example of a modifiable risk factor would be strength and balance issues. We know that as you lose strength and you start having balance problems, that can increase the risk of a fall but you can modify this risk factor by working with a physical therapist or by doing strength and balance exercises and that will decrease your risk of a fall.
08:39 DH: Okay.
08:39 DB: Now an example of an unmodifiable risk factor would be age. We know that those 85 years and over are more likely to fall compared with those under 85 years. However, unfortunately it's not possible for any of us to become younger as much as we might like to but this doesn't mean it's hopeless for older people, you can't change your age but there actually might be a modifiable risk factor that's associated with aging that you can change so for example, as we age we lose muscle strength and we have increased balance issues. That strength and balance as I said, is a modifiable factor. So even the very oldest, older adults could reduce their fall risk by doing strength and balance exercises or working with a physical therapist and I wanted to just review what modifiable risk factors STEADI assesses older adults for to see if they're at risk for a fall.
09:43 DB: Those factors include gait strength and balance issues. Medications that might increase fall risk because of side effects, home hazards, which would be things like throw rugs or a slippery tub floor, orthostatic hypotension, which means that when you go from lying or sitting down to standing up, you have a sudden drop in blood pressure. Vision problems, foot and footwear problems are also risk factors, low vitamin D levels and finally comorbidities including but not limited to things like depression, osteoporosis and diabetes.
10:24 DH: So you talked about a couple of things that were actually on my next list of questions which was about effective interventions but you talked about some strength conditioning, I was gonna ask you maybe about environmental conditions, you mentioned things like really doing a site survey to take a look at the environment that the patient might be in. You might add to that effective interventions in terms of bathroom safety could be things like grab bars, etcetera but that's what I was gonna ask you just about what you think are... What would be any additional effective interventions that would be kind of common?
11:03 DB: Yes. Each of the risk factors that I mentioned does have an evidence-based intervention associated with it that can help reduce fall risk, which is one of the reasons we focus on these risk factors for STEADI because there is a way to address each one of these risk factors and I thought you mentioned and I mentioned before, you can work with a physical therapist or you can do strength and balance exercise such as Tai Chi to help you with your gait, strength and balance issues.
11:33 DH: One of the...
11:33 DB: For medications, as we age... Oh I'm sorry.
11:35 DH: Go ahead. No, go ahead, go ahead.
11:39 DB: As we age, our bodies process medications differently than they did when we were younger and this can lead to increase fall risk from side effects of medications. Healthcare providers, including pharmacists can evaluate your medications and possibly suggest an alternative or even reduce the dosage to reduce the impact of side effects and reduce your fall risk. As far as home hazards, we found that the research literature shows that having an occupational therapists assess your home and suggest ways to remedy any hazards is an effective way to reduce your fall risk. Older adults who have vision... Yes?
12:22 DH: Dr. Bergen, does diet have anything to do with this at all?
12:30 DB: We have not found an association between diet and falls, however it's not something that we have studied in our research. There may be an association between diet than osteoporosis and osteoporosis does increase your fall risk but again, it's something that we haven't specifically studied. Okay. So yeah. I think that I mentioned vision. If an older adult has vision or foot problems, they can see an eye doctor or a podiatrist to address those issues and finally, healthcare providers can address orthostatic hypotension and comorbidity issues in different ways including more effectively treating the condition like depression so that it doesn't have the side effects or the symptoms that maybe increase your fall risk. Or they can assess the medications you're getting for that condition to see if those medications might be causing some of your problems that are increasing your fall risk.
13:34 DH: So really, you start with the deep dive of making a determination as to whether they're screened and not at risk or screened and at risk and then you start to look at ways that you can create these effective interventions to start to moderate or eliminate some of those risks wherever possible.
13:53 DB: That's correct and for each, what we're doing is recommending that a physician assess each older adult and determine their unique set of fall risk and address that unique set. So an older adult can be recommended one or multiple interventions that are unique to what their problem is.
14:14 DH: I was amazed when I started to look at all of the resources that the CDC has available for caregivers, specifically related to the STEADI program. Just some absolutely astounding resources that have been developed and I'm really blessed for you to come on the show and really be able to talk with us about that and share some of those resources. How can a caregiver get themselves better equipped? What does the CDC have available as components of the STEADI program for caregivers?
14:44 DB: We offer a brochure specifically targeted towards caregivers with tips to keep the person they're caring for from falling and there's a second general brochure with fall prevention tips called What You Can Do To Prevent Falls. And both of those summarise some of the things I've said and give additional tips for preventing falls. We offer two assessment tools, I already talked about the Stay Independent brochure that a caregiver can use to determine if an older adult is at risk for a fall. However, we also offer a Check For Safety brochure. This Brochure guides the caregiver through walking through the older adults home and assessing the home to see what hazards might be there and it also offers suggesting suggestions for reducing those hazards. We offer a brochure that explains a simple chair exercise that older adults can do to reduce their fall risk and then finally, we have a brochure that explains what orthostatic hypotension is and why that might lead to increase fall risk. All of these can be... Okay.
15:52 DH: Just real quickly, what is orthostatic hypotension? I don't know what that is.
15:57 DB: Okay. Orthostatic hypotension is when you might be lying down or you might be sitting down and when you stand up, you have a sudden drop in your blood pressure and it can make you dizzy or light-headed and increase your risk of falling.
16:12 DH: Sure, sure.
16:13 DB: So all of these resources can be... You can get to these resources again at www.cdc.gov/STEADI and we have a heading there called Materials for Patients that has materials for patients and also includes the caregiver materials there.
16:32 DH: So with the materials for patients just be, "Hey, here's some stuff to read on some of these mitigation things." And some of the things that we're looking at when we're looking for... When we're working with patients through that STEADI program.
16:47 DB: With the exception of the caregiver brochure, actually all the resources I mentioned above are also suitable for patients also to read and in addition to what I mentioned, there is a fact sheet in the same location that goes over falls, it talks about the impacts of falls and some of the data you mentioned and talks about what you can do to reduce your risk of a fall. I wanted to mention two additional non-STEADI resources that are directed toward older adults that may be of interest. CDC developed the My Mobility plan to help older adults plan for how their mobility may change as they age and it gives tips to reduce their risk of a fall or a motor vehicle crash injury. It was designed to be more holistic and cut across both falls and motor vehicle crashes, which are the leading causes of injury for older adults. It provides worksheets that older adults can use to create a personalised plan to help them maintain their independence as they age.
17:51 DB: CDC also developed the medicine's risk fact sheet to inform older adults about how side effects from their medicines may increase their risk of a fall or a motor vehicle crash injury and along with the fact sheet, there's a worksheet where you can record your medicines and details about them and a worksheet that guides you in discussing your medicine with a healthcare provider or a pharmacist if you have some concerns about your medicines and both of these are available from... Not from the STEADI page but from CDC's older adult falls page.
18:25 DH: And how do they get there? How would they find that?
18:29 DB: I believe that, it's kind of a long URL so I believe the best way probably would be to Google "CDC and older adult falls."
18:39 DH: Okay and what we'll do too is we'll drop a link to that on our social media so people that are listening to the show can just grab that quick link. Hey, I got a quick question for you. You mentioned a little bit earlier but I'm hoping that you'll have time while I got on the phone to unpack it a little bit for us in more detail. You had talked about the right questions to ask older adult patients, just kind of as a standard process for caregivers that should always be at the forefront of their mind when they're thinking about how to reduce Elderly Accidents, deaths and injuries but can you kinda walk us through the three main questions that you alluded to about some questions that caregiver should always be looking at or asking of their patients?
19:22 DB: Earlier I had said that the first step recommended by STEADI is to screen older adults once a year to see if they're at fall risk and I talked about the 12 questions in the Stay Independent brochure, which are good detailed questions that can offer the healthcare provider some insight into maybe what some of the causes of the fall risk are. However, we know that time is very limited for healthcare providers during their office visit and with all the health problems they may be addressing with an older adult patient, there may not be time to go through the 12 questions, so we've also identified three questions that the healthcare provider can quickly ask to identify patients at risk. These three questions are: Have you fallen in the past year? Do you feel unsteady when standing or walking? And do you worry about falling? This is different from the stay independent because there's no score involved. If the patient answers yes to any one of these questions, then he or she should be considered to be at risk for a fall and the next step would be for the healthcare provider to assess that patient to determine what modifiable risk factors they may have.
20:39 DH: Great. Three questions. Have you fallen in the past year? Do you feel unsteady when standing or walking? Do you worry about following and an answer of yes to any of those puts that patient into the At Risk category?
20:55 DB: Yes, yes. And this gives you a quick way to test who's at risk.
21:00 DH: Excellent resource. Talk about opportunities that there are for continuing education on the STEADI program. Is the best way to engage, if I were an independent caregiver to spend some time on the STEADI website? What other resources are available for continuing education for caregivers?
21:20 DB: CDC offers two free online trainings on STEADI. We have one class for pharmacists and we actually have had one out there for general health care providers, however we're in the process of updating that one. The new training for healthcare providers, we're hoping will be up in the next month. Both of these trainings offer continuing education credits and they are both available at www.cdc.gov/STEADI and they're under the materials for health care providers.
21:58 DH: Dr. Bergen, the work that you do on behalf of our caregivers and our patients, with the CDC's National Centre for Injury Control and Prevention is so significant. I just wanna thank you for coming on the AwareGiver Caregiver Show. For those of you that are listening, you can follow the CDC on Facebook at their Facebook address is simply at CDC. You can follow them on Twitter @CDCgov C-D-C-G-O-V. Same on Instagram at CDCgov also you can also find them on Instagram, Snapchat and YouTube. We'll drop a link to the STEADI program on the AwareGiver Facebook page but you can also get the best place for you to focus your energy out there caregivers is by spending some time at that CDC.gov/STEADI. You can also enter your email address there at the STEADI website for email updates on this program and other CDC program caregivers may be interested in. I'm David Happe, on behalf of the AwareGiver Caregiver Radio Show, thank you for listening and please, please spend some time on that CDC website, taking a look at how to enhance the life of your charge of your patient by becoming more familiar with the CDC's STEADI program.