93. A STEADI APPROACH: ASSESSING FALL RISK FACTORS IN A GERIATRIC PSYCHIATRY CLINIC

Introduction

Falls are a significant public health concern among older adults, representing the leading cause of disability and a major factor affecting quality of life. The risk of falls is particularly elevated in those with psychiatric conditions. Prior research has identified a correlation between psychiatric medications and fall risk, and further studies have identified medical co-morbidities— such as sleep disorders, neurocognitive impairments, and osteoporosis— as contributing to increased fragility and susceptibility to falls. While prior research has examined these factors individually, there remains a gap in the literature concerning the combined impact of psychiatric conditions, psychiatric medications, and medical co-morbidities on fall risk among older adults receiving psychiatric care. This study aims to fill this gap by using the CDC’s Stopping Elderly Accidents, Deaths, and Injuries (STEADI) questionnaire to identify key contributors to fall risk in a geriatric psychiatry clinic.

Methods

The geriatric psychiatry clinic at University of Texas Southwestern Medical Center began administering the STEADI questionnaire with pre-visit check-in forms in September 2023. We extracted data from patients who completed the full questionnaire, including demographics, psychiatric medications, PHQ-9, GAD-7, and CHRT-SR7 scores, as well as diagnoses related to sleep, cognition, and bone health. To assess whether there was a significant difference in STEADI scores between individuals taking specific classes of medications (Yes/No), we conducted two-sample, two-tailed Z-tests for independent means in Microsoft Excel. Given that each group had a sufficiently large sample size (n ≥ 30), we assumed normality under the Central Limit Theorem. We also compared STEADI scores between in-person and virtual visits using the same Z-test approach. Additionally, we examined the relationship between PHQ-9, GAD-7, and CHRT-SR7 mood questionnaires and STEADI scores by performing Shapiro-Wilk normality tests, followed by Spearman correlation analyses.

Results

Data were extracted for 2,055 patients who completed the STEADI questionnaire. The cohort was 64.4% female (1,324 patients) with a mean age of 68.4 years. Racial demographics included 88.8% White (1,825), 7.6% Black (156), 3.0% Asian (62), with the remainder identifying as American Indian, Alaskan Native, Pacific Islander, multiple races, or unknown. Eighty-seven percent (1,783) identified as non-Hispanic, while 8.3% (170) identified as Hispanic. Among encounters, 1,232 were video visits, 726 were in-office visits, 94 were no-shows, and 3 visits were not characterized. Sixty-five percent of STEADI responses (2951 responses) scored ≥ 4, indicating a high fall risk.

Medication and Fall Risk:

SSRIs, benzodiazepines, and non-benzo hypnotics did not significantly impact fall risk (z=0.48, z=1.59, and z=-1.46, respectively). Individuals on antipsychotics appeared to have a significantly higher risk of falls (z=5.86, p < 0.001).

Visit Type and Fall Risk:

There was not a statistically significant difference in fall risk between visit types (in-office and virtual, z=1.00, p < 0.05).

Psychological Factors and Fall Risk:

Shapiro-Wilk tests indicated that GAD-7, PHQ-9, and CHRT-SR7 scores were not normally distributed (p < 0.05). Therefore, Spearman correlation analyses were performed, revealing significant positive correlations between STEADI scores and GAD-7 (ρ = 0.34, p < 0.001), PHQ-9 (ρ = 0.44, p < 0.001), and CHRT-SR7 (ρ = 0.42, p < 0.001).

Conclusions

Our findings provide practical insights to help clinicians better screen for fall risk by considering the unique characteristics of older adults receiving psychiatric care. In total, almost two thirds (65%) were at high risk for falling. The use of antipsychotics was significantly associated with increased fall risk, while SSRIs, benzodiazepines, and non-benzodiazepine hypnotics were not significantly linked to higher fall risk in this study. We identified significant links between fall risk and psychological factors such as anxiety, depression, and hopelessness. These results underscore the importance of integrating fall risk assessment into a comprehensive approach to care in geriatric psychiatry.