Older Adult Fall Prevention

An older adult falls every second of every day.1 In adults aged 65 and older, most injuries, both fatal and non-fatal, are caused by falls.2 In 2018, 32,731 older adults died as result of a fall in the United States. 3 Falls are the leading cause of traumatic brain injuries and hip fractures among older adults. Serious injuries occur in nearly 20% of falls.4,5,6,7

Although falls affect older adults at a disproportionate rate, they are preventable. To address the health concerns of a rapidly aging society, the National Association of County and City Health Officials (NACCHO) recognizes older adult fall prevention as a significant public health issue. With support from the Centers for Disease Control and Prevention (CDC), NACCHO is working on a project titled "Developing the Capacity to Support Older Adult Falls". The project aims to help local health departments (LHDs) develop their capacity to identify older adults at high risk for falls, create awareness among older adults about fall risk and prevention, and partner with community resources to support LHD’s fall prevention efforts.

Older adults huddle

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Issue Brief: Older Adult Fall Prevention

A NACCHO-developed issue brief highlighting the prevalence of falls in older adults and evidence-based prevention practices.

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Issue Brief: Older Adult Fall Prevention

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Podcast from Washington: Older Adult Fall Prevention

NACCHO sits down with Kevin McGinnis to discuss community paramedicine and how these programs help to prevent older adult falls.

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Podcast from Washington: Older Adult Fall Prevention

Fall prevention is key to retaining independence for community-dwelling older adults. NACCHO is collecting resources to help LHDs develop their capacity to identify older adults at risk for falls and to implement evidence-based fall prevention programs and practices with their community resources.

General older adult fall prevention resources, including guidelines, frameworks, reports and initiatives can be found at the following resource centers:

This toolkit classifies resources by the following four topic areas:

  • Community Awareness
  • Data and Evaluation
  • Planning and Implementation
  • Programs, Practices, and Interventions

For any requests to submit materials that support older adult fall prevention for LHDs and their partners, please contact us at IVP@naccho.org.

Title Level Source Summary
Fall Prevention for Adults Local Union County Health Department Webpage offering events, classes, and resources for older adults susceptible to falls, as well as information on the local falls coalition.
Fall Prevention Facts National National Council on Aging Patient-oriented fact sheet providing information on the prevalence and impact of older adult falls.
Falls Prevention: National, State, and Local Solutions to Better Support Seniors National Special Committee of Aging- United States Senate Report outlining the impact of falls, interventions to prevent their occurrence, as well as additional information on the Federal response.
Medicines & Fall Risk State Maryland Falls Free Coalition Material prepared by the University of Maryland School of Pharmacy providing the public information on fall prevention for older adults taking medication.
Preventing Falls State Maryland Falls Free Coalition Material prepared by the University of Maryland School of Pharmacy providing fall prevention tips for older adults.
Falls Prevention and Your Older Patients State Maryland Falls Free Coalition Material prepared by the University of Maryland School of Pharmacy for healthcare providers on steps to prevent falls in their older adult patients.
Falls & Injuries - Falls Prevention Information and Resources State Arizona Healthy Aging-Arizona Department of Health Services Materials to communicate and raise awareness about falls, including fact sheets, flyers, a media toolkit, and infographics .
Toolkits & Media - State Iowa Department of Public Health Falls Prevention Awareness Day materials including handouts, promotional materials, and a media toolkit.
Falls Prevention Local Spokane Regional Health District Webpage containing information on falls risk factors, data, and prevention tips.
Falls Prevention Checklist State Pennsylvania Department of Aging Checklist to help older adults reduce risk for in-home falls.
Fall Prevention Resource Guide State Vermont Department of Health Guide that features information about falls nationally and in Vermont, as well as resources and services available, for older adults, caregivers, community partners, and health care providers.
Infographics & Handouts National National Council on Aging Communications, patient education, and media materials (e.g., social media messages, images, fact sheets, and infographics) to raise awareness of older adult falls.
Falls Prevention Awareness Day 2014: A Compendium of State and National Activities National National Council on Aging Overview of Falls Prevention Awareness Day 2014, an effort spearheaded by NCOA in collaboration with Falls Free. Information on the programs and practices of 48 participating states.
Title Level Source Summary
Falls Data Resources National Fall Prevention Center of Excellence Resources for falls data at the national, state, and local levels.
North Carolina Falls Prevention Coalition Falls Data State North Carolina Falls Prevention Coalition Links to CDC's injury and falls data, as well as statewide surveillance and data dashboards for North Carolina.
Los Angeles County Fall Data Local County of Los Angeles Public Health Data reports, tables, charts, and maps on emergency department visits, hospitalizations, and mortality in Los Angeles County from falls.
Falls Injury Data State North Carolina Public Health, Chronic Disease and Injury Section Reports and fact sheets on fall injuries in North Carolina, including those from the Behavioral Risk Factor Surveillance System and the North Carolina Division of Public Health.
Lake County Resident Senior Falls 2009-2012 Local Lake County Health Department and Community Health Center Report analyzing the frequency, scope, and impact of falls on Lake County seniors.
Complete Health Indicator Report of Fall Injury (Unintentional) State Utah's Public Health Data Resource Report outlining unintentional fall hospitalizations in Utah by age, sex, and local health districts.
Fall Prevention Coalition of San Mateo County 2007-2016 Report Local San Mateo County Report on unintentional falls resulting death and hospitalizations in San Mateo County from 2007-2016. Also includes information on methods used to decrease falls.
Falls Among Older Adults: From the National, States and Local Perspectives Local Nassau County Department of Health Report providing statistics and facts about falls, discussing the issue from a multi-level public health lens.
Special Emphasis report: Fall Injuries Among Older Adults State Ohio Department of Health Data on unintentional fall injuries and death of Ohio residents over age 65 from 2005-2014.
Evaluation Guide for Older Adult Clinical Fall Prevention Programs National CDC Framework to assist providers and organizations in evaluation of their fall prevention programs.
Falls Database: Data Migration Excel Template National National Council on Aging Data migration template for organizations to manage falls prevention program participant and workshop data.
Title Level Source Summary
STEADY U Ohio State State of Ohio-Department of Aging Statewide comprehensive falls prevention initiative to strengthen existing falls prevention activities, identify opportunities for new initiatives, and coordinate an educational campaign.
Finding Our Balance: 2018 Washington State Action Plan for Older Adult Falls Prevention State Washington Department of Health Washington's five-year action plan focusing on six strategy areas in the prevention of older adult falls.
Falls Free Initiative National National Council on Aging A national initiative that includes a national action plan, a national Falls Free Coalition, and coalition workgroups.
Hawaii Falls Prevention State Plan State Executive Office on Aging, Hawaii Department of Health Framework from the Hawaii's Statewide Task Force on Fall Prevention's outlining the state's action on fall prevention, targeting the community, health care providers, and policymakers.
Fall Prevention and Management State Texas Health and Human Services Resources to develop effective systems for fall risk management, including toolkits, assessments, and worksheets.
Falls Prevention Strategy Local Baltimore City Health Department Overview of Baltimore City Health Department's B'FRIEND Initiative, a three-step fall prevention strategy.
Falls Among Older Adults: Strategies for Prevention State Washington State Department of Health Report detailing best practices and recommendations for developing a falls prevention program, as well as screening, assessments, tools, and clinical guidelines.
Falls Prevention Conversation Guide for Caregivers State Iowa Department of Public Health Guide for caregivers of those at risk of falls that covers risk factors, conversation starters, and guidelines for action plan development.
STEADI-Rx National Centers for Disease Control and Prevention Guide for pharmacists on screening pharmacy patients, assessing their medications, and intervening to reduce fall risk.
Preventing Falls Among Older Adults in Oklahoma State Oklahoma Department of Health Guide outlining the state plan for falls prevention and commitments to action.
Falls Prevention Statewide Strategic Plan State Iowa Department of Public Health Strategic plan to reduce the prevalence of falls and fall-related injuries among Iowans.
Overcoming Obstacles to Effective Senior Falls Prevention and Coordinated Care National Office of Lead Hazard Control and Health Homes, U.S. Department of Housing and Urban Development Toolkit that highlights obstacles to the development and implementation of older adult falls prevention and coordinated care policies and programs, as well as resources to overcome these obstacles.
Preventing Falls: A Guide to Implementing Effective Community-Based Fall Prevention Programs National CDC Guide for community-based organizations to provide information in how to choose and implement fall prevention programs.
Best Practice System Summary/Technical Assistance Worksheet State Texas Health and Human Services A worksheet identifying key elements of an effective fall risk management system that can be used by facility staff to identify opportunities for improvement.
Fall Risk Assessment for Older Adults: The Hendrich Fall Risk Model National The Hartford Institute for Geriatric Nursing Tool developed to assess the fall risk in older adults.
Assessment of Fear of Falling in Older Adults: The Falls Efficacy Scale-International (FES-I) National The Hartford Institute for Geriatric Nursing Tool developed to assess the fear of falling in older adults
State Policy Toolkit for Advancing Fall Prevention: Select Resources National National Council on Aging Toolkit describes Medicare coverage for falls-related services and the use of the falls v-code which was created to help health care providers document medically necessary care they deliver to people at risk for falling.
Balance and Falls National American Physical Therapy Association Webpage includes articles and resources about falls prevention for physical therapists.
Falls Prevention National American Occupational Therapy Association Webpage highlights resources for occupational therapy practitioners working in falls prevention as well as information about occupational therapy's role in preventing falls.
Falls Risk Reduction Toolkit National American Society of Consultant Pharmacists and National Council on Aging Toolkit emphasizes the role of pharmacists in falls risk reduction, comprehensive assessment of falls risk, the importance of falls risk reduction, and management via an interprofessional approach.
Falls Prevention for Older Adults Webinar National Resources for Integrated Care Webinar provides information about the public health impact of falls in older adults, risk factors, and interventions, including how to leverage person-centered care plans to reduce the risk of falls.
Key Principles, Tools, and Resources to Maximize Your Falls Prevention Program National Relias Webinar that educates about risk factors for falling in older adults, best practices and practical interventions to reduce falls, and where to find educational resources for staff, family, and caregivers.
An Insider's Look: The Range of Home Modifications and Decision making National USC Leonard Davis School of Gerontology Webinar in which an architect and occupational therapist discuss a range of home modifications to support aging in place.
Webinar: Falls and Brain Injuries Among Older adults, Part 1: Connection, Prevention, and Resources National National Council on Aging Webinar explores the connection between falls and traumatic brain injuries in older adults, discussing risk factors, fall and brain injury detection assessments, and prevention and education resources.
Issue Brief: Funding for Older Adult Falls Prevention National National Council on Aging Issue brief outlines the problem and presents research on significant returns on investment and reductions in falls among prevention interventions.
Falls Prevention Sustainability National National Council on Aging Project Lifecyle guidelines to help support implementation of falls prevention programs.
Title Level Source Summary
Older Falls Prevention Local Erie County Health Department Resources for individuals and providers to evaluate fall-risk in older adults, provide trainings for evidence-based interventions, and raise awareness.
Evidence-Based Falls Prevention Programs National National Council on Aging Hub containing summaries of multiple evidence based programs that have been proven to aid the reduction of older adult falls
Remembering When Program National National Fire Protection Association Teaching and communications materials for a fall prevention program for older adults.
Falling Less in Kansas, Falls Awareness and Prevention and Strategies for Adults: The Falling LinKS Toolkit State Wichita State University Regional Institute of Aging Community-facing toolkit with information for at-risk populations, including the top four risk factors for falling. Also contains checklists and plans to help reduce falls risk.
Step BY Step: Thoughtful Fall Prevention Local North Central Area Agency on Aging, Inc. Promising practice that included a fall risk assessment at local senior centers, as well as teachable prevention practices for each risk factor identified.
A Metter of Balance Local Clay County Public Health Center and Clay County Senior Health Services Promising practice that aims to reduce the fear of falling and modifiable risks for falling.
Stepping on Fall Prevention Workshops Local Safe Communities of Dane County Evidence-based program that includes a community-based, small group workshop that aims to reduce falls and build confidence in older adults.
Strong Seniors Local Reno County Health Department Promising practice that consists of strength training sessions over a 12 week period, aimed to help seniors prone to falls increase strength, balance, and flexibility.
Fall Risk Management Evidence-Based Best Practice State Texas: Health and Human Services A resource summarizing the key elements of an effective fall risk management program.
NYS Older Adult Fall Prevention Program Local NYS Department of Health, Bureau of Occupational Health & Injury Prevention A comparison of five evidence-based older adult fall prevention programs implemented in three New York counties.
Adult Injury Prevention: New Mexico's Evidence-Based Adults Falls Prevention Program State New Mexico Department of Health Guide including community-based interventions, hospital-based interventions and health-care provider focused information.
Baltimore Falls Reduction Initiative Engaging Neighborhoods and Data Local Baltimore City Health Department Description of partners, interventions, data, and lessons learned from Baltimore's B'FRIEND Initiative.
MyMobility Plan National CDC Mobility planning tool that provides information and guidance to older adults on staying independent, safe at home, and mobile in the community.
STEADI (Stopping Elderly Accidents, Deaths, & Injuries) National CDC Initiative to help reduce fall risk among older patients that includes resources and training for clinicians, pharmacists, patients, and caregivers.
A CDC Compendium of Effective Fall Interventions: What Works for Community-Dwelling Older Adults National CDC A description of interventions for which there is published evidence of the intervention's ability to reduce falls among community-dwelling older adults.
Fall Prevention Center of Excellence: Home Modification Resource Inventories State Fall Prevention Center of Excellence Information on home modification, assessment instruments, and funding sources as resources to reduce fall risk for older adults.
Help for Seniors-Livingston County Local Rural Health Information Hub Information about the Help for Seniors program which screens older adults for unmet healthcare needs and educates EMTs on geriatric care.
Abbeville County's Community Paramedic Program Local Rural Health Information Hub Information about the Abbeville County Community Paramedic Program, including a description, evidence level, evaluation results, challenges, and replicability.
Community Healthcare Integrated Paramedic Program (CHIPP) Local Rural Health Information Hub Information about the CHIPP program which was developed to reduce 911 use for non-emergencies and improve older adults' health, including a description, evidence level, evaluation results, challenges, and replicability.
Rugby Community Paramedic Program Local Rural Health Information Hub Information about the Rugby Community Paramedic Program which makes non-emergent house calls to patients, including a description, evidence level, evaluation results, challenges, and replicability.
Forsyth County Community Paramedic Program Local Forsyth County, North Carolina Webpage describing the Forsyth County Community Paramedic Program - including information about falls prevention.
Alameda County Senior Injury Prevention Program (SIPP) Local Alameda County Emergency Medical Services Agency Program that aims to reduce preventable injuries among the older population in Alameda County, including falls prevention strategies, presentations, and other helpful links.

NACCHO, with support from the Centers for Disease Control and Prevention, is continuing work on Developing the Capacity to Support Older Adultsa project designed to assist local health departments identify older adults at high risk for falls, increase awareness about fall risk and prevention among older adults, and partner with community resources to support fall prevention efforts.

To aid in this work, NACCHO is looking for local health departments to volunteer to participate in key informant interviews. These key informant interviews will help NACCHO learn more about the role of local health departments and their partners in implementing clinical fall prevention programs and initiatives.

Local health departments that operate or support older adult fall prevention programs and are interested in participating should reach out to the NACCHO Injury and Violence Prevention Team at IVP@naccho.org by March 26, 2021. NACCHO will be selecting up to nine local health departments to participate in the interviews.

Public Health Infrastructure and Systems

Stacy Stanford

Director, Public Health Transformation

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Programs

Caroline Snyder

Senior Program Analyst

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Community Health Program

Zinat Mohamed

Program Analyst

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Programs

Jasmyn Rudd

Senior Program Assistant

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References
1 Moreland B, Kakara R, Henry A. Trends in Nonfatal Falls and Fall-Related Injuries Among Adults Aged ≥65 years—United States, 2012-2018, MMWR Morb Mortal Wkly Rep 2020;69(27):875–881. DOI; http://dx.doi.org/10.15585/mmwr.mm6927a5
2 Centers for Disease Control and Prevention. Web-based Injury Statistics Query and Reporting System (WISQARS) [Online]. (2003). National Center for Injury Prevention and Control, Centers for Disease Control and Prevention (producer). Available from: URL: www.cdc.gov/ncipc/wisqars. [2020 Nov 9].
3 Ibid.
4 Hayes WC, Myers ER, Morris JN, Gerhart TN, Yett HS, Lipsitz LA. Impact near the hip dominates fracture risk in elderly nursing home residents who fall. Calcif Tissue Int 1993;52:192-198.
5 Parkkari J, Kannus P, Palvanen M, Natri A, Vainio J, Aho H, Vuori I, Järvinen M. Majority of hip fractures occur as a result of a fall and impact on the greater trochanter of the femur: a prospective controlled hip fracture study with 206 consecutive patients. Calcif Tissue Int, 1999;65:183–7.
6 Taylor CA, Bell JM, Breiding MJ, Xu L. Traumatic Brain Injury–Related Emergency Department Visits, Hospitalizations, and Deaths—United States, 2007 and 2013. MMWR Surveill Summ 2017;66(No. SS-9):1–16. DOI: http://dx.doi.org/10.15585/mmwr.ss6609a1
7 Sterling DA, O’Connor JA, Bonadies J. Geriatric falls: injury severity is high and disproportionate to mechanism. Journal of Trauma–Injury, Infection and Critical Care 2001;50(1):116–9
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