FY 2014 Background Document
Preventing Falls Among Older Adults Saves Lives
The Centers for Disease Control and Prevention’s National Center for Injury Prevention and Control (CDC’s Injury Center) is committed to helping older adults maintain their health, independence, and self-sufficiency through the prevention of falls. Despite the prevalence, falls are not an inevitable part of aging.Today, there are proven interventions thatcan reduce falls and help older adults live better and longer.
Public Health Problem
Falls are the leading cause of injury deaths among older adults. Equally troubling, nonfatal falls account for significant public health impact and societal costs too.
About 20% of older adult falls cause serious injuries such as fractures and head injuries, which can limit mobility, diminish quality of life, and increase the risk of premature death.
Annually, older adult falls are responsible for over 20,000 deaths, 2.3 million emergency department visits, and more than$30 billion in direct medical costs.
Fall death rates have been rising steadily—from 2000 to 2010, rates rose 63% for men and 83% for women. The U.S. population is aging and falls will continue to increase unless preventive action is taken.
Falls can also have major psychological and social consequences. Seniors may restrict their activities because of a fear of falling and a loss of self-confidence – leading to reduced mobility, fewer social interactions, decreased physical fitness, and increased fall risk.
Strategies that Work
The most effective multifaceted fall prevention strategy involves clinical assessment by a healthcare provider and subsequent treatment of the individual’s fall risk factors. This individualized and tailored approach is recommended by the American and British Geriatric Societies’ Clinical Practice Guidelines. There also are effective nonclinical strategies that individuals can use to reduce their risk of falling and increase their ability to live independently. The most important prevention strategies are:
Exercise
Engaging in exercise to increaselower body strength and balance, either individually or in a group setting. There are several exercise programs, which have been shown to prevent falls among older adults. These include the Tai Chi: Moving for Better Balance program and the home-based Otago Exercise Program.
Medication Review
Having a doctor or pharmacist review all the medications a person is taking. A medication review includes both prescription and over-the-counter drugs. Based on a review, a healthcare provider may recommend reducing the number of medications, finding alternative drugs, and/or adjusting dosages to reduce side effects and interactions, such as drowsiness or dizziness, which may lead to falls.
Vision
Having annual vision exams and updating eyeglasses to optimize vision. It is important that older adults visit an eye doctor at least once a year and update prescriptions as needed to optimize vision. Glasses with single vision distance lenses may be helpful for some activities such as walking outside.
Home Environment
Modifying the home environment to reduce fall risks and improve safety. This strategy is effective when combined with exercise and/or medication review. It includes installing stair railings and grab bars, improving lighting, and removing clutter and tripping hazards.
Unique Role of the CDC Injury Center and Federal Partnerships
CDC’s Injury Center uses the best available scientific data to identify effective programs and determine the optimal strategies to promote widespread adoption of these programs. The CDC Injury Center supports state health departments and other key partners in disseminating and implementing evidence-based community fall prevention programs as well as linking clinical practice with community programs.
The CDC Injury Center’s efforts complement those of the Administration for Community Living’s (ACL) Administration on Aging Unit (AoA). Specifically, CDC Injury Center’s role in falls prevention is to develop and test interventions for effectiveness and to translate these into community programs. AoA currently provides funding to 24 state Area Agencies on Aging through the Healthy Aging Initiative to implement effective programs. Within these funded states, 11 conduct falls prevention activities including theOtago Exercise Program,Stepping On, Tai Chi: Moving for Better Balance, and Matter of Balance, a program that reduces fear of falling. CDC’s Injury Center also has provided technical assistance as well as data analysis to evaluate several AoA programs related to falls.
Additionally, AoA and CDC’s Injury Center are funding the National Council on Aging to conduct activities related to falls prevention, including overseeing and coordinating the activities of the Falls Free Coalition and revising the CDC publication, Preventing Falls: How to Develop Community-based Fall Prevention Programs for Older Adults.
Older Adult Falls Preventionin Action
CDC’s Injury Center develops, disseminates, and supports proven strategies preventing older adult falls. This is done through disseminating and implementing evidence-based programs, capacity building, and by developing resources to help healthcare providers incorporate fall prevention into clinical practice:
Identifying and Funding Evidence-Based Interventions and Programs
CDC’s Injury Center regularly reviews the peer-reviewed literature to identify effective interventions, which may be candidates for translation into community fall prevention programs. While prior studies have demonstrated the effectiveness of Tai Chi: Moving for Better Balance, Stepping On and the Otago Exercise Program, identifying and disseminating other promising programs is critical to providing a comprehensive approach to fall prevention.
CDC’s Injury Center has funded the state of Wisconsin to implement the effective fall prevention program Stepping On. In addition, the state has funded the Wisconsin Institute for Healthy Aging to provide support, technical assistance,and training for Stepping On implementers and instructors. The Wisconsin Institute provides ongoing support for Stepping On—making the program sustainable and positioned for national dissemination.
Supporting States to Implement and Evaluate Evidence-Based Programs
CDC’sInjury Center funded fourstate health department’s injury programs (California, New York, Oregon, Wisconsin) for two years to work with partners to implement Tai Chi: Moving for Better Balance program and/or Stepping On an adult education program. This pilot helped determine the state health departments’ ability to implement community-based fall prevention programs and identified the specific technical support required for future broad scale implementation.
Following the success of the pilot,CDC’s Injury Center has since provided supplemental funding to three states (Colorado, New York and Oregon) through the Core Violence and Injury Prevention Program to build on the capacity and expertise within state health departments to provide state leadership in integrating evidence-based practices and interventions within communities and clinical care practice.
CDC’s Injury Center is also working to build capacity and facilitate the dissemination of effective fall prevention programs by providing training and technical assistance to other key partners, such as the YMCA USA. The YMCA USA is training 20 master trainers and 400 instructors to offer Tai Chi: Moving for Better Balance through YMCAs throughout the United States.
Promoting Fall Risk Assessment, Treatment and Referrals in Clinical Practice
CDC‘s Injury Center has developed resources to help healthcare providers integrate fall prevention into clinical practice. STEADI (Stopping Elderly Accidents, Deaths and Injuries) is a toolkit for healthcare providers to help them integrate fall risk assessment, treatment and referral into their practice.
Additionally, CDC’s Injury Center has funded three state health departments (Colorado, New York and Oregon) to integrate healthcare and aging services to clinical practice as a comprehensive fall prevention approach. This approach is expected to show county-level decreases in emergency room visits for older adult falls.
CDC’sInjury Center is also funding the Oregon Research Institute to study the dissemination of the evidence-based program, Tai Chi: Moving for Better Balance, through referrals by healthcare providers. The study will examine reach, effectiveness, adoption, implementation and sustainability to better understand the facilitators and barriers to linking clinical practice with fall prevention programs.
Successes
Developing Unique Partnerships
Developing a partnership with Humana to disseminate a validated self-risk assessment instrument through a monthly newsletter to their members. This instrument will heighten members’ awareness of fall risks and empower them to discuss fall prevention with their healthcare providers.
Leveraging State Capacity
Supporting state health departments (CO, OR, NY) to implement three evidence-based community fall prevention programs (Tai Chi: Moving for Better Balance,Otago, and Stepping On), as well as a clinical intervention (STEADI). This comprehensive approach will link fall prevention in clinical practice with community programs. Each program is suitable for older adults with differing levels of physical functioning.
Showcasing Potential Cost Savings
Building a “business case” for fall prevention to help private insurers understand the return on investment associated with several effective programs. Returns on investments were $1.80 per dollar invested for Moving for Better Balance and $1.10 per dollar invested for Stepping On.
Future Goals
The number of people age 65 and older in the United States is growing and will continue to grow. As a result, continued efforts to reduce falls, save lives,and reduce associated costs are critical. CDC’s Injury Center plans to continue developing and promoting evidence-based programs, supporting state-level implementation, and promoting changes in clinical practice including:
Short-Term Goals
•Disseminating the STEADI toolkit to help healthcare providers prevent falls, ensureolder adults stay healthy and independent, reduce hospital admissions for fall injuries, and reduce Medicare costs.
•Creating tools to support the use of effective programs, including a website (currently in development) to support implementation of Tai Chi: Moving for Better Balance. Training materials will be developed for both instructors and master trainers. This resource will expand the number of trained instructors and lead to more widespread dissemination of this Tai Chi program.
•Expanding partnerships with non-governmental organizations, such as the partnership with YMCA USA, to expedite the development of a national training structure for Tai Chi: Moving for Better Balance.
Long-Term Goals
•Reducing the number of fall-related injuries in targeted communities within the threefunded state health department injury programs.
•Increasing the proportion of primary healthcare providers incorporatingfall prevention into their clinical practice.
•Increasing the number of states utilizinga comprehensive approach to preventing older adult falls by integrating clinical practice with evidence-based community programs.
•Making an integrated clinical and community-based prevention approach the standard of care for older adults at risk of falling.
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