COMMENTARY

Are You Asking Older Adult Patients the Right Questions?

Grant T. Baldwin, PhD, MPH

Disclosures

March 16, 2015

Editorial Collaboration

Medscape &

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Routine questions are part of every medical visit, but are you asking patients aged 65 years and older about their fall risk? One out of three people in this age group falls each year, but fewer than half of those who fall talk to their healthcare provider about it. By asking three simple questions and taking action—when needed—you can reduce the risk of falling.

Some patients think that falls just happen when you get older or are the result of bad luck, but falls are not an inevitable part of aging. There are specific things that you can do to reduce your patients' chances of falling.

Hello. I'm Grant Baldwin, director of the Division of Unintentional Injury Prevention at CDC's Injury Center.

When you see patients aged 65 years and older, make these three questions a routine part of your exam:

  • Have you fallen in the past year?

  • Do you feel unsteady when standing or walking?

  • Do you worry about falling?

Patients who answer "yes" to any of these key screening questions are considered at increased risk of falling, and further assessment is recommended.

To help, CDC created a simple tool kit called STEADI. This stands for Stopping Elderly Accidents, Deaths and Injuries.[1] The STEADI tool kit includes a wealth of information that can be easily downloaded and printed for display in your office or clinic. Materials include:

  • Assessment tools;

  • Case studies;

  • Videos; and

  • Educational handouts for your patients.

STEADI is based on an algorithm adapted from the American and British Geriatric Societies' clinical practice guidelines. Using STEADI, you will be able to:

  • Identify patients at low, moderate, and high risk for a fall;

  • Identify modifiable risk factors; and

  • Offer effective interventions.

Two validated fall prevention interventions from the STEADI algorithm that can be easily integrated into routine office visits are vitamin D supplementation[3,4] and medication management.[5]

Vitamin D supplementation has been shown to reduce the risk of falling in older adults who are vitamin D deficient and is a simple thing that your patients can add to their daily routines.

Medication management works by reducing interactions and side effects that may lead to falls. Effectively managing medications includes:

  • Eliminating medications if there is no active indication;

  • Reducing doses of necessary medications to the lowest effective dose; and

  • Avoiding prescribing medications for an older person in whom the risk from side effects outweighs the benefits of the drug.

Many medications have been linked to falls.[6] However, three types of medications that you should immediately consider reducing or eliminating among your older adult patients include:

  • Psychoactive medications (especially benzodiazepines);

  • Medications with anticholinergic side effects; and

  • Sedatives that can be purchased over-the-counter, such as Tylenol® PM and Benadryl®.

In our rapidly aging population, older adult fall prevention demands immediate attention. The good news is that you can make a big difference in your patients’ lives. You can help them stay healthy and independent longer by reducing their chances of falling. We hope that the information provided here will help you make fall prevention a routine part of your clinical practice.

To download the STEADI algorithm and learn more about what you can do to help keep your patients safe from falls, go to the STEADI website.

Web Resources

STEADI (Stop Elderly Accidents, Death & Injuries) Tool Kit for Health Care Providers

STEADI Tool Kit Materials

Algorithm for Fall Risk Assessment & Interventions

Grant T. Baldwin, PhD, MPH, is the director of the Division of Unintentional Injury Prevention (DUIP) at the National Center for Injury Prevention and Control (NCIPC) in the Centers for Disease Control and Prevention. He has served in this capacity since September 2008.

Unintentional injuries are the leading cause of death for persons 1 to 44 years of age. DUIP is dedicated to reducing the number and severity of unintentional injuries through science-based programs and applied research. CDC is focused on preventing injuries and fatalities from motor vehicle-related crashes, older adult falls, prescription drug overdoses, and traumatic brain injuries.

Dr Baldwin joined the CDC Injury Center in November 2006 as acting deputy director. In this role, Dr Baldwin assisted the NCIPC director in providing overall leadership and direction for the Center. He began his career at CDC in September 1996.

Dr Baldwin received his PhD in Health Behavior and Health Education at the University of Michigan School of Public Health in 2003. He also received an MPH in Behavioral Sciences and Health Education from the Rollins School of Public Health at Emory University in 1996.

He is an adjunct associate professor at Emory University's Rollins School of Public Health and teaches two courses, Social Behavior and Public Health and Community Needs Assessment.

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