Application Study Of STEADI Toolkit To Prevent Elderly Falls In The Community

Objectives:To screen and evaluate the risk factors for the elderly(?60 years old)in the community in Chongqing,to formulate and to implement a stratified intervention plan for the prevention of falls in the community,and to reduce the incidence and injury rate of falls.Methods:Part I:Stay Independent Brochure of the STEADI Toolkit was translated into simplified Chinese,then back-translation and cultural adaptation was conducted to develop the questionnaire for pilot survey.197 elderly inpatients,196 elderly outpatients,and 232 community-dwelling elderly residents were surveyed to test the reliability and validity.Part II: A multi-stage cluster random sampling was adopted to select senior citizens who met the inclusion criteria in a community in Chongqing as the research object,and the STEADI toolkit(2017 version)was used to conduct fall screening and fall risk rating assessment for the senior citizens in the community who met the inclusion criteria.Part III:According to the screening and evaluation results in Part II,a muti-disciplinary team of fall interventions conducts hierarchical and muti-professional interventions on the risk factors of the elderly in the community.The intervention period is 6 months.Intervention measures include medication adjustment,postural hypotension management,muscle strength training,home environment intervention,personalized intervention of the elderly foot structure and foot pain,etc.6 months later,the incidence and injury rate of falls in the elderly before and after intervention was compared.Check the implementation of the fall prevention measures for the elderly through the phone every month.For elderly people with poor implementation status,the community medical staff will conduct home visits to supervise their implementation plan when necessary.After the6-month intervention,the elderly fall situation was followed-up by telephone calls.Results:Part I results:The Cronbach's alpha reliability coefficients of the Chinese version of the Elderly Fall Risk Self-Assessment Scale in inpatients,outpatients,and community elderly were 0.716,0.674,and0.608,respectively.Retest reliability r values were 0.992,0.996,and 0.998,respectively.The content validity index S-CVI / UA of the scale was 0.92,S-CVI / AVE was 0.980,and the content validity index I-CVI of each item was 0.8-1.The success rate of the aggregation validity test was100%.Structure validity KMO values were 0.801,0.771,0.737.The factor analysis extracted four common factors.The common factors and corresponding items of hospitalization,outpatient,and community were different,their cumulative variance contribution rates were 54.096%,52.730%,and 51.180%,respectively.Part II results:1168 elderly persons were effectively screened,including 896 elderly persons with low risk of falls(76.71%),251 elderly persons with medium risk(21.49%),and 21 elderly persons with high risk(1.80%).The total incidence rate of falls was 14.98%,and the average number of falls was 0.17±0.425 times.Among them,the incidence rates of falls in the high-,middle-,and low-risk groups were 100.00%,18.33%,and12.05%,respectively.There were statistical differences in the scores of the three groups of elders in 13 items including education level,whether they live alone,life care condition,history of falls,gait,and abnormal balance condition,etc.(P <0.05).Part III results:Among the 1168 elderly people who received the intervention,a total of 710 elderly people had completed 6 follow-up visits,and the effective follow-up rate was 60.8%.The proportion of implementing one or more fall interventions increased from 56.6% in the first month to 71.8% in the sixth month.After the intervention period,1168 elderly people were followed up by telephone.A total of 825 people were effectively followed,with an effective follow-up rate of 70.71%.In 6months,64 people had 80 falls,the average number of falls was 0.1 ± 0.351,the incidence of falls was 7.76%,and the rate of falls was 32.81%.The fall rate of elderly people after intervention were all lower than before.The fall rate of low-risk elderly people was 6.33%,the fall rate of middle-risk elderly people was 11.59%,The fall rate of high-risk elderly was 30.77%.Conclusions:The Chinese version of the elderly self-assessment of fall risk has good reliability and validity,and can be used for the self-assessment of falls of Chinese elderly.The STEADI toolkit can comprehensively screen out various factors that affect the elderly in Chongqing 's communities and scientifically grade their fall risks.The fall prevention plan detailed in its intervention strategy can reduce the incidence of falls among the elderly in the community,and it is recommended to promote it in the practice of elderly care.