The Centers for Disease Control and Prevention (CDC) developed the STEADI protocol as an evidence-based approach to combat the high rate of falls among older adults. The framework provides a clear, systematic process for health care providers to follow, making fall prevention a standard part of clinical care. The process is broken down into three core steps, with a detailed algorithm guiding the provider through each stage.
The Three Core Steps of STEADI
STEADI operates on a simple yet effective three-part model: Screen, Assess, and Intervene. This sequence allows healthcare professionals to identify at-risk patients efficiently, pinpoint the specific risk factors involved, and provide tailored, effective solutions.
Step 1: Screen for Fall Risk
The first step involves identifying older adults who are at risk of falling. The CDC recommends screening all patients aged 65 and older annually, or any time a patient presents with a fall. The screening process is quick and can be done by asking a few simple questions:
- Have you fallen in the past year?
- Do you feel unsteady when standing or walking?
- Are you worried about falling?
A 'yes' answer to any of these questions, or a score of four or higher on the optional 12-question "Stay Independent" self-assessment, indicates an increased fall risk and requires further assessment. For patients who screen negative, the provider can still offer general fall prevention brochures and education.
Step 2: Assess Risk Factors
If a patient screens positive for fall risk, the next step is a more detailed assessment to identify modifiable risk factors. This involves a comprehensive evaluation of several areas, including:
- Medication Review: A pharmacist or physician reviews all medications (including over-the-counter drugs) that could increase fall risk. The SAFE (Screen, Assess, Formulate, Educate) method is recommended for this review.
- Functional Mobility: Standardized physical performance tests are used to evaluate a patient's strength, gait, and balance. Common tests include:
- Timed Up & Go (TUG): Measures the time it takes for a patient to stand up from a chair, walk 10 feet, turn, walk back, and sit down again.
- 30-Second Chair Stand Test: Measures leg strength and endurance by counting how many times a patient can stand from a seated position and sit back down in 30 seconds.
- 4-Stage Balance Test: Evaluates static balance by timing how long a patient can hold four progressively difficult positions.
- Other Clinical Evaluations: Other assessments may include measuring orthostatic blood pressure, checking visual acuity, assessing feet and footwear, and evaluating Vitamin D levels.
Step 3: Intervene to Reduce Risk
Based on the assessed risk factors, the final step is to provide tailored interventions to mitigate the patient's specific risks. Effective strategies often include a combination of clinical and community-based interventions, such as:
- Medication Management: Stopping, switching, or reducing the dosage of high-risk medications when medically appropriate.
- Exercise Programs: Prescribing or referring the patient to strength and balance programs, with Tai Chi being a widely recommended example.
- Vitamin D Supplementation: Recommending daily vitamin D with calcium to improve bone, muscle, and nerve health.
- Home Safety Modifications: Providing education on home hazards and offering referrals to occupational therapists to conduct home safety assessments.
- Vision and Foot Care: Referring patients for updated eyewear or to a podiatrist for foot health and proper footwear advice.
- Patient Education: Discussing fall prevention strategies and empowering patients and caregivers to play an active role in their health.
Comparison of STEADI Functional Assessment Tests
| Feature | Timed Up & Go (TUG) Test | 30-Second Chair Stand Test | 4-Stage Balance Test |
|---|---|---|---|
| Purpose | Measures dynamic balance and gait speed. | Measures leg strength and endurance. | Measures static balance in progressively challenging stances. |
| Procedure | Patient rises from a chair, walks 10 feet, turns, walks back, and sits. | Patient stands up and sits down from a chair as many times as possible in 30 seconds. | Patient holds four positions for 10 seconds each: feet side-by-side, heel-to-side, heel-to-toe, and on one foot. |
| At-Risk Indicator | Takes 12 seconds or more to complete. | Score is low for their age group. | Unable to hold the tandem stand (heel-to-toe) for at least 10 seconds. |
| Equipment | Standard chair with arms, 10-foot walkway, stopwatch. | Standard chair with a back, stopwatch. | Stopwatch. |
Implementation in Practice
The STEADI algorithm is designed to be integrated into standard clinical workflows and electronic health record (EHR) systems. For practices, this means creating a systematic process that assigns tasks to the appropriate team members, from initial screening by a medical assistant to in-depth assessment by a physician or specialist. The key is to make fall prevention a routine part of care rather than an afterthought, which requires collaboration and effective use of the available tools. The CDC also provides supplementary resources, including training materials and patient handouts, to support implementation and ensure a standardized approach.
Conclusion
The STEADI protocol, with its core steps of Screen, Assess, and Intervene, provides a clear and actionable framework for healthcare professionals to address fall risk in older adults systematically. By moving beyond simple screening and incorporating targeted assessments and evidence-based interventions, the protocol empowers clinicians to have a measurable, positive impact on patient outcomes. Adherence to these steps helps reduce the incidence and severity of falls, allowing older adults to maintain their independence and quality of life for longer. Integrating STEADI into routine practice is a critical strategy for improving patient safety and reducing the overall burden of fall-related injuries and costs. For comprehensive resources, clinicians can find more information on the official CDC STEADI website.
