A 76-year-old client visits the primary care clinic for an annual wellness exam. The client reports falling once in the past 6 months and feels unsteady when standing. According to the CDC STEADI initiative, which intervention should the nurse prioritize?

The CDC STEADI initiative (Stopping Elderly Accidents, Deaths, and Injuries) follows a Screen-Assess-Intervene workflow. The client has positive screening (one fall in 12 months and unsteadiness), so the next step is structured assessment, including the Timed Up and Go (TUG) test. A TUG result of 12 seconds or more indicates increased fall risk and triggers the intervention bundle (medication review, vitamin D, balance and strength exercise, home safety, vision and footwear). A hip x-ray is reactive imaging, aerobic exercise alone misses balance training, and hearing evaluation is a downstream intervention only after assessment.

In-depth explanation

<span class="merci-scenario-label">Clinical Judgment</span><br>STEADI flow: <span class="merci-kw">Screen → Assess → Intervene</span>. Positive screen here = 1 fall + unsteadiness. Next is structured assessment with <span class="merci-kw">TUG</span>, <span class="merci-kw">30-second chair stand</span>, and <span class="merci-kw">4-stage balance test</span>. TUG ≥<span class="merci-value">12 seconds</span> = increased fall risk.<br><br><span class="merci-scenario-label">Memory Tip</span><br><span class="merci-kw-mark">STEADI: Screen → Assess (TUG ≥12s) → Intervene (meds, vit D, exercise, home safety)</span><br><br><span class="merci-scenario-label">KR vs US</span><br>STEADI is a CDC framework but the assessment tools (TUG, chair stand) are global. Korean Geriatrics Society fall guideline uses the same tests; community senior centers and tertiary geriatric clinics in Korea have adopted multifactorial fall risk assessment.

Clinical scenario

<span class="merci-scenario-label">Clinical Practice Guide</span><br>CDC STEADI multifactorial assessment for older adults with positive screen:<br>- <span class="merci-kw">Timed Up and Go</span>: rise from chair, walk 3 m, return, sit. <span class="merci-value">≥12 seconds</span> = high risk.<br>- <span class="merci-kw">30-second chair stand</span>: number of stands without using arms; sex- and age-adjusted norms.<br>- <span class="merci-kw">4-stage balance</span>: progressive standing positions; failure on tandem or single-leg = high risk.<br>- Postural BP, vision, footwear, home hazards, medication review (focus on <span class="merci-value-abnormal">benzodiazepines, opioids, anticholinergics</span>).<br>- Recommend vitamin D 800-1000 IU daily, supervised exercise (Tai Chi, Otago).<br><br><span class="merci-scenario-label">Caution</span><br><span class="merci-value-abnormal">Two or more falls in 12 months OR a fall with injury</span> warrants immediate physician referral for a comprehensive geriatric assessment.

Key concepts

• STEADI — CDC initiative Stopping Elderly Accidents, Deaths, and Injuries. Three-step framework: Screen with three key questions, Assess high-risk clients with validated tools, Intervene with evidence-based multifactorial actions. Free toolkit available at cdc.gov/steadi.
• Timed Up and Go (TUG) — Standardized mobility test: client rises from a chair, walks 3 meters, turns, returns, and sits. Cut-off ≥12 seconds = increased fall risk. Sensitive screening tool for community-dwelling older adults.
• Multifactorial intervention — Bundle of evidence-based fall prevention measures: medication review (deprescribe sedatives, anticholinergics, polypharmacy), vitamin D, balance and strength training, home hazard reduction, vision and footwear correction, postural blood pressure management.