The Stopping Elderly Accidents, Deaths, and Injuries Initiative: A Community-Based Program to Reduce Emergency Visits for Falls

Falls are the leading cause of trauma-related emergency department visits among U.S. adults ≥65, yet many injuries are preventable with multifactorial interventions. Despite the CDC's Stopping Elderly Accidents, Deaths, and Injuries (STEADI) initiative, most primary care clinicians do not routinely screen for fall risk nor feel prepared to address it, sustaining a major prevention gap that drives emergency utilization. The objective of this study was to assess the feasibility of community-based STEADI screening to identify high-risk older adults.

A pilot implementation of fall risk screenings was conducted at four walk-in urban community events from 2023 to 2024. Adults ≥65 completed fall risk assessments through the STEADI initiative, which includes a 12-item fall risk questionnaire, blood pressure monitoring, and physical function testing. They also report their fall risk perception and how they engage in fall prevention. Participants then received individualized, risk-based education and resources. After the community screening, participants were recruited to include their data in our study and invited to complete follow-up surveys. Statistical analyses were performed to summarize fall risk, risk perception, and health care engagement.

Among 53 consented participants (age m = 74.6; 73% female), we found that community-based STEADI reached individuals with a wide range of fall risks (STEADI fall risk score mean=5.6±3.89; 1-14 score; ≥4 high fall risk) and that only 45% reported discussing fall prevention with a primary care provider in the past year. Approximately 66% were categorized as high fall risk; however, only half of those identified perceived themselves to be at elevated risk, raising concern for the proactivity of patients seeking primary care intervention and participation in activities known to reduce their fall risk. The 6-month follow-up survey response rate was 29%.

Community-based fall risk screening using STEADI reaches older adults with substantial and often unrecognized fall risk. Discrepancies between objective risk, perceived risk, and health care engagement highlight an actionable opportunity for emergency medicine-adjacent prevention strategies. Identifying high-risk patients early could reduce preventable fall-related emergency department visits.