STEADI Self-Report Measures Independently Predict Fall Risk

Abstract

Falls are a significant contributor to disability and death among older adults. Despite practice guidelines to increase falls screening in healthcare settings, preventive care for falls continues to be infrequently delivered. Simplifying screening by relying on self-report of balance, gait, or strength concerns, alone may increase the frequency of falls screening. We assessed the diagnostic accuracy of self-report measures of gait, strength, and balance from the Centers for Disease Control and Prevention's Stopping Elderly Accidents, Deaths, and Injuries (STEADI) for identification of fall risk. The criterion standard for fall risk was the Timed Up-and-Go (TUG). Assessments were conducted with 95 adults aged 65 years or older in an outpatient osteoporosis clinic between May 2015 and September 2016. Receiver operating characteristic curve analysis found that two self-report questions ("I feel unsteady with walking" and "I need my arms to stand from a chair") had high discriminatory ability (AUC 0.906; 95% CI 0.870-0.942) to identify those at high fall risk; additional questions did not substantially improve discrimination. These findings suggest that two self-report questions identify those at risk of falling who would benefit from interventions (e.g., physical therapy). Performance testing as part of routine falls screening of older persons in the outpatient setting may be unnecessary.

Keywords: clinical geriatrics; falls; prevention; veterans.

Figure 1.

STEADI (Stopping Elderly Accidents, Deaths, and Injuries) self-report question combinations receiver operating characteristic curve for fall risk. All three self-report questions (blue); Unsteady with walking; arms to stand (green); Arms to stand; history of fall (red); Unsteady with walking; history of fall (orange); Reference line (0.5 cut off; yellow).