Preventing Falls: How to Develop Community-based Fall ...

PREVENTING FALLS:

A Guide to Implementing Effective Community-Based Fall Prevention Programs

Preventing Falls:

A Guide to Implementing Effective Community-Based Fall Prevention Programs

2nd Edition Division of Unintentional Injury Prevention National Center for Injury Prevention and Control Centers for Disease Control and Prevention

Atlanta, Georgia 2015

This document is a publication of the National Center for Injury Prevention and Control of the Centers for Disease Control and Prevention:

Centers for Disease Control and Prevention Thomas R. Frieden, MD, MPH, Director

National Center for Injury Prevention and Control Debra Houry, MD, MPH, Director

Division of Unintentional Injury Prevention Grant Baldwin, PhD, MPH, Director

Home, Recreation, and Transportation Branch Ann Dellinger, PhD, MPH, Branch Chief

Home and Recreation Injury Prevention Team Robin Lee, PhD, MPH, Team Lead

ACKNOWLEDGEMENTS

CDC would like to acknowledge the contributions of the Administration for Community Living (ACL) and U.S. Department of Housing and Urban Development (HUD) for their continued expertise and guidance on the development of this guide. The partnership between CDC, ACL, and HUD is critical for advancing the use and uptake of effective fall prevention programs that can help safeguard the health of older Americans.

Suggested Citation: National Center for Injury Prevention and Control. Preventing Falls: A Guide to Implementing Effective Community-based Fall Prevention Programs. 2nd ed. Atlanta, GA: Centers for Disease Control and Prevention, 2015.

Disclaimer: Reference herein to any specific commercial products, programs, or services by trade name, trademark, manufacturer, or otherwise, does not necessarily constitute or imply its endorsement, recommendation, or favoring by the United States Government. The views and opinions of authors expressed herein do not necessarily state or reflect those of the United States Government, and shall not be used for advertising or product endorsement purposes.

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CONTENTS

Chapter 1. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Why fall prevention is important . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Understanding fall risk factors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Effective interventions can prevent older adult falls . . . . . . . . . . . . . . . . . . . . . . . . 4 Purpose of this guide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Chapter 2. Planning for a Fall Prevention Program . . . . . . . . . . . . . . . . . . . 7 Determine your community's needs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Identify resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 Determine your organization's readiness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 Selected web resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Chapter 3. The Important Role of Partnerships . . . . . . . . . . . . . . . . . . . . . 11 Developing partnerships . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Maintaining partnerships . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Building an infrastructure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Budget adequate resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Selected web resources for developing partnerships . . . . . . . . . . . . . . . . . . . . . . . 14

Chapter 4. Selecting an Evidence-Based Fall Prevention Program . . . . . . . . . 15 What is an evidence-based program? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 Community fall prevention programs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 Selecting a program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 Program characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 Selected program web resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

Chapter 5. Raising Awareness about Your Program . . . . . . . . . . . . . . . . . . 19 Reaching your intended audience . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 Increasing public awareness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 Developing a plan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 Provider education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 Public education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 Selected fall prevention education web resources . . . . . . . . . . . . . . . . . . . . . . . . 22

Chapter 6. Implementing Your Fall Prevention Program . . . . . . . . . . . . . . . 23 Identify your target audience . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 Think collaboratively . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 Recruiting program participants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 Assuring program quality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27

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Appendix E--Template for Developing a Sustainability Plan

A GUIDE TO IMPLEMENTING EFFECTIVE COMMUNITY-BASED FALL PREVENTION PROGRAMS

Program fidelity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 Continuous quality improvement (CQI) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 Selected implementation web resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 Chapter 7. Evaluating Your Fall Prevention Program . . . . . . . . . . . . . . . . . 31 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 Why evaluate? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 Measuring program effectiveness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 Goals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 Evaluation methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 Types of data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 Types of evaluation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 Determining which method to use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 Selected evaluation web resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37 Chapter 8. Promoting Your Fall Prevention Program . . . . . . . . . . . . . . . . . 39 Conducting a successful campaign . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 Working with the media . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 Selected promotional web resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42 Chapter 9. Sustaining Your Fall Prevention Program . . . . . . . . . . . . . . . . . 43 Establish your vision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43 Build collaborations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44 Secure funding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44 Demonstrate benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 Delivery infrastructure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 Strategies for achieving financial sustainability . . . . . . . . . . . . . . . . . . . . . . . . . . 45 Selected sustainability web resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47 Appendices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49 Appendix A--Stay Independent brochure . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49 Appendix B--Educational Materials for Older Adults . . . . . . . . . . . . . . . . . . . . . . 50

What YOU Can Do to Prevent Falls--A fall prevention brochure . . . . . . . . . . . . . . . 50 Check for Safety--A home safety checklist . . . . . . . . . . . . . . . . . . . . . . . . . . . 50 Exercise & Physical Activity Book . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51 Appendix C--Sample Letter to a Health Care Provider for Referrals . . . . . . . . . . . . . 52 Appendix D--Program Evaluation Checklist . . . . . . . . . . . . . . . . . . . . . . . . . . . 53 Appendix E--Template for Developing a Sustainability Plan . . . . . . . . . . . . . . . . . 56

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Chapter 1. Introduction

CHAPTER 1

Introduction

Falls are the leading cause of fatal and nonfatal injuries among adults 65 and older and 10,000 people in the United States turn 65 every day. Community-based organizations (CBOs) play an important role in promoting the health and well-being of the residents in their community. Many of the services provided by CBOs like yours help people of all ages maintain healthy lifestyles and improve their quality of life. This includes expanding efforts to reduce falls among older adults.

CBOs who want to prevent falls recognize that they must offer effective evidence-based fall prevention programs. However, choosing a fall prevention program that is appropriate for clients, readily available with training and tools in place, and affordable can be a daunting task.

The purpose of this guide is to provide information to help CBOs choose and implement evidence-based fall prevention programs based on their organization's goals and clients' needs. It also describes the organizational resources and partners needed to support and sustain the program.

This guide addresses questions that are important to CBOs when implementing fall prevention programs such as:

??How do we find a fall prevention program that best meets

the needs of our clients?

??How can we know that this program works and will achieve

the desired results?

??What resources will be needed to support it?

??What partners should we consider to help us offer

the program?

??How can we support and sustain the program into

the future?

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Appendix E--Template for Developing a Sustainability Plan

A GUIDE TO IMPLEMENTING EFFECTIVE COMMUNITY-BASED FALL PREVENTION PROGRAMS

This revision of the 2008 publication, Preventing Falls: How to Develop Communitybased Fall Prevention Programs for Older Adults, will improve your organization's ability to reach out to the older members of your community as well as enhance your capacity to implement and maintain effective fall prevention programs.

Please note: The interventions and programs discussed in this guide are not designed for hospital patients, assisted living or nursing home residents, or patients with dementia or Alzheimer's disease. These persons require programs and interventions that are specifically designed for their increased frailty and fall risk.

Why fall prevention is important

Falls are a major threat to the health and independence of older adults. Each year, one in three older adults aged 65 and older experiences a fall, and people who fall once are two to three times more likely to fall again.

Falls can be devastating. Falls are the leading cause of nonfatal injuries among older adults. One out of ten falls causes a serious injury, such as a hip fracture or head injury, which requires hospitalization. In addition to the physical and emotional pain, many people need to spend at least a year recovering in a long-term care facility. Some are never able to live independently again.

Falls can be deadly. Among older adults, falls are the leading cause of fatal injuries. Each year, at least 25,000 older adults die as a result of falls. And the rate of fallrelated deaths among older adults in the United States has been rising steadily over the past decade.

Falls are preventable. People are living longer and falls will increase unless we make a serious commitment to providing effective fall prevention programs. Fortunately, the opportunity to help reduce falls among older adults has never been better, because research has demonstrated that falls can be prevented.

Today, there are effective fall prevention programs that can be used in community settings. By offering these programs in our communities, we can reduce falls and help older adults maintain their health and independence.

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