Community Health Workers and Care Managers Implement the CDC’s Stopping Elderly Accidents, Deaths, and Injuries (STEADI) Program for Older Adults in a Low and Middle-Income Country: A Pilot Study

Abstract

Background: Older adults in low-and middle-income countries experience a disproportionate burden of non-communicable diseases (NCDs). Unintentional injuries are among the major NCDs, and falls are the second leading cause of these injuries and deaths worldwide, including in Thailand. We aimed to culturally adapt the CDC's Stopping Elderly Accidents, Deaths, and Injuries (STEADI) for Thai older adults, examine the initial efficacy of STEADI using a two-group pretest-posttest design, and explore the feasibility, appropriateness, and acceptability of STEADI delivered by community health workers (CHWs) and care managers (CMs). Methods and Results: STEADI take a coordinated care approach that consists of three steps: screening, assessing, and intervening. In Step a, CHWs screened fall risk in 20 community-dwelling older adults using three key questions and found that all of them had fall risk, then CHWs screened with a Stay Independent questionnaire (range 0-14) and found that 100% have high fall risk. In Step b, CMs assessed balance, vision, footwear, postural hypotension, medications, and CHWs assessed home hazards. They found that 50% had poor balance, 70% took 4+ medications,75% fell on the walkway, and 70% had no bathroom modifications. In Step c, individual participants received fall prevention interventions to mitigate their specific fall risk factors. CHWs and CMs indicated high acceptability, appropriateness, and feasibility of the Thai-STEADI intervention. The Thai-STEADI group had a significant reduction in the CDC fall risk score from pre-intervention (M=11.60, SD=1.52) to post-intervention (M=10.80, SD=1.64) (effect size Wilcoxon r=0.89; p=0.03) but not in the control group. Conclusion:Our study showed that the community-based multifactorial Thai-STEADI delivered by CHWs and CMs is feasible and acceptable to prevent falls in older adults with limited access to health care.