Preventing Falls

:
How to Develop Community-based
Fall Prevention Programs for Older Adults
2008
Injury Prevention
·
Preventing Falls:
How to Develop Community-based
Fall Prevention Programs for Older Adults
National Center for Injury Prevention and Control
Atlanta, Georgia
2008
Tis 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
Julie L. Gerberding, MD, MPH, Director
Coordinating Center for Environmental Health and Injury Prevention
Henry Falk, MD, MPH, Director
National Center for Injury Prevention and Control
Ileana Arias, PhD, Director
Division of Unintentional Injury Prevention
David Wallace, MSEH, Acting Director
Home and Recreation Injury Prevention Team
Michael Ballesteros, PhD, Team Leader
Acknowledgements

We acknowledge and appreciate the contributions of National Center for Injury Prevention
and Control staf Judy Stevens, PhD, Michael Ballesteros, PhD, Michele Huitric, MPH,
Amanda Tarkington, MC, Jane Mitchko, MEd, CHES, and Leslie Dorigo, MA. Tis project
was assisted by Macro International Inc. Carol Freeman, BA, served as the Macro project
director, Sally York, MN, RNC, and Mary E. Miller, MA, served as writer/editors and
Lucinda Austin served as project assistant. Cover and text design by Monika Gullett, MA.
We thank Tom Snyder, BA, MDiv, Ilene F. Silver, MPH, and Jane Mahoney, MD
for their thorough review and valuable suggestions.
Suggested Citation: National Center for Injury Prevention and Control. Preventing Falls:
How to Develop Community-based Fall Prevention Programs for Older Adults. Atlanta, GA:
Centers for Disease Control and Prevention, 2008.
Chapter 1 Introduction
Why fall prevention is important ........................................................1
Understanding the risk factors for falls among older adults .................2
Effective interventions can prevent older adult falls .............................3
Purpose of this guide ...........................................................................4
Chapter 2 Planning an Effective Fall Prevention Program

Key steps in developing a fall prevention program ...............................8
Who can deliver effective fall prevention program components.........10
Where to conduct fall prevention program components ...................11
Chapter 3 The Important Role of Partnerships in Fall
Prevention Programs
How to develop partnerships ............................................................13
How to maintain partnerships ..........................................................15
Partnership web resources .................................................................16
Chapter 4 Education: The Foundation of Effective Fall
Prevention Programs
Provider education ............................................................................17
Public education ...............................................................................18
Education web resources ...................................................................19
Chapter 5 The 5 Building Blocks of Effective Community-based
Fall Prevention Programs
Building Block 1 Education programs for older adults and
their caregivers ..............................................................................22
Building Block 2: Progressive exercise programs to improve
mobility, strength, and balance .....................................................24
Building Block 3: Medication review and management .....................30
Building Block 4: Vision exams and vision improvement ..................33
Building Block 5: Home safety assessment and
home modifcation ........................................................................36
Contents
Chapter 6 Evaluating Your Fall Prevention Program
Methods for conducting evaluation ...................................................42
The stages of evaluation ....................................................................47
Determining which stage to use ........................................................51
Evaluation web resources ..................................................................52
Chapter 7 Promoting Your Fall Prevention Program
Conducting a successful campaign ....................................................53
Working with the media ...................................................................57
Promotional web resources ................................................................58
Chapter 8 Sustaining Your Fall Prevention Program
Establish your vision .........................................................................59
Build collaboration ...........................................................................59
Advocate for support.........................................................................59
Find funding .....................................................................................60
Appendices
Appendix A: Sample Individual Falls Risk Assessment ......................62
Appendix B: Identifying Partners Worksheet .....................................64
Appendix C: Sample Fall Prevention Brochure ..................................66
Appendix D: Sample Fall Prevention Presentation .............................69
Appendix E: Sample Exercises ...........................................................72
Appendix F: Sample Medication Review Form .................................75
Appendix G: Sample Home Fall Prevention Safety Checklist ............77
Appendix H: Sample Program Evaluation Tool .................................86
Appendix I: Sample Pitch Letter ......................................................90
Appendix J: Key Points ....................................................................92
Appendix K: Sustainability Plan Template.........................................94
Injury Prevention
1
Your community-based organization (CBO) plays an
important role in promoting the health and well being
of the residents in your community. Many of the services
provided by CBOs like yours help people of all ages
maintain healthy lifestyles and improve their overall
quality of life. Now, with the help of this new publication,
Preventing Falls: How to Develop Community-based Fall
Prevention Programs for Older Adults, your organization
can reach out to the older members of your community
and fulfll an increasingly important need for effective,
community-based fall prevention programs.
Why fall prevention is important
Falls are a major threat to the health and independence of older
adults, people aged 65 and older. Each year in the United States,
nearly one-third of older adults experience a fall.
Falls can be devastating. About one out of ten falls among older
adults result in a serious injury, such as a hip fracture or head
injury, that 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 never return to their homes.
Falls can be deadly. Falls are the leading cause of injury deaths
among older adults. The rate of fall-related deaths among older
adults in the United States has risen signifcantly over the past
decade. In 2004, falls were responsible for 14,900 deaths.
Chapter 1
Introduction
2
Falls are costly. Fall-related injuries among older adults, especially
among older women, are associated with substantial economic costs.
In 2000, direct medical costs for fatal and nonfatal fall injuries totaled
$19 billion. As the number of older adults increases dramatically over
the next few decades, so will the economic burden of falls.
Falls are preventable. The opportunity to help reduce falls among
older adults has never been better. Today, there are effective fall
prevention interventions that can be used in community settings. By
offering effective fall prevention programs in our communities, we
can reduce falls and help older adults live better, longer lives.
Understanding the risk factors for falls among
older adults
Falls are not an inevitable consequence of aging, but falls do occur
more often among older adults because fall risk factors increase with
age and are usually associated with health and aging conditions.
These risk factors include:
Biological risk factors
Mobility problems due to muscle weakness or balance •



problems
Chronic health conditions such as arthritis and stroke
Vision changes and vision loss
Loss of sensation in feet
Behavioral risk factors
Inactivity •


Medication side effects and/or interactions
Alcohol use
Environmental risk factors
Home and environmental hazards (clutter, poor lighting, etc.) •



Incorrect size, type, or use of assistive devices (walkers, canes,
crutches, etc.)
Poorly designed public spaces
3
Chapter 1
Usually two or more risk factors interact to cause a fall (such as poor
balance and low vision, which can cause a trip and fall going up a
single step). Home or environmental risk factors play a role in about
half of all falls.
Understanding these risk factors is the frst step to reducing older
adult falls. Over the past two decades, researchers around the world
have used descriptive studies to identify risk factors and randomized
controlled trials to test fall interventions. The results of these
studies show that reducing fall risk factors signifcantly reduces
falls among community-dwelling older adults—those people living
independently in the community.
Many older adults, as well as their family members and caregivers,
are unaware of factors or behaviors that put them at risk of falling,
and are also unaware of what actions they can take to reduce their
risk. Fall risk factor assessment is rarely a part of an older adult’s
routine health care, even if they have had a fall or fall injury. All
older adults should be encouraged to seek an individual fall risk
assessment from their healthcare provider, especially older adults
with a history of falls and/or with mobility or balance impairments
who are at highest risk for falls.
A self-administered risk assessment form for older adults can be
useful when the results are discussed with a healthcare provider who
can help modify or manage identifed risk factors.
Appendix A shows an example of a fall risk assessment developed by
the Washington State Department of Health’s Injury and Violence
Prevention Program for individuals to use when discussing fall
prevention with a healthcare professional.
Effective interventions can prevent older adult falls
Effective fall interventions reduce fall risk factors through either
exercise alone or by combining exercise with other risk reduction
approaches such as medication review and management, vision
screening and correction, education, and safer living environments.
The Centers for Disease Control and Prevention (CDC) has
reviewed and identifed community-based fall prevention
interventions that have strong scientifc evidence of effectiveness.
4
Introduction
These interventions have been summarized and compiled in
Preventing Falls: What Works. A CDC Compendium of Effective
Community-based Interventions from Around the World, the
companion publication to this document.
CDC would like to help CBOs move these proven fall
interventions into communities to protect the health and
independence of older adults.
Purpose of this guide
CDC developed this guide for communities and CBOs, so they
can begin developing effective fall prevention programs. The main
purpose of this guide is to:
Defne the key elements of what makes fall prevention •

programs effective
Provide information to communities and CBOs on how to
develop effective older adult fall prevention programs
This guide is intended to be used by CBO decisionmakers, program
managers, and partners in organizations that serve independent
living, community-dwelling older adults, such as:
Public health departments •








Healthcare organizations that provide individual health
care, individual or group community programs, and
home-based services
Hospital outpatient and community programs
Senior and community centers
Parks and recreation programs
Emergency medical services
Faith-based and parish nurse services and programs
Home-based services (e.g., home health, meal-delivery
services, chore services)
Area Agencies on Aging
5
Chapter 1




Independent/retirement living, residential, and senior housing
facilities/settings for older adults who live independently
Nonproft organizations that provide direct services to
older adults
Universities/community colleges that offer or work with
community programs for community-dwelling older adults
Note: The interventions and programs in this guide are not designed for
hospital inpatients, assisted living residents, Alzheimer’s care programs
and facilities, or nursing home residents, all of whom require programs
and interventions that are specifcally designed for their increased frailty
and fall risk.
6
Introduction
Notes:
Injury Prevention
7
When planning your fall prevention program, remember that the
most effective programs address many of the risk factors described
in Chapter 1. An effective fall prevention program should be offered
by trained healthcare professionals and include education about
falls and fall risk factors. (See the chart on page 10 for a list of
professionals.) The main components that should be part of your fall
prevention program include the following:
Education about older adult fall risk factors and prevention †
†
†
†
†
strategies for older adults, families, and caregivers. Information
can be communicated on an individual, one-on-one basis, or
in a group setting.
Exercise that can be offered through group classes or
individually. Exercise programs can be offered in a
community setting, at home with supervision, or in a
program that combines group classes or one-on-one training
with home-based exercise. Appropriate types of exercises that
effectively reduce falls in older adults include:
Tai Chi •


Strengthening exercises combined with balance training
Balance exercises
Medication review by a pharmacist or healthcare professional,
with medication adjusted or modifed by a physician or
nurse practitioner.
Vision assessment and vision correction by an optometrist
or ophthalmologist.
Home safety assessment including home modifcations
as needed.
Chapter 2
Planning an Effective
Fall Prevention Program
8
These building blocks of an effective fall prevention program are
discussed in more detail in Chapter 5, but keep them in mind
during the planning process for your program.
Key steps in developing a fall prevention program
Follow this nine-step process in planning your fall prevention program.
Step 1. Assess your community’s needs.
Before deciding what type of fall prevention program to develop,
use the following checklist to assess your community’s needs and
identify appropriate resources:
What are the fall prevention program needs in your †
†
†
†
†
†
community?
What related programs or services are currently being offered
by other organizations?
What are your organization’s current and future goals and
resources for providing services to independent older adults
in your community?
How much support for starting a fall prevention program is
there at all levels of your organization—from the board and
director, to the staff, volunteers, and older adult clients?
What community resources exist that could provide services
to address older adult fall risk factors?
What community resources and organizations are
potential partners?
Step 2. Establish your program’s purpose, goals, and objectives.
Develop a purpose statement and determine the goals and objectives
of your program. Ask questions such as, “Why are we developing
this program?” and “What do we hope to accomplish both short
term and long term?” Your purpose and goals should be specifc,
realistic, and clearly stated. Goals should be quantitative with
objectives that can be easily measured. Think of the goal as a
destination and the objectives as methods of getting you to your
goal. With a clear set of objectives, you can easily measure the
success of your program during the evaluation phase. With a solid
purpose, concrete goals, and action-oriented objectives, you can
build an effective fall prevention program for older adults.
Chapter 2
Step 3. Determine what risk factors your program will address.
There are two types of effective fall prevention programs: single
intervention and multifaceted intervention programs:
†
†
Single intervention programs
Exercise is the only intervention that by itself reduces falls
among older adults. Many organizations have developed
group and/or individualized exercise programs for older
adults that improve strength and balance. You can develop
an exercise program by using the information in this guide
and working with trained professionals in your community.
See Chapter 5 on page 21 for examples of effective exercise
programs and related resources.
Multifaceted intervention programs
A multifaceted intervention combines exercise with other
intervention components to reduce fall risk factors. Such a
program might include exercise, vision assessment, and
fall prevention education. To create the most effective fall
prevention program, begin with exercise and incorporate at
least one other intervention component.
Step 4. Collaborate with partners to address additional risk
factors. Partnering with other organizations can help you develop
a more comprehensive and effective fall prevention program.
Chapter 3 will provide more detail on how to identify and work
with fall prevention partners.
Step 5. Decide who will implement the various program
components. The following chart shows which healthcare providers
and other professionals can deliver each type of intervention.
9
Planning An Effective Fall Prevention Program
10
Who Can Deliver Fall Prevention Program Components?
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Balance; simple * * *  * * * *
Balance; in-depth * * *  *
Strength * * *  * * * *
Exercise
1:1 balance alone   * * *
1:1 strength with balance training    *
Group class *   * 
Individualized exercise/PT      
Tai Chi * * 
Medication
Medication review   *
Medication management 
Vision
Basic assessment   * *
Detailed assessment 
Vision correction  
Home Safety
Assessment * * *  *
Basic modifcation**    *
Skilled modifcation** 
Other
Assistive device training
 
* Additional specialized education and training required
** Basic modifcation includes clutter/throw rug removal, rearrange furniture; skilled modifcation includes grab bars, ramps, electrical work.
Note: Partnerships may facilitate delivering multifaceted programs in community settings.
11
Chapter 2
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Assessment
Gait       
Balance; simple       
Balance; in-depth       
Strength       
Exercise
1:1 balance alone      
1:1 strength with balance training      
Group class   
Individualized exercise/PT      
Tai Chi   
Medication
Medication review       
Medication management   
Vision
Basic assessment     
Detailed assessment  
Vision correction  
Home Safety
Assessment  
Basic modifcation**  
Skilled modifcation**  
Other
Assistive device training       
** Basic modifcation includes clutter/throw rug removal, rearrange furniture; skilled modifcation includes grab bars, ramps,
electrical work.
Note: Partnerships may facilitate delivering multifaceted programs in community settings.
Where to Conduct Fall Prevention Program Components
Step 6. Find a location to conduct the program. When
considering what type of program to develop, consider the types of
places where a program can be held. The following chart provides
suggestions for each type of fall prevention component.
Planning An Effective Fall Prevention Program
12
Step 7. Evaluate your program. Evaluation helps determine
whether a program is appropriate and effective. The results of the
evaluation will guide you in maintaining or modifying any aspects
of the program and tell you if the program is worth continuing.
Chapter 6 will help you develop evaluation strategies to document
your program’s effectiveness.
Step 8. Promote your program. Making the community aware of
your fall prevention program is crucial to its success. No matter the
size of your outreach effort, Chapter 7 will help you in developing
a campaign to publicize your program and provide you with tips on
working with your local media.
Step 9. Sustain your program. To sustain your program, you will
need to review and make modifcations. This means keeping sight
of your goals and maintaining momentum in building
collaborations, advocating for support, and seeking new sources of
funding. Chapter 8 will help guide you through this process.
Injury Prevention
13
Chapter 3
The Important Role of
Partnerships in Fall
Prevention Programs
Because falls are the result of multiple fall risk factors, it may
be diffcult for your organization, on its own, to develop a
comprehensive program. By collaborating with other community
organizations and professionals that specialize in different types
of services for older adults, such as healthcare, exercise, home
safety assessment, and education, you can make your program
more comprehensive and effective. For example, a public health
or healthcare organization may partner with a senior services or
parks and recreation organization to create a program that includes
exercise and fall prevention education.
Collaborating with other CBOs can provide additional resources,
outreach channels, or referral sources for your program. Because
of its many benefts, collaboration can be essential in developing
your program.
How to develop partnerships
† Assess your current situation. Planning your prevention
program involves a careful analysis of your organizational
resources and needs, including staff, funding, facilities,
technology, and expertise. This information clarifes when a
potential partnership with another organization can support
your program goals.
† Identify potential partners. Partnerships should be
mutually benefcial. Identify organizations that share your
mission of improving health and safety for older adults or
that have a vested interest in reducing falls among older
adults. Determine how a collaboration will mutually support
short- and long-term goals.
14
† Develop your “pitch” for partnership. After strategically
selecting potential partners, develop your “pitch,” or selling
points, for partnership. This will vary based on the resources,
needs, and priorities of each organization. Showcase the
benefts for your potential partners.
† Create your messages and materials. Develop message
points—short, concise statements that refect your main
messages. These are useful for internal and external
communications, as well as for presentations to partners.
For these messages:
• Develop themes or adapt materials that will engage your
potential partners.
• Produce materials (computer-generated presentations,
fyers, etc.) that will effectively convey your messages.
• Pretest your materials among potential partners.
• Develop a method for tracking partnerships and other
outreach efforts.
† Make contact. Whenever possible, deliver your partnership
proposal in person. Consider bringing at least one other
person, because different communication styles and
demeanors can infuence an encounter. Sharing the workload
and presentation delivery reduces the pressure of thinking on
your feet. However, make sure that your team speaks with
one voice, based on the messages you develop. Delivering
mixed messages creates confusion and weakens your credibility.
† Seal the deal. Being credible and offering incentives are
important, but these may not be enough to seal the deal. Use
your passion to make potential partners believe they should
be involved.
• Describe how your programs and services can make a
difference.
• Share information about the burden of falls and fall injuries.
• Underscore how your community will beneft from your
efforts and how others are getting involved.
15
Chapter 3
• Remind potential partners of their strengths and how
even seemingly small contributions can help prevent
injury and death.
• Confrm how the proposed partnership is mutually
benefcial.
• Be specifc about what you are asking them to contribute
and do.
How to maintain partnerships
Relationships need to be maintained. While commitment is
important, so is continuing to review your resources, needs, and
expectations as the program evolves. Involving local organizations
will be an ongoing effort, so remember to engage as many facets of
your community as you can, including:
• Hospitals and healthcare centers
• Local and state government offcials and offces
• Faith-based organizations
• Civic organizations
• Senior citizen groups
• Commercial establishments serving older adults
• Clubs that may have a large older-adult membership (such as
the Veterans of Foreign Wars)
• Universities or colleges that offer academic programs or
services for older adults
Never forget the power of the phrase “thank you.” Acknowledge
partnership agreements promptly. Look for creative ways to convey
your gratitude to partners often and thank them publicly. See
Appendix B for an inventory form that can be useful for identifying
community resources and potential program partners.
The Important Role of Partnerships in Fall Prevention Programs
16
Partnership web resources
The National Council on Aging’s Partnering to Promote
Healthy Aging: Creative Best Practice Community
Partnerships
www.healthyagingprograms.org/content.asp?sectionid=
92&ElementID=160
Falls Free: A National Falls Prevention Action Plan
www.healthyagingprograms.org/content.asp?sectionid=98
California Blueprint For Falls Prevention
www.archstone.org/publications2292/publications_show.htm?doc_
id=246660
Queensland, Australia Statewide Action Plan: Falls Prevention
in Older People 2002-2006
www.health.qld.gov.au/phs/Documents/shpu/13693.pdf
WA State Dept. of Health Report - Falls Among Older Adults:
Strategies for Prevention
www.doh.wa.gov/hsqa/emstrauma/injury/pubs/
FallsAmongOlderAdults.pdf
Health care & public health partnerships
repositories.cdlib.org/cgi/viewcontent.cgi?article=1003&context=iha
Community Toolbox for Public Health Partnerships
ctb.ku.edu/WST/initiatives_show.jsp?initiative_id=44
Partnership self-assessment tool
www.cacsh.org/psat.html
Injury Prevention
17
Increasing awareness about fall risk factors and ways to reduce fall
risk is crucial in helping older adults, their families, caregivers, and
service providers to effectively prevent falls.
There are two types of audiences for fall prevention education: the
professionals who will implement the fall prevention program and
older adults and their caregivers.
People in your community who are qualifed to provide public and
professional fall prevention education sessions include:
• Healthcare professionals
• Public health professionals
• Senior service providers
• Emergency medical service professionals
Provider education
Provider education is necessary to inform healthcare and
senior service providers about the current state of knowledge in fall
prevention for older adults. Key aspects of professional
education include:
• National, state, and county data on fatal and nonfatal
fall injuries and healthcare costs. National and some state
data are available from CDC’s National Center for Injury
Prevention and Control. Additional state and county data
may be available from health departments, local emergency
services, and fre departments. Data on cost of falls may be
available from local hospitals.
Chapter 4
Education: The Foundation
of Effective Fall
Prevention Programs
18
Information about fall risk factors among older adults (see
the web resources at the end of this chapter).
Information about effective fall prevention interventions
(see the web resources at the end of this chapter and the
Compendium).
Tools and resources to train professional staff to deliver
fall prevention information tailored to their audience
(see the web resources at the end of each chapter and the
Compendium).



Public education
Public education includes communicating the
importance of fall prevention to the general
public and directly informing older adults how to
maintain a healthy lifestyle that reduces the risk
of falls. When promoting your fall prevention
program, you will also be creating awareness
for the necessity of fall prevention in your
community. You can fnd more information in
Chapter 7 about promoting fall prevention and
your fall prevention program.
Educating older adults about individual risks and
methods of prevention is an important building
block of every fall prevention program. More
information on educating older adults about
the risk of falls and fall prevention activities will
follow in the next chapter.
Fall Intervention Studies that Include Education
Stay Active, Stay Safe (Barnett, et al.)
The Otago Exercise Program (Campbell, et al., Robertson, et al.)
Tai Chi: Moving for Better Balance (Li, et al.)
Australian Group Exercise Program (Lord, et al.)
Simplifed Tai Chi (Wolf, et al.)
Home Visits by an Occupational Therapist (Cumming, et al.)
Falls-HIT (Home Intervention Team) Program (Nikolaus, et al.)
Stepping On (Clemson, et al.)
PROFET (Prevention of Falls in the Elderly Trial) (Close, et al.)
The NoFalls Intervention (Day, et al.)
The SAFE Health Behavior and Exercise Intervention
(Hornbrook, et al.)
Yale FICSIT (Frailty and Injuries: Cooperative Studies of
Intervention Techniques) (Tinetti, et al.)
A Multifactorial Program (Wagner, et al.)
For more details, refer to the companion publication,
Preventing Falls: What Works. A CDC Compendium of
Effective Community-based Interventions from Around
the World
19
Chapter 4
Education web resources
CDC’s “What You Can Do To Prevent Falls” and
“Home Safety Checklist” brochures for older adults
www.cdc.gov/ncipc/duip/fallsmaterials.htm
CDC Falls Prevention page
www.cdc.gov/ncipc/duip/preventadultfalls.htm
Center of Excellence for Fall Prevention
www.stopfalls.org
National Institute on Aging, AgePage: Preventing
Falls and Fractures
www.niapublications.org/agepages/PDFs/preventing_Falls_and_
Fractures.pdf
The American Geriatrics Society Guideline for the Prevention of
Falls in Older Persons
www.americangeriatrics.org/products/positionpapers/abstract.shtml
Center for Healthy Aging Falls Free Electronic News
www.healthyagingprograms.org
California Blueprint for Falls Prevention
www.archstone.org/publications2292/publications_show.htm?doc_
id=246660
National Safety Council
www.nsc.org/issues/fallstop.htm
“Getting Up From a Fall” handout from the American Academy
of Orthopaedic Surgeons
orthoinfo.aaos.org/topic.cfm?topic=A00098
20
Notes:
Education: The Foundation of Effective Fall Prevention Programs
Injury Prevention
21
The most effective fall prevention programs address many of the risk
factors described in Chapter 1. Based on your resources, you can
start your program using one building block and then expand its
effectiveness by adding more blocks over time.
The fve main building blocks of an effective community-based fall
prevention program are:
Education about falls and fall risk factors.
Exercises that improve mobility, strength, and balance,
and that are taught by trained, nationally certifed exercise
instructors or physical therapists. Exercise programs include:
Tai Chi
Individualized exercise sessions
Group exercise classes
Home exercise programs with supervision until the older
adult can exercise independently
Medication review to identify side effects or drug
interactions that may contribute to falls. The reviews should
be conducted by pharmacists or healthcare providers.
Medication management—adjustments to or changes in
medications—should be provided by physicians.
Vision exams by trained healthcare professionals with vision
correction by an optometrist or ophthalmologist.
Home safety assessment and home modifcation by
occupational therapists or other healthcare professionals with
specialized training, to identify and modify home hazards
that can increase older adults’ risk of falling.
†
†
†
†
†




Chapter 5
The 5 Building Blocks of
Effective Community-based
Fall Prevention Programs
22
Building Block 1: Education programs for older
adults and their caregivers
When developing a fall prevention program, it is important to
include an educational component. While education alone has not
proven to effectively reduce falls among older adults, it is typically
combined with one of the other building blocks. Education for
older adults and their caregivers can be delivered to individuals or
to groups. Individual education sessions may work better for people
who are hearing or vision impaired or have special needs. Sessions
should be tailored to the attention span and cognitive ability of
older adults. Visual aids such as brochures, fact sheets, and checklists
will help facilitate the education session.
Group sessions provide the benefts of social interactions. Informal
group discussions that include sharing personal experiences may
reduce anxiety and increase motivation to adopt new behaviors.
Group teaching saves time and helps spread the information more
quickly to more people.
Tips for developing an effective education component
† Education should be delivered by trained professionals.
† Education should include problem solving and goal setting
on the part of the learner.
† The length of the education session should depend on
the individual characteristics of the older adult, such as
concentration, hearing or visual impairment, etc.
† Group vs. individual education may be determined based on
which other bulding block is being offered in combination.
† Visual aids are valuable tools in increasing comprehension.
† Materials should be designed with a high contrast
background and large lettering.
† Materials should refect literacy levels and be culturally
appropriate.
† Presentations and materials should not contain abbreviations
and jargon.
† Education is most effective when offered on an ongoing basis.
23
Chapter 5
There is a wealth of educational materials available on the Internet.
You can fnd visual aids, including posters, videos and presentations,
brochures, and checklists, or you can develop your own materials.
See Appendices C and D for an example of a brochure and a
presentation. A set of fall prevention posters is also available through
the CDC website listed below. Use the following websites for
additional education materials.
Education web resources
CDC’s “What You Can Do To Prevent Falls” and
“Home Safety Checklist” brochures for older adults
www.cdc.gov/ncipc/pub-res/toolkit/brochures.htm
CDC Falls Prevention page
www.cdc.gov/ncipc/duip/preventadultfalls.htm
Center of Excellence for Fall Prevention
www.stopfalls.org
National Institute on Aging, AgePage: Preventing
Falls and Fractures
www.niapublications.org/agepages/PDFs/preventing_Falls_and_
Fractures.pdf
The American Geriatrics Society Guideline for the Prevention of
Falls in Older Persons
www.americangeriatrics.org/products/positionpapers/abstract.shtml
Center for Healthy Aging Falls Free Electronic News
www.healthyagingprograms.org
California Blueprint for Falls Prevention
www.archstone.org/publications2292/publications_show.htm?doc_
id=246660
American Academy of Orthopaedic Surgeons
orthoinfo.aaos.org/menus/safety.cfm
National Safety Council
www.nsc.org/issues/fallstop.htm
The 5 Building Blocks of Effective Community-Based Fall Prevention Programs
24
Building Block 2: Progressive exercise programs to
improve mobility, strength, and balance
Among older adults, strength and balance exercises, such as Tai Chi,
can reduce falls by improving mobility, strength, and balance. These
programs focus on exercises that are specifcally designed or adapted
for older adults.
Tips for developing an effective exercise component
† To be safe and effective, older adult exercise
programs (one-on-one or group classes) must
be taught by one or more of the following
professionals:
• Nationally certifed ftness/exercise
instructors with specialized training in
working with older adults. Because exercise
instructors are not licensed, having a
national certifcation or accreditation is the
minimum qualifcation requirement for
teaching fall prevention exercise programs
to older adults.
• Exercise science/physiology professionals
with a bachelor’s degree or master’s degree
in this feld.
• Physical therapists.
• Occupational therapists.
• Recreational therapists with a bachelor’s
or master’s degree.
• Tai Chi instructors, masters or grand
masters, who have completed a Tai Chi
course taught by a Tai Chi master or grand
master, have a national certifcation in older
adult physical activity, and have experience
in teaching exercise to older adults.
• Physical, occupational, and recreational
therapy assistants who are under the direct
supervision of a physical, occupational, or
recreational therapist.
Fall Intervention Studies that Include Exercise
Stay Active, Stay Safe (Barnett, et al.)
The Otago Exercise Program (Campbell, et al., Robertson, et al.)
Tai Chi: Moving for Better Balance (Li, et al.)
Australian Group Exercise Program (Lord, et al.)
Veterans Affair Group Exercise Program (Rubinstein, et al.)
Simplifed Tai Chi (Wolf, et al.)
Home Visits by an Occupational Therapist (Cumming, et al.)
Falls-HIT (Home Intervention Team) Program (Nikolaus, et al.)
Stepping On (Clemson, et al.)
The NoFalls Intervention (Day, et al.)
The SAFE Health Behavior and Exercise Intervention
(Hornbrook, et al.)
Yale FICSIT (Frailty and Injuries: Cooperative Studies of
Intervention Techniques) (Tinetti, et al.)
A Multifactorial Program (Wagner, et al.)
For more details, refer to the companion publication,
Preventing Falls: What Works. A CDC Compendium of
Effective Community-based Interventions from Around
the World
25
Chapter 5
PROGRAMS IN ACTION
Stay Active and Independent for Life (SAIL):
A strength and balance ftness class for adults 65+
The SAIL program combines health information with exercises specifcally designed
to safely and easily improve endurance, strength, and balance in adults aged 65
and older. The program was researched and developed as a community-based fall
prevention program by the Washington State Department of Health.
The SAIL program helps older adults to stay active and independent. It helps to
prevent falls, through group exercise classes that meet for 1 hour, three times a
week. The classes are held at community sites, such as senior centers, parks and
recreation facilities, and community ftness centers that often work in partnership
with community healthcare and senior service organizations to offer the program.
Classes are led by certifed ftness instructors who have attended the 2-day SAIL
Instructor Training Program, which was designed by physical therapists and a
registered nurse.
The program name and its key messages were developed through older adult focus
groups to emphasize a specifc description of the program and its positive benefts:
• “ It works…you’ll be stronger, have better balance, feel better, and this will help
you stay independent, active, and prevent falls.”
• “ It’s safe…the instructors are experienced and skilled, and exercises have been
tested with seniors.”
• “ It’s fun…you’ll meet other seniors and make new friends.”
The SAIL class exercises are designed to be done either sitting or standing, and
at individually adjustable paces. The class includes aerobic and balance exercises,
strength training with wrist and ankle weights, and fexibility exercises. The
class participants also receive brief “Fitness Checks” when they start the classes
for measuring progress and improvement after they start the classes. These
measurements of walking speed and arm and leg strength, are repeated every
3 to 6 months throughout the year, enabling class participants to monitor their
individual progress. In addition to the exercises, health information is included
in the classes, which addresses topics such as exercising safely, medication and
home safety, and footwear and foot care. The education information is provided
in a booklet published by the Washington State Department of Health: “Stay
Active and Independent for Life: An Information Guide for Adults 65+.” All class
participants receive a free copy of the booklet.
For more information contact:
www.cdc.gov/ncipc/profles/core_state/wa/default.htm or
www.doh.wa.gov/hsqa/emstrauma/injury/pubs/default.htm#seniorfalls
The 5 Building Blocks of Effective Community-Based Fall Prevention Programs
26
†
†
†
†
†
†
†
†
All professionals who teach exercise to older adults must have
a current CPR/AED certifcation.
To be effective in reducing falls, exercises must be performed
at least twice weekly on an ongoing basis and progress in
diffculty throughout the program.
Ideally, the exercise classes should be offered on an ongoing
basis for long-term attendance. Short-term programs that have
a set number of sessions should provide written instructions so
participants can continue to do the exercises at home.
Participants should be taught the exercises under the direct
supervision of a trained exercise instructor or physical or
occupational therapist, either in one-on-one home sessions or in
group sessions, before performing them independently at home.
Evaluate how the program instructor delivers the exercise
program. Use process evaluation methods to ensure that the
exercises are being taught properly and consistently. Also,
obtain feedback from the program participants.
Base program content on current published materials
specifcally developed for older adults by exercise science,
physical therapy, or Tai Chi professionals.
Assess older adults’ strength, balance, and ftness at the
beginning and end of each new exercise program.
Limit the number of participants in group classes to no more
than 15 to allow the instructor the ability to closely observe
and supervise participants during the class session.
The National Council on Aging’s Center for Healthy
Aging has developed a detailed checklist for fall prevention
programs in Evidence-based Healthy Aging Programming:
Tools and Checklists at healthyagingprograms.org/content.
asp?sectionid=32&ElementID=439
Appendix E provides examples of strengthening and balance
exercises from the Stay Safe Stay Active Daily Exercise Program.
Additional exercise examples can be found in the Preventing Falls:
What Works. A CDC Compendium of Effective Community-based
Interventions from Around the World.
27
Chapter 5
Exercise program web resources
CDC Physical Activity Resources
www.cdc.gov/nccdphp/dnpa/physical
National Council on Aging: Center for Healthy Aging, 2005.
Evidence-based Healthy Aging Programming: Tools
and Checklists
www.healthyagingprograms.org
International Curriculum Guidelines for Preparing Physical
Activity Instructors of Older Adults
www.seniorftness.net/international_curriculum_guidelines_for_
preparing_physical_activity_instructors_of_older_adults.htm
Growing Stronger: Strength Training for Older Adults—a web
based strength training exercise program
www.cdc.gov/nccdphp/dnpa/physical/growing_stronger
National Institutes of Health: NIH Publication No. 01-4256, 2001
Exercise: A Guide from the National Institute on Aging
www.nia.nih.gov/HealthInformation/Publications/ExerciseGuide
National Council on Aging: Center for Healthy Aging,
Issue Brief #2, Winter 2004 Designing Safe and Effective
Physical Activity Programs
www.healthyagingprograms.com/resources/IssueBrief_
PhysicalActivity.pdf
National Council on Aging: Center for Healthy Aging,
Issue Brief #4, Fall 2005 Keeping Current on Research and
Practice in Physical Activity for Older Adults
www.healthyagingprograms.com/resources/IssueBrief_
KeepCurrentPA.pdf
National Council on Aging: Center for Healthy Aging, Moving
Ahead: Strategies and Tools to Plan, Conduct and Maintain
Effective Community-based Physical Activity Programs for
Older Adults
www.healthyagingprograms.com/resources/PRC-HAN_conference_
monograph.pdf
The 5 Building Blocks of Effective Community-Based Fall Prevention Programs
28
American College of Sports Medicine’s Physical Activity
Guidelines for adults over age 65
www.acsm.org/AM/Template.cfm?Section=Home_Page&
TEMPLATE=/CM/HTMLDisplay.cfm&CONTENTID=
7764#Over_65_or_50_64
Human Kinetics’ Senior Fitness Test Manual and Software:
manual and software for testing and tracking functional
ftness measures in older adults
www.humankinetics.com/products/showproduct.cfm?isbn=
9780736033589
American Council on Exercise and AARP Fitness Resources
www.aarpftness.com
Exercise and Older Adults
nihseniorhealth.gov/exercise/toc.html
References
Berg K. Balance and its measure in the elderly: A review.
Physiother, Canada. 1989:41;240-246.
Chang JT, Morton SC, Rubenstein LZ, et al. Interventions for
the prevention of falls in older adults: Systematic review and
meta-analysis of randomized clinical trials. Br Med Journal.
2004:328;680-683.
Cotton, RT. Exercise for older adults: American Council on
Exercise’s guide for ftness professionals. Human Kinetics:
Champaign, IL;1998.
Dunkin, A. All you need to know about back pain.
Arthritis Foundation: Atlanta, GA;2002.
Gillespie LD, Gillespie WJ, Robertson MC, Lamb SE, Cumming
RG, Rowe BH. Interventions for preventing falls in elderly
people. Cochrane Database Syst Rev. 2003:4;CD000340.
Herdman, S. Vestibular Rehabilitation. F.A. Davis Company:
Philadelphia, PA;2000.
29
Chapter 5
Haas EN ed; Handbook of Injury and Violence Prevention
Atlanta GA, Springer 2007 Author of chapter. Chapter 3:
Interventions to prevent falls among older adults. In: Haas,
EN, ed. Handbook of Injury and Violence Prevention.
Atlanta, GA:Springer;2007.
Nelson M, et al. Physical activity and public health in older
adults: Recommendations from the American College of Sports
Medicine and the American Heart Association. Am J Sports Med.
2007:39(8);1435-1445.
Nelson, ME. Strong women stay young. Bantam Books:
New York, NY;2000.
Podsaidlo D, Richardson S. The timed up and go: A test of
basic functional mobility for frail elderly persons. Journal of the
Am Geriatr Soc. 1991:39;142-148.
Rikli RE, Jones CJ. Senior ftness test manual human kinetics:
Champaign, IL;2001.
Rose, D. Fall Proof: A comprehensive balance and mobility
training program human kinetics: Champaign, IL;2003.
Shumway-Cook A, Brauer S, Woollacott M. Predicting the
probability of falls in community-dwelling older adults using the
“Timed Up and Go Test.” Phys Ther. 2000:80;896-903.
Tinetti ME. Performance-oriented assessment of mobility problems
in elderly patients. J Am Geriatr Soc. 1986:34;119-126.
The 5 Building Blocks of Effective Community-Based Fall Prevention Programs
30
Building Block 3: Medication review and
management
The purpose of medication review and management is to identify
and eliminate medication side effects and interactions, such as
dizziness or drowsiness, that can increase the risk of falls.
Many older adults are unaware that their daily medications may
increase their fall risk. Aging affects the absorption, distribution,
metabolism, and elimination of medications. Age can also
increase sensitivity to potential side effects. Older adults may get
prescriptions from multiple doctors. Fall risk increases with the total
number of prescription and over-the-counter medications.
Psychoactive medications (drugs that alter brain function) increase
fall risk. These include antidepressants, tranquilizers, antipsychotics,
antianxiety drugs, and sleep medications. Other medications
that may cause problems include those prescribed to treat seizure
disorders, blood pressure-lowering medications, cholesterol-lowering
medications, heart medications, and painkillers. A medication review
checklist is included in Appendix F.
Drug side effects that can contribute to falling include blurred
vision, hypotension leading to dizziness and lightheadedness,
sedation, decreased alertness, confusion and impaired judgment,
delirium, compromised neuromuscular function, and anxiety.
Review and modifcation of the medication regimen by a healthcare
provider can frequently reverse or minimize these effects.
Clinical practice recommendations include medication reviews by
healthcare providers for older adults who have fallen.
Fall Intervention Studies
that Include Medication
Review and Management
PROFET (Prevention of Falls in the
Elderly Trial) (Close, et al.)
Yale FICSIT (Frailty and Injuries:
Cooperative Studies of Intervention
Techniques) (Tinetti, et al.)
A Multifactorial Program (Wagner, et al.)
For more details, refer to
the companion publication,
Preventing Falls: What Works. A
CDC Compendium of Effective
Community-based Interventions
from Around the World
31
Chapter 5
PROGRAMS IN ACTION
California Department of Aging’s Medication Management Program
The Medication Management Program is an evidence-based, federally funded
program under Title IIID of the Older Americans Act. Funds are distributed to
California Area Agencies on Aging to provide a wide variety of community-based
services and information at multipurpose senior centers, at congregate meal sites,
through home delivered meal programs and at other appropriate sites.
The purpose of the Medication Management Program is to improve the quality
of life for older adults and prevent premature institutionalization by working
with them to manage their use of over the counter and prescription medications,
vitamin, mineral, and herbal supplements.
The target population for this program included individuals aged 60 years and
over who live in an area of greatest economic need, who live in a medically
underserved area of the region, or who have a chronic medical conditions that can
improve with education and non-medical intervention.
The following are examples of the community-based activities and partnerships in
this program:
• Pharmacists’ or pharmacy students’ presentations on how older adults can manage
their medications, drug-nutrient interactions, and supplements. The presentation may
include a personalized medication review to identify expired medications, answer
client questions, and counsel older adults to assure they understand, are following
directions, and taking medications properly. The pharmacists also encourage older
adults to communicate with their doctors so they will be better informed about what
medicines are being prescribed, why, and what results and/or side effects to expect.
• Partnerships with community-based organizations to provide “Rx Check Up” clinics.
• Distribution of passport size books for older adults to keep records of health
and medications. Older adults can take the books with them to share with their
doctors and pharmacist.
• Distribution of brochures related to medication management.
• Distribution of pill minders in various languages to help older adults manage
their prescriptions.
• Information provided at Senior Health Fairs, through an Info Van, and through
the Information and Assistance Program.
• Automated medication dispensers for frail and/or blind clients in their home.
For more information, visit www.aging.ca.gov/html/programs/medication_
management.html
The 5 Building Blocks of Effective Community-Based Fall Prevention Programs
32
Tips for developing an effective medication review and
management component
† Medication reviews are recommended for older people taking
four or more medications and those taking any psychoactive
medications.
† Medication reviews can be done in screening clinics,
hospital programs, home visits by home health professionals,
pharmacies, and doctors’ offces.
† Medication reviews can be done by a pharmacist or a
healthcare provider. Coordinated medication management
that involves changing or reducing types or dosages of
medications, should be done by the older adult’s
healthcare provider.
† Medication review and management may include assessing
the need for vitamin D and calcium supplements as well as
osteoporosis treatment.
† The amount and frequency of alcohol use should be included
in a medication review.
Medication review and management
web resources
National Institutes of Health Senior Health
nihseniorhealth.gov/takingmedicines/toc.html
American Geriatrics Society Clinical Guidelines for Prevention
of Falls in Older Persons
www.americangeriatrics.org/products/positionpapers/Falls.pdf
Medications and falls in the elderly
www.pharmacists.ca/content/cpjpdfs/julaug04/July-August-
FocusonPatientCareRevised.pdf
“10 questions to ask your doctor or pharmacist about
your medications”
www.a4aa.com/Ten_Questions_to_Ask_Your_Doctor_or_
Pharmacist_Outreach__2_.pdf
33
Chapter 5
Building Block 4: Vision exams and vision
improvement
Vision changes and vision loss associated with aging are common
fall risk factors among older adults. Vision loss can contribute
to falls by disturbing balance and by obscuring tripping and
slipping hazards.
Many vision conditions, such as cataracts, glaucoma, and macular
degeneration, are gradual and painless. However, if these conditions
are diagnosed early, they can be managed to minimize vision loss.
Older adults may have diffculty learning about and/or accessing
community programs that offer vision care services. CBOs can
play an important role by providing information about and
encouraging regular vision exams and care, and by referring older
adults to community vision care services and resources.
Tips for developing an effective vision component
† Limited basic or simple vision screening can be performed
by trained healthcare professionals such as physicians, nurse
practitioners, physicians’ assistants, registered nurses, and
occupational therapists. However, basic vision screening
does not identify all types of vision problems that need to
be corrected.
† Comprehensive vision exams must be performed using
specialized equipment. Therefore, these must be done by an
optometrist or ophthalmologist.
† Medicare provides coverage for dilated eye exams, which are
considered comprehensive vision exams.
Fall Prevention Intervention
Studies that Include Vision
Assessment
PROFET (Prevention of Falls in the
Elderly Trial) (Close, et al.)
The NoFalls Intervention (Day, et al.)
A Multifactorial Program (Wagner, et al.)
For more details, refer to
the companion publication,
Preventing Falls: What Works. A
CDC Compendium of Effective
Community-based Interventions
from Around the World
The 5 Building Blocks of Effective Community-Based Fall Prevention Programs
34
PROGRAMS IN ACTION
Vision Loss Resources
Vision Screening, Resource, and Education
Vision Loss Resources is an independent nonproft 501 C(3) agency in
Minneapolis, Minnesota. Its mission is to assist people who are blind or visually
impaired achieve their full potential and to enrich the lives of all persons affected
by blindness, vision loss, or hearing loss. Vision Loss Resources provides programs
to enhance independent living and educate the community about vision loss.
Programs include:
• In-home assessment with service and resource plan development
• In-home vision evaluation for adaptive vision aids
• Hearing assessments with advocacy and resources for adaptive equipment
• Volunteers for assisting vision impaired clients to live independently
• Peer counseling and support and growth groups
• Leisure opportunities at the Vision Loss Resources’ Community Center
• Life skills classes, training, and resources for maintaining independence
• Community and professional education about vision loss and resources
• Outreach and special projects providing resources and services for individuals
and groups, with emphasis on special needs and cultural diversity.
For more information, Vision Loss Resources can be contacted by phone
at 612.871.2222, on the web at www. visionlossresources.com, or
e-mail at cleach@vlrw.org
Vision care is provided primarily by the following professionals:
† Optometrists examine people’s eyes to diagnose vision
problems and eye diseases, test patients’ visual acuity,
depth, and color perception, and test their ability to focus
and coordinate their eyes. They prescribe eyeglasses
and contact lenses and provide vision therapy and
low vision rehabilitation.
† Ophthalmologists are physicians who perform detailed,
comprehensive, and dilated vision exams and eye surgery.
Like optometrists, they examine eyes and prescribe eyeglasses
and contact lenses. They also diagnose and treat eye diseases
and injuries.
35
Chapter 5
† Dispensing opticians ft and adjust eyeglasses and, in some
states, may ft contact lenses according to prescriptions
written by ophthalmologists or optometrists.
† Local Area Agencies on Aging and state ophthalmology
and optometry associations can provide information
about community vision programs for older adults, for
vision screening and/or exams, and fnancial assistance for
vision needs.
† After the age of 60, vision assessments are recommended at
least every 2 years, and more frequently if an eye condition
has been diagnosed.
† Detailed eye exams by an optometrist or ophthalmologist are
recommended at least once every 2 years for managing vision
conditions and for corrective eye procedures, medications,
and eyeglass prescriptions.
Vision web resources
National Institutes of Health Senior Health: Vision conditions
and low vision topics
nihseniorhealth.gov/listoftopics.html
Medicare benefts for vision exams and vision care
www.medicare.gov
The American Academy of Ophthalmology
www.aao.org
The American Optometric Association
www.aoa.org
Opticians Association of America
www.oaa.org/index.shtml
National Eye Institute: Glaucoma—Resources for Patients
and the Public
www.ski.org/Colenbrander/Images/Low_Vision_Exam.pdf
catalog.nei.nih.gov/productcart/pc/viewCat_L.asp?idCategory=78
The 5 Building Blocks of Effective Community-Based Fall Prevention Programs
36
Building Block 5: Home safety assessment and
home modifcation
Environmental factors play a part in approximately half of all falls
that occur at home. Falls can be caused by slipping and tripping
hazards, poor lighting, or the lack of needed home modifcations
such as bathroom grab bars, handicapped showers, stair railings,
and ramps.
A home safety assessment can identify factors that may put an
individual at risk for falling. Many older adults can beneft from
home safety assessments, but those with a history of falls and/
or with mobility or balance diffculties have the greatest need for
such an assessment. Home assessments can be combined with or
included with other direct one-on-one services that are provided by
community service programs to residents in their homes.
A self-administered home safety assessment
checklist can be helpful if there is a plan for
follow-up review with a trained professional to
follow up and if information and referrals to
home modifcation programs and resources are
provided. A Home Fall Prevention Checklist is
provided in Appendix G.
Older adults may have diffculty learning
about and/or accessing home safety and home
modifcation information and resources. Local
Area Agencies on Aging (AAA) can provide
information and referrals to local home
modifcation programs. AAA can also provide
information about state and federal programs
that offer services and fnancial assistance to
low-income seniors.
For an older adult who has been injured in a fall, Medicare may
cover a home safety assessment and home modifcation if it is
performed by an occupational or physical therapist. The senior
must meet the home health reimbursement criteria, and these
home services must be prescribed by a doctor, nurse practitioner,
or physician assistant.
Adult Fall Prevention Interventions with
Home Safety Assessment & Modifcation
Research Study Components
Home Visits by an Occupational Therapist (Cumming, et al.)
Falls-HIT (Home Intervention Team) Program (Nikolaus, et al.)
Stepping On (Clemson, et al.)
PROFET (Prevention of Falls in the Elderly Trial) (Close, et al.)
The NoFalls Intervention (Day, et al.)
The SAFE Health Behavior and Exercise Intervention
(Hornbrook, et al.)
Yale FICSIT (Frailty and Injuries: Cooperative Studies of
Intervention Techniques) (Tinetti, et al.)
A Multifactorial Program (Wagner, et al.)
For more details, refer to the companion publication,
Preventing Falls: What Works. A CDC Compendium of
Effective Community-based Interventions from Around
the World
37
Chapter 5
PROGRAMS IN ACTION
Pitt County Council on Aging: SPICE for Life
Senior Safety, Prevention, Intervention, and Community Education
This North Carolina fall prevention program’s target population is low-income
older adults, aged 60+, who are at high risk for loss of independence due to a
decreased ability to function within the home. Fall risk factors typically
addressed include:
• Home and environmental safety
• Medications
• Vision
• Mobility
• Lighting
Referrals for the program are called into the Pitt County Council on Aging (PCCOA)
or are identifed by PCCOA social workers. If the individual meets the criteria
for the SPICE program and grant funding is available, a referral is sent to the
program’s lead occupational therapist (OT). The OT then further assesses eligibility
and sets up an appointment for a home visit to perform a home modifcation and
fall risk assessment.
SPICE makes use of two assessment tools that are standard
to the program:
• A fall interview questionnaire to assess the individual
• A home safety modifcation assessment tool
Once the needs are identifed, each low-income older adult who qualifes for the
fall prevention/home safety program is educated about fall prevention strategies
and provided with the necessary equipment and home modifcations. When
necessary, referrals for additional services are made to other service providers and
agencies. Referral sources are varied (physicians, home health providers, aging
network providers, etc.) and are continuing to increase as the community becomes
more aware of the program. Community partnerships and involvement are critical
elements of this program’s success.
To contact the Pitt County Council on Aging, please call
(252) 752-1717
The 5 Building Blocks of Effective Community-Based Fall Prevention Programs
38
Occupational therapists can conduct environmental assessments,
assess how the older adult interacts with their home environment,
and suggest adaptations or modifcations that can help older
adults with limited physical function or low vision prevent falls
and live independently.
Tips for developing an effective home safety component
† Home safety assessments and modifcations are most
effective when they are done in the home by an
occupational therapist and when they include education,
recommendations, and a follow-up home visit to assess the
need for additional modifcations.
† Home assessments and modifcations by an occupational
therapist are especially effective in reducing falls among
older adults who have already had a fall.
† Occupational therapists are specifcally trained to help
individuals adapt their living environments to their
physical needs, so they can perform their daily activities as
independently and safely as possible. Occupational therapists
are also trained to provide education to older adults, their
family members, and caregivers.
† Trained professionals such as a Certifed Aging in Place
Specialist (certifed by the National Association of Home
Builders), registered nurses, and physical therapists can also
effectively carry out home assessments and modifcations, in
collaboration with occupational therapists.
† In addition to home modifcations, some older adults may
need to use personal assistive safety and mobility devices.
An occupational or physical therapist can provide the
training needed to use these devices properly.
39
Chapter 5
Home safety web resources
American Occupational Therapy Association’s Fact Sheet on
Occupational Therapy and Prevention of Falls
www.aota.org/Consumers/WhatisOT/FactSheets/
Conditions/39478.aspx
CDC’s “Check for Safety: A Home Fall Prevention Checklist for
Older Adults” brochure
www.cdc.gov/ncipc/duip/fallsmaterial.htm
National Resource Center on Supportive Housing and
Home Modifcation
www.homemods.org
Home Safety Council: State of Home Safety’s Facts About
Safety in the Home
homesafetycouncil.org/state_of_home_safety/sohs_2004_p017.pdf
Home Safety Checklist (in English, Spanish, Chinese, Italian,
Russian, Tagalog)
www.aging.ca.gov/resources/home_housing/home_safety_checklist.html
Ladder Safety Information Sheets
orthoinfo.aaos.org/fact/thr_report.cfm?Thread_
ID=92&topcategory=Injury%20Prevention
The 5 Building Blocks of Effective Community-Based Fall Prevention Programs
40
Notes:
Injury Prevention
41
CDC’s National Center for Injury Prevention and Control
has developed recommended approaches for evaluating
injury prevention programs, and these can be adapted
for fall prevention programs. This chapter summarizes the key
elements of these approaches. More complete and detailed
information can be found in Demonstrating Your Program’s Worth:
A Primer on Evaluation for Programs to Prevent Unintentional Injury
The full text of this publication can be found in pdf or html format
at www.cdc.gov/ncipc/pub-res/demonstr.htm.
With objective evaluation, program managers and staff can:
• Show that their program is benefting the community
• Show funding agencies that their program is successful
• Produce facts and fgures to demonstrate positive outcomes
• Share the results in publications and presentations to be more
likely to receive continued funding
Evaluation should begin while the program is in the earliest
development stages, not after the program is complete. Evaluation
is an ongoing process that begins as soon as someone decides to
develop and implement a program; it continues throughout the life
of the program; and it ends with a fnal assessment of how well the
program met or is meeting its goals. Goal setting is crucial to the
evaluation of your program whether you measure the number
of participants who complete an exercise program or the percent
change in participants’ knowledge about fall risk factors.
Chapter 6
Evaluating Your
Fall Prevention Program
42
The earlier evaluation begins, the fewer mistakes are made and the
greater the likelihood of success. In fact, for an injury prevention
program to show success, evaluation must be an integral part of its
design and operation and evaluation activities must be part of the
program activities.
If a program is well designed and well run, evaluating the fnal
results will be a straightforward task of analyzing information that
is gathered while the program is in operation. The results will be
extremely useful, not only to your own program, but to other
community partners, similar organizations, and injury prevention
programs.
The following sections will help clarify:
• Why evaluation is worth the resources and effort involved
• How to conduct an evaluation, and
• How to incorporate evaluation into fall prevention programs.
These guidelines will help program managers conduct basic
evaluations. Refer to Appendix H for a complete program
evaluation checklist.
Methods for conducting evaluation
There are two methods of program evaluation:
• Qualitative methods (information or opinions collected in
narrative form, such as through open-ended questions or
interviews)
• Quantitative methods (information collected objectively or
in number form through tracking, counting, or measuring)
The basic information in this chapter provides enough information
for you to conduct simple evaluations. However, some organizations
may choose to hire an evaluation consultant. The Demonstrating
Your Program’s Worth: A Primer on Evaluation for Programs to Prevent
Unintentional Injury publication also provides detailed information
to enable you to communicate with, hire, and supervise evaluation
consultants.
43
Chapter 6
Summary of qualitative evaluation methods—
personal interview
Method:
Personal interviews
Purpose:
1. To have individual, open-ended discussion on a range of issues.
2. To obtain in-depth information from individuals about their perceptions and concerns.
Number of People to Interview or Events to Observe:
The larger and more diverse the target population, the more people must be interviewed.
Resources Required:
Trained interviewers •
Written guidelines for interviewer •
Recording equipment •
A transcriber •
A private location •
Advantages:
Can be used to discuss sensitive subjects that the interviewee may be reluctant to •
discuss in a group.
Can probe individual experience in depth. •
Can be done by telephone. •
Disadvantages:
Time consuming to conduct interviews and analyze data. •
Transcription can be time-consuming and expensive. •
One-on-one interviews can lead participants to bias their answers toward •
“socially acceptable” responses.
Evaluating Your Fall Prevention Programs
44
Summary of qualitative evaluation methods—
focus group
Method:
Focus Groups
Purpose:
1. To have an open-ended group discussion on a range of issues.
2. To obtain in-depth information about perceptions and concerns from a group.
Number of People to Include:
4 to 8 participants per group.
Resources Required:
Trained moderator(s) •
Appropriate meeting room •
Audio and/or visual recording equipment •
Advantages:
Can interview many people at once. •
Response from one group member can stimulate ideas of another. •
Disadvantages:
Individual responses can be infuenced by group. •
Transcription can be expensive. •
Participants choose to attend and may not be representative of target population. •
Because of group pressure, participants may give “socially acceptable” responses. •
Focus groups are harder to coordinate than individual interviews. •
45
Chapter 6
Summary of qualitative evaluation methods—
participant-observation
Method:
Participant-Observation
Purpose:
To see frsthand how an activity operates.
Number of Events to Observe:
The number of events to observe depends on the purpose. To evaluate people’s behavior
during a meeting may require observing only one event (meeting). However, to see if grab
bars are installed correctly may require observing many events (installations).
Resources Required:
Trained observers •
Advantages:
Provides frsthand knowledge of a situation. •
Can discover problems the people involved are unaware of (e.g., that their own actions •
in particular situations cause others to react negatively).
Can determine whether products are being used properly (e.g., whether a walking device •
is being adjusted and used correctly).
Can produce information from people who have diffculty verbalizing their points of view. •
Disadvantages:
Can affect the activity being observed. •
Can be time consuming. •
Can be labor intensive. •
Evaluating Your Fall Prevention Programs
46
Summary of quantitative evaluation methods—
counting system
Method:
Counting systems
Purpose:
1. To record the number of contacts with program participants (e.g., number of people
attending each exercise class).
2. To record the number of contacts with people outside the program (e.g., number of
meetings with partners).
3. To record the number of items a program distributes or receives (e.g., brochures and
fact sheets).
4. To measure changes in people’s knowledge, attitudes, beliefs, or behaviors by collecting
the same information at the beginning and end of the program.
5. To estimate the amount spent on delivering your program.
47
Chapter 6
The stages of evaluation
There are four stages of program evaluation:
• Formative
• Process
• Impact
• Outcome
The appropriate time to conduct each stage and the most suitable methods to use
are outlined below.
Stage 1: Formative evaluation
What it shows:
• Whether proposed messages are likely to reach, to be understood by, and to be accepted
by the people you are trying to serve (e.g., shows the strengths and weaknesses of
proposed educational materials).
• How people in the target population get information (e.g., which newspapers they read or
radio stations they listen to).
• Whom the target population respects as a spokesperson (e.g., a physician or local celebrity).
• Details that program developers may have overlooked about materials, strategies, or ways
of distributing information (e.g., that seniors have diffculty reaching the location where
classes are being held).
When to use:
• During the development of a new program.
• When an existing program 1) is being modifed, 2) has problems with no obvious
solutions, or 3) is being used in a new setting, with a new population, or to target a new
problem or behavior.
Why it is useful:
• Allows programs to make revisions before the full effort begins.
• Maximizes the likelihood that the program will succeed.
Methods to use:
• Qualitative methods such as personal interviews with open-ended questions, focus
groups, and participant observation.
(For details, see page 25 of Demonstrating Your Program’s Worth: A Primer on Evaluation for
Programs to Prevent Unintentional Injury)
Evaluating Your Fall Prevention Programs
48
Stage 2: Process evaluation
What it shows:
• How well a program is working (e.g., how many people are participating in the program
and how many people are not).
• Identifes early any problems that occur in reaching the target population.
• Allows programs to evaluate how well their plans, procedures, activities, and materials
are working and to make adjustments before logistical or administrative weaknesses
become entrenched.
When to use:
• As soon as the program begins operation.
Why it is useful:
• Allows programs to make revisions before the full effort begins.
• Maximizes the likelihood that the program will succeed.
Methods to use:
• Quantitative methods, such as:
– Tracking direct contacts with all who are served by the program (older adults who
have had direct contact with the program, the nature of the direct contacts, number
of educational brochures distributed).
– Tracking indirect contacts (through health care providers, adult children of older
adults, or other organizations who are sharing information with older adults).
(For details, see page 27 of Demonstrating Your Program’s Worth: A Primer on Evaluation
for Programs to Prevent Unintentional Injury)
49
Chapter 6
Stage 3: Impact evaluation
What it shows:
• The degree to which a program is meeting its intermediate goals (e.g., how awareness
about the value of exercise or home safety has changed among program participants).
• Changes in the target population’s knowledge, attitudes, beliefs, or measurable
fall risk factors.
When to use:
When the program is being implemented and has made contact with at least one person •
or one group of people in the target population.
Why it is useful:
Allows management to modify materials or move resources from a nonproductive to a •
productive area of the program.
Tells programs whether they are moving toward achieving their goals. •
Methods to use:
Baseline measurement: measuring the target population’s knowledge, attitudes, •
beliefs, behaviors, or health risk factor (such as muscle strength or balance) before
beginning the program or receiving services, using surveys and/or objective participant
assessments.
Progress measurement: measuring the target population’s knowledge, attitudes, beliefs, •
behaviors or health risk factors (such as muscle strength or balance) at a predetermined
amount of time such as at the end of a 3-month exercise class or at regular intervals
in an ongoing program. Measurements can be made using surveys and/or objective
participant assessments.
(For details, see page 29 of Demonstrating Your Program’s Worth: A Primer on Evaluation
for Programs to Prevent Unintentional Injury)
Evaluating Your Fall Prevention Programs
50
Stage 4: Outcome evaluation
What it shows:
• The degree to which the program has met its ultimate goals (e.g., how much an exercise
and education program has improved a person’s ability to carry out daily activities and
reduce fall risks).
When to use:
For ongoing programs (e.g., group exercise classes offered throughout the year) at •
appropriate intervals.
For one-time programs (e.g., a 6-month program to conduct home safety assessments •
and distribute home modifcation equipment or devices) when program is complete.
Why it is useful:
Allows programs to learn from their successes and failures and to incorporate what they •
have learned into the program or into their next project.
Provides evidence of success for use in future budget development and requests •
for funding.
Methods to use:
Generally the same methods used in impact evaluation are used in •
outcome evaluation.
(For details, see page 32 of Demonstrating Your Program’s Worth: A Primer on Evaluation
for Programs to Prevent Unintentional Injury)
51
Chapter 6
Determining which stage to use
To fnd out which stage of evaluation your program is ready for,
answer the questions below. Then follow the directions provided
after the answer.
Q. Does your program meet any of the following criteria?
• It is just being planned and you want to determine how best
to operate.
• It has some problems you do not know how to solve.
• It has just been modifed and you want to know whether the
modifcations work.
• It has just been adapted for a new setting, population,
problem, or behavior.
If yes to any of the four criteria, begin formative evaluation.
If no to all criteria, read the next question.
Q. Your program is now in operation. Do you have information
on who is being served, who is not being served, and how much
service you are providing?
If yes, read the next question.
If no, begin process evaluation. You may also be ready for impact
evaluation. Read the next question.
Q. Your program has completed at least one encounter with
one member or one group in the target population
(e.g., completed one exercise class). Have you measured
the results of that encounter?
If yes, read the next question.
If no, you are ready for impact evaluation. If you believe you have
had enough encounters to allow you to measure your success in
meeting your overall program goals, read the next question.
Q. Is your program complete?
If yes, you are ready for outcome evaluation.
If no, reread the above questions or refer to the publication
in Demonstrating Your Program’s Worth: A Primer on Evaluation
for Programs to Prevent Unintentional Injury. If you are still
uncertain, consult a professional.
Evaluating Your Fall Prevention Programs
52
Evaluation web resources
Thompson NJ, McClintock HO. Demonstrating Your
Program’s Worth: A Primer on Evaluation for Programs
To Prevent Unintentional Injury. Atlanta: Centers for
Disease Control and Prevention, National Center for Injury
Prevention and Control, 1998; revised March 2000.
www.cdc.gov/ncipc/pub-res/demonstr.htm
British Columbia Research Institute for Children’s & Women’s
Health, Injury Prevention Program Evaluation Manual
www.injuryresearch.bc.ca/Publications/Reports/ProgEvalMan%20
Report.pdf
National Council on Aging’s Evidence-based Healthy Aging
Programming: Tools and Checklists
healthyagingprograms.org/content.asp?sectionid=32&ElementID=439
CDC Evaluation Working Group: resources for project evaluation
www.cdc.gov/eval/resources.htm
RE-AIM Evaluation Framework
www.re-aim.org/2003/commleader.html
Basic Guide to Outcomes Based Evaluation for Nonproft
Organizations with Very Limited Resources
www.managementhelp.org/evaluatn/outcomes.htm
Injury Prevention
53
Publicizing your fall prevention program to older adults, the media,
and others in the community will be critical to its success. This
chapter provides tips and techniques that you can use to engage your
community in fall prevention by:
• Conducting a successful community outreach campaign
• Working with the media
Conducting a successful campaign
The word “campaign” applies to a public health education effort of
any size. Even if you are only developing a fyer to announce your
new home-based exercise program for older adults, you still need
to determine the who, what, when, where, how, and why of getting
the fyer written, designed, printed, and distributed so that it will
effectively reach your target audience.
This section provides an overview of campaign development, from
concept through evaluation. For more detailed information on the
theory and application of health communication, visit the CDC
National Center for Health Marketing website shown at the end of
this section.
The eight steps outlined below will help you make the best use
of your limited time and resources in developing a successful
community outreach campaign.
Chapter 7
Promoting Your
Fall Prevention Program
54
Step 1: Assess your current situation. Take a realistic look at your
community and ask pertinent questions.
† Is your community concerned about fall prevention or will
you need to lay some educational groundwork?
† Do you believe your local media (radio, TV, newspaper,
websites) would support your campaign?
† What resources do you have that can help your efforts?
† Would a campaign be easier to mount if you partnered with
other organizations in your community who serve older adults?
Step 2: Set your campaign goal and objectives. Identify the goals
and objectives for your outreach campaign. A goal is the overall
health improvement you hope to achieve, such as reducing falls
among older adults in your community. An objective is a specifc
outcome that you can use to measure progress toward your goal.
Set realistic and measurable objectives. For example:
† Double the enrollment of your exercise classes for seniors.
† Increase the percentage of older adults served by your
organization who have installed grab bars or railings.
Step 3: Identify the target audiences your campaign should
reach. Identify the groups of people you need to reach to meet
the goal you set in Step 2. Learn as much as you can about them.
Remember that the needs, beliefs, values, and expectations of target
audiences vary.
† Do the older adults you wish to reach see themselves as active
and youthful?
† Are they committed to living independently?
† Should you reach out to adult children of older adults or
healthcare providers in your campaign?
The more you know about your target audience, the more effectively
you can tailor your promotional efforts. For example, the Internet
may not be an effective way to reach certain groups of older adults.
55
Chapter 7
Step 4: Develop your messages for the campaign. Messages can
be informative and convey new facts, or be persuasive and alter
attitudes or change behavior. Sometimes they are both.
† Many messages begin by raising awareness about an issue or
program so people can agree with it, understand it, believe it,
and then eventually act on it.
† Consider gender, culture, and age groups. Messages aimed
at people aged 60 to 70 should be framed differently from
those for individuals over 70. If the older adults you want
to reach perceive themselves as youthful, they may ignore
a message about the health problems of aging. A message
focused on “staying healthy and independent” may generate
more positive response than one focused on “preventing hip
fractures and other injuries.”
† Pretest your messages with a sample of the audience and see
if your message appeals to them.
† Use audience feedback to make adjustments before launching
your campaign.
Step 5: Identify message outlets. Decide how you can deliver your
message most effectively. Answers to the following questions can
help you identify the best outlets for your message.
† Where does your audience get information that they trust? Is
it from the media, their peers, their physicians, or children?
† Where does your audience spend time? Do they spend time
at senior centers, libraries, or faith-based organizations such
as churchs or synagogues?
Partnerships offer unique opportunities to reach complementary
target audiences. Healthcare providers can publicize your fall
prevention program to older adults. Providers also can directly refer
high-risk adults to your program. When asking a partner to help
with promotional activities, emphasize the connection between their
work and your program goal. See Appendix I for a sample letter to
healthcare providers to solicit referrals.
Promoting Your Fall Prevention Programs
56
Step 6: Develop an action plan for the campaign. Create an
action plan that demonstrates good time and resource management.
While it can be simple or complex, at a minimum your action plan
should identify:
† Major activities and tasks
† Target date for completing each task
† The person responsible for ensuring that each task is
completed
Step 7: Develop and pretest campaign materials. In developing
materials, pay attention to reading level, print size, and languages.
† Keep your wording simple and direct.
† Consider design as well as content. For example, older adults
may prefer larger type.
† Pretest any materials you develop as part of your campaign
with members of your target audience group and make
modifcations based on their feedback.
This crucial step can make the difference between success and failure
in a community outreach campaign.
Step 8: Implement, evaluate, and modify your campaign. As
you carry on your outreach campaign, determine if you are moving
toward your goal. If not, investigate the reasons why.
† See what barriers are preventing the message from reaching
the target audience.
† Determine what you can do to remove these obstacles.
† Use what you learn to improve your campaign.
57
Chapter 7
Working with the media
You can use media such as local newspapers, radio, and television
stations, to enhance your promotion activities. The media has
a mandate to be of public service, so they should welcome the
opportunity to make the community aware of your organization’s fall
prevention program. See your relationship with the media as one
of mutual advantage; you provide useful and timely information for
their audiences, and they provide public access and outreach for you.
† Start with your local telephone directory and create a list of
media names and contact information for local reporters,
especially the health reporter.
† Check with your library or bookstore to fnd media
directories that list daily and weekly newspapers, television
stations, radio stations, newswire services, Internet
news outlets, magazines, newsletters, and business trade
publications in your community. Some examples of media
directories include Bacon’s MediaSource and the News Media
Yellow Book. (These web links can be found at the end of
this section.)
† Don’t overlook community newspapers as potential news outlets.
† Local organizations such as faith-based, and senior citizen
groups that publish their own newsletters may be eager to
publicize your prevention program.
† Develop key points to include in the media materials.
Highlight the importance of your fall prevention program.
If you’re hosting a community event, offer key points to
guest speakers in advance so they can include them in their
remarks. Appendix J has key points that include facts and
national statistics about falls among older adults. For a
greater effect, try to include statistics about falls among older
adults in your state or community. These statistics may be
available from state and county health departments and
local hospitals.
Promoting Your Fall Prevention Programs
58
Promotional web resources
CDC National Center for Health Marketing
www.cdc.gov/healthmarketing
CISION
us.cision.com
News Media Yellow Book
www.leadershipdirectories.com/products/nmyb.htm
Injury Prevention
59
Chapter 8
Sustaining Your
Fall Prevention Program
Create a written sustainability plan to provide a road map to guide
you and your program’s community partners as you work on
sustainability efforts.
The process of creating a written sustainability plan can strengthen
community partners’ commitment and understanding of the efforts
needed to keep your program operating and improving. A tangible
document that describes your sustainability plan helps you and your
community partners monitor progress on sustainability efforts. In
developing your plan, consider the following:
Establish your vision
Determine the vision of your program. A common vision unifes
all of your program’s sustainability efforts. Write it down and
share it with all involved. Keeping your vision in sight will serve to
strengthen your program’s sustainability.
Build collaboration
Continue to look for new community partners who possess unique
skills and resources that will contribute to your program. Expanding
your base of support is crucial to sustaining your program and
providing its benefts to the older adults in your community.
Advocate for support
Seek advocates for your program among business leaders, other
CBOs, and government representatives who will speak up and take
action on behalf of your program.
60
Integrate your program into community healthcare and senior
services by linking with senior service providers, the health
department, healthcare organizations, and the local Area Agency on
Aging; they can provide ongoing community support and referrals.
Find funding
Secure diversifed funding streams from public and private sources
to increase your program’s sustainability. Sources of funding include:
• Medicare
• Health Maintenance Organizations
• Private or managed care insurers
• Private organizations
• Federal/state/local government or agency
• Local, state, or national (public or private) grant funders
• Program participant fees
Use your program evaluation results to promote sustainability.
Study your program goals and evaluation results to identify areas
for improvement or change that might make your program
more sustainable.
Demonstrate the benefts of your program. Share your evaluation
results with your target audience, the community, your partners,
your current and potential funding sources, and stakeholders.
See Attachment K for a template to help you create a sustainability
plan for your fall prevention program.
Appendix A
Sample Individual
Falls Risk Assessment
My Falls-Free Plan
As we grow older, gradual health changes and some medications can cause falls, but many falls can be prevented.
Use this to learn what to do to stay active, independent, and falls-free.
The more “Yes” answers you have, the greater your chance of having a fall. Be aware of what can cause falls, and take
care of yourself to stay independent and falls-free!
Name: ____________________________ Date: _________
Reviewed by: ___________________
This material is in the public domain and may be reproduced without permission. If you use or adapt this
material, please credit the Washington State Department of Health, Injury & Violence Prevention Program.
Check “Yes” if you experience
this (even if only sometimes)
What to do if you checked “Yes” No Yes

Talk with your doctor(s) about your falls and/or concerns.

Show this checklist to your doctor(s) to help understand and treat
your risks, and protect yourself from falls.

Review your medications with your doctor(s) and your pharmacist
at each visit, and with each new prescription.

Ask which of your medications can cause drowsiness, dizziness,
or weakness as a side effect.

Talk with your doctor about anything that could be a medication
side effect or interaction.

Tell your doctor(s) if you have any pain, aching, soreness, stiffness,
weakness, swelling, or numbness in your legs or feet—don’t
ignore these types of health problems.

Tell your doctor(s) about any difficulty walking to discuss treatment.

Ask your doctor(s) if physical therapy or treatment by a medical
specialist would be helpful to your problem.

Ask your doctor for training from a physical therapist to learn what
type of device is best for you, and how to safely use it.
Ask your doctor for a physical therapy referral to learn exercises
to strengthen your leg muscles.
Exercise at least two or three times a week for 30 min.

Tell your doctor, and ask if treatment by a specialist or physical
therapist would help improve your condition.

Review all of your medications with your doctor(s) or pharmacist
if you notice any of these conditions.

Schedule an eye exam every two years to protect your eyesight
and your balance.

Schedule a hearing test every two years.

If hearing aids are recommended, learn how to use them to help
protect and restore your hearing, which helps improve and protect
your balance.

Ask your doctor(s) what types of exercise would be good for
improving your strength and balance.

Find some activities that you enjoy and people to exercise with
two or three days/week for 30 min.

Limit your alcohol to one drink per day to avoid falls.

See your doctor(s) as often as recommended to keep your health
in good condition.
Ask your doctor(s) what you should do to stay healthy and active
with your health conditions.

Report any health changes that cause weakness or illness as soon
as possible.
Have you had any falls in the last
six months?
Do you take four or more
prescription or over-the-counter
medications daily?
Do you have any difficulty walking
or standing?
Do you use a cane, walker, or
crutches, or have to hold onto
things when you walk?
Do you have to use your arms to
be able to stand up from a chair?
Do you ever feel unsteady on your
feet, weak, or dizzy?
Has it been more than two years
since you had an eye exam?
Has your hearing gotten worse
with age, or do your family or
friends say you have a hearing
problem?
Do you usually exercise less than
two days a week? (for 30 minutes
total each of the days you exercise)
Do you drink any alcohol daily?
Do you have more than three
chronic health conditions? (such
as heart or lung problems, diabetes,
high blood pressure, arthritis, etc.
Ask your doctor(s) if you are unsure.)
Appendix A – Risk Assessment
63
Appendix B
Identifying Partners
Worksheet
Appendix B – Identifying Potential Partners


Community
Partners/
Resources
Fall Prevention Intervention Components
Education
• Group
• Individual
Assessment
• Gait
• Balance; simple
• Balance; in-depth
• Strength
Exercise
• 1:1 balance alone
• 1:1 strength with
balance training
• Group class
• Individualized
exercise/PT
• Tai Chi
Medication
• Medication
review
• Medication
management
Vision
• Basic
assessment
• Detailed
assessment
• Vision
correction
Home Safety
• Assessment
• Basic
modification**
• Skilled
modification**
Other
• Assistive
device
training
Area Agency on
Aging

Community
health care
providers

Community
hospital (s)
outpatient
programs and
services

EMS/Trauma
Injury Prevention
Coordinator

Fire Depts.

Gym/fitness
center

Health
Department

Home health
agency

Home
modification
resources

Library system

Local service
organization(s)

Other resources

Parks and
recreation

Pharmacy

Physical/occupat
ional therapy
clinics

University/
Community
College

YMCA


65
Appendix C
Sample Fall Prevention
Brochure
67
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Appendix C – Sample Fall Prevention Brochure
68
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Appendix C – Sample Fall Prevention Brochure
Appendix D
Sample Fall Prevention
Presentation
70
1
Preventing
Falls
What YOU Can Do
To Prevent Falls
Many falls can be prevented.
By making some changes, YOU
can lower your chances of falling.
3
Four Things
YOU
Can Do To
Prevent
Falls
Begin a regular
exercise program.
Have your healthcare
provider review
your medicines.
Have your
vision checked.
Make your
home safer…
1
2
3
4
3
FLOORS: Look at the floor in each room.
Q: When you walk
through a room,
do you have to
walk around
furniture?
† Ask someone to move
furniture so your path
is clear.
Q: Do you have throw
rugs on the floor?
† Remove rugs or use a
non-slip backing so
rugs won’t slip.
Q: Are there papers,
books, towels,
magazines, shoes,
boxes, blankets or
other objects on
the floor?
† Pick up things on the
floor. Always keep
objects off the floor.
“Last Saturday our son helped us
move our furniture. Now all the
rooms have clear paths.”
3
3
3
STAIRS AND STEPS:
Look at the stairs you use both
inside and outside your home.
Q: Are you missing
a light over the
stairway?
† Have an electrician
put in an overhead
light at the top and
bottom of the stairs.
3
Photo courtesy of Jake Pauls
Q: Is the carpet on
the steps loose
or torn?
† Make sure carpet is
firmly attached to
every step.
3
Q: Are the handrails loose or broken?
† Fix loose rails or put in new ones. Make sure
handrails are on both sides of the stairs.
3
3 3
BEDROOMS:
Look at all your bedrooms.
Q: Is the light near the
bed hard to reach?
† Place a lamp close to the
bed where it’s easy to reach.
3
Q: Is the path from your
bed to the bathroom
dark?
† Put in a night-light so you
can see where you’re
walking. Some night-lights
go on by themselves after
dark.
3
Appendix D – Fall Prevention PPT Thumbnails
71
2
BATHROOMS:
Look at all your bathrooms.
Q: Is the tub or shower floor
slippery?
† Put a non-slip rubber mat or
self-stick strips on the floor of the
tub or shower.
3
Q: Do you need some support
when you get in and out of
the tub or up from the toilet?
† Have a carpenter put grab bars
inside the tub and next to the toilet.
3
3 3
KITCHEN:
Look at your kitchen and eating area.
Q: Are the things you use
often on high shelves?
† Move items in your cabinets.
Keep things you use often on
the lower shelves (above
waist level).
3
Q: Is your step stool
unsteady?
† If you must use a step stool, get
one with a bar to hold on to.
Never use chairs as step stools.
3
Other Things
YOU
Can Do To
Prevent
Falls
† Get up slowly after you
sit or lie down.
3
† Wear shoes both inside
and outside the house.
Avoid going barefoot or
wearing slippers.
3
† Improve the lighting in your
home. Put in brighter bulbs.
Fluorescent bulbs are bright
and cost less to use.
3
† It’s safest to have uniform
lighting in a room. Add
lighting to dark areas.
Hang lightweight curtains or
shades to reduce glare.
3
3
More Safety Tips
† Exercise regularly. Exercise
makes you stronger and
improves your balance and
coordination.
3
† Have your vision checked at
least once a year by an eye
doctor. Poor vision can
increase your risk of falling.
3
† Keep emergency numbers
in large print near each
phone.
3
3
You Can
Prevent
Falls
“Making changes in our home to prevent falls
is good for us and good for our granddaughter
when she comes to visit.”
3
For more information, contact:
Centers for Disease Control and Prevention
National Center for Injury Prevention and Control
1.800.CDC.INFO
www.cdc.gov/injury
Department of Health and Human Services
Centers for Disease Control and Prevention
Appendix D – Fall Prevention PPT Thumbnails
Appendix E
Sample Exercises
Appendix E - Barnett Exercise Intervention
Stay Safe Stay Active
Daily Exercise Program
1. Warm up
t
t
2. Shoulder rolls (Flexibility)
3. March on spot (moblllty)
4. Ankle (strength)
5. Knee bend (strength) 6. Sillo SIand (strength)
a Calf (streich)
7. Calf (stretch)
\
\
Thank you Sally Castell for your diagrams
73
Appendix E - Barnett Exercise Intervention
Stay Safe Stay Active
Daily Exercise Program (Stage 2)
2. Foot Circles'
1. Hip to the side'
4. Shoulder blade exercises'"
3. Lift leg backwards'
6. Knees in and out ••
5. Arm cur'"
7. Ankle Pumps ..
8. Hip extension ..
Thank you to Stay on Your Feel* and Roybal- Boston University** for allowing
us to use your diagrams
74
Appendix F
Sample Medication
Review Form
Appendix F – Fall Prevention Medication Review Checklist


Pat i ent Name: ______________________Revi ew Dat e: _______

Number of medi cat i ons pat i ent was t aki ng: ________

Pl ease i ndi cat e whi ch of t he f ol lowi ng recommendat i ons were made/ act i ons t aken when
revi ewi ng t he above pat i ent ’ s medi cat i on i nt ake.
□ Decrease number of medications, if possible (especially if taking more than four
medications).
Notes:




□ Investigate lower dosages of medications, especially psychotropic drugs, diuretics and
cardiovascular drugs.
Notes:




□ Consider withdrawal of digoxin:
ƒ In patients with stable CHF
ƒ If CHF is due to valvular disease or hypertension
ƒ If there is no response to digoxin after one month with decreased heart size, or
increased exercise capacity
Notes:




□ Stop or decrease number of psychotropic medications
ƒ Neuroleptics (i.e., Phenothiazines, Butyrophenones)
ƒ Sedative/hypnotics (i.e., Barbiturates, Hydroxyzine)
- Antidepressants (i.e., Tricyclic Antidepressants, Selective Serotonin Uptake Inhibitors
(SSRIs)
- Benzodiazepines
Notes:




□ Avoid combination of certain drugs
• Narcotics with psychotropics
• More than one psychotropic
Notes:




Court esy of t he Mi chi gan Fal l Prevent i on Proj ect
Mi chi gan Depart ment of Communi t y Heal t h
76
Appendix G
Sample Home Fall
Prevention Safety Checklist
78
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2005
Appendix G – Sample Home Fall Prevention Safety Checklist
79
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Appendix H
Sample Program
Evaluation Tool
Appendix H – Program Evaluation Checklist

Program Eval uat i on Checkl i st

This is a checklist of tasks that organizations developing fall prevention
programs can follow to make sure no evaluation steps are omitted during
program development, operation, and completion.

1. Program Devel opment
As soon as you or someone in your organization has the idea for a fall
prevention program, begin evaluation.

Investigate to make sure an effective program similar to the one you
envision does not already exist in your community.
If a similar program does exist and if it is fully meeting the needs of your
proposed target population, modify your ideas for the program so that you
can fill a need that is not being met.
Decide where you will seek financial support.
Find out which federal, state, or local government agencies give grants for
the type of program you envision.
Find out which businesses and community groups are likely to support your
goals and provide funds to achieve them.
Decide where you will seek non-financial support.
Find out which federal, state, or local government agencies provide
technical assistance for the type of program you envision.
Find out which businesses and community groups support your goals and are
likely to provide technical assistance, staff, or other non-financial support.
Develop an outline of a plan for your fall prevention program. Include in the
outline the methods you will use to provide the program service to
participants and the methods you will use to evaluate your program’s
impact and outcome.
Evaluate the outline. For example, conduct personal interviews or focus
groups with a small number of the people you will try to reach with your fall
prevention program. Consult people who have experience with programs
similar to the one you envision, and ask them to review your plan. Modify
your plan on the basis of evaluation results.

87
Appendix H – Program Evaluation Checklist

Develop a plan to enlist financial and non-financial support from all the
agencies, businesses, and community organizations you have decided are
likely sources of support. Use the outline of your plan for the injury
prevention program to demonstrate your commitment, expertise, and
research.
Evaluate the plan for obtaining support. For example, conduct personal
interviews with business leaders in your community. Modify your plan on the
basis of evaluation results.
Put your plan for obtaining support into action.
Keep track of all contacts you make with potential supporters.
If unexpected problems arise while you are seeking support, re-evaluate
your plan or the aspect of your plan that seems to be the source of the
problem. For example, if businesses are contributing much less than you
had good reason to expect, then seek feedback from businesses that are
contributing and those that are not. Or if you did not receive grant funds for
which you believed you were qualified, contact the funding agency to find
out why your proposal was rejected. Modify your plan according to your re-
evaluation results, and continue seeking support.
When you have enough support for your program, expand on the outline of
your plan for the fall prevention program. Include in the design a
mechanism for evaluating the program’s impact and outcome.
Evaluate your program’s procedures, materials, and activities. For example,
conduct focus groups within your target population. Modify the plan on the
basis of evaluation results.
Develop forms to keep track of program participants, program supporters,
and all contacts with participants, supporters, or other people outside the
program.
Measure the target population’s knowledge, attitudes, beliefs, and
behaviors that relate to your program goals. The results are your baseline
measurements.










88
Appendix H – Program Evaluation Checklist

2. Program Operat i on
Put your program into operation.
Track all program-related contacts (participants, supporters, or others).
Track all items either distributed to or collected from participants.
As soon as the program has completed its first encounter with the target
population, assess any changes in program participants’ knowledge,
attitudes, beliefs, and (if appropriate) behaviors.
Continue tracking and assessing program-related changes in participants
throughout the life of the program. Keep meticulous records.
If unexpected problems arise while the program is in operation, re-evaluate
(using qualitative methods) to find the cause and solution. For example,
your records might show that not as many people as expected are
responding to your program’s message, or your assessment of program
participants might show that their knowledge is not increasing. Modify the
program on the basis of evaluation results.
Evaluate ongoing programs (e.g., exercise and education classes) at suitable
intervals to see how well the program is meeting its goal of reducing fall
related morbidity and mortality.

3. Program Compl et i on
Use the data you have collected throughout the program to evaluate how
well the program met its goals: to increase behaviors that prevent falls and,
consequently, to reduce the rate of falls and fall injuries.
Use the results of this evaluation to justify continued funding and support
for your program.
If appropriate, publish the results of your program in a scientific journal.
Thi s t ool was based on gui del i nes f rom t he Demonst rat i ng Your Program's Wort h, A Pri mer
on Eval uat i on f or Programs t o Prevent Uni nt ent i onal Inj ury (CDC NCIPC, 2000), a book
desi gned t o hel p program st af f underst and t he processes i nvolved i n pl anni ng, desi gni ng,
and i mpl ement i ng eval uat i on of programs t o prevent uni nt ent i onal i nj uri es.
www.cdc.gov/ncipc/pub-res/demonstr.htm
89
Appendix I
Sample Pitch Letter
Appendix I – Sample Letter to Health Care Referral Source


[Title]
[Name of organization]
[Address]

Dear [Name]:
Our organization needs your help in preventing falls among older adults—the leading
cause of injury deaths and nonfatal injuries for persons aged 65 and older. We are
offering a [free/low-cost] fall prevention [exercise class, counseling, home visits, etc.]
to individuals whose current health status places them at increased risk of falling.
Please recommend our service, described in more detail below, to your patients who
would benefit from it.

Our program is [name and description of program; program details. For example:

“Stay Safe, Stay Active,” an evidence-based exercise program for older adults at risk
of falling due to lower limb weakness, poor balance, slow reaction time, or a
combination of these symptoms. We will hold 37 weekly classes of moderate exercise,
led by a trained fitness instructor, beginning March 1, from 9 to 10 a.m., at the YMCA
at 321 Main Street, Anytown. We will also provide participants with fall prevention
strategies and exercises to do at home. Participants will improve their balance and
coordination, muscle strength, reaction time, and aerobic capacity while reducing
their likelihood of falling or being injured in a fall.]

The Centers for Disease Control and Prevention has identified this intervention as
effective in preventing falls.

More than one-third of people aged 65 and older fall each year. Help your patients
maintain their health and independence by learning how to avoid falls. Please call me
at [telephone number] if you would like further information. [Recommended step:
(Program) fliers to distribute to high-risk patients are available.]

Sincerely,



[Your name and title]

91
Appendix J
Key Points

Appendix J – Key Points Regarding Falls Among Older Adults

Heal t h Consequences of Fal l s (age 65+)
• Falls are a major threat to the health and independence of older adults.
• Each year in the United States, nearly one-third of older adults experience a
fall.
• Falls are the leading cause of injury deaths and the most common cause of
nonfatal injuries and hospital admissions for persons aged 65 and older.
• In 2004, more than 14,900 people aged 65 or older died of a fall-related injury.
Another 1.85 million were treated in emergency departments for nonfatal
injuries related to falls.
• About one out of ten falls among older adults results in a serious injury (such as
a hip fracture or head injury) that requires hospitalization.
• In 2004, one adult died from a fall every 35 minutes. Every hour, 211 older
adults were treated in emergency rooms for fall-related injuries.
• In 2000, direct medical costs totaled $179 million for fatal falls and $19 billion
for nonfatal fall injuries.
• In [your state/community], falls account for [X percentage] of emergency room
visits by people aged 65 or older.
• In [your state/community], falls account for [X percentage] of hospital
admissions for injuries among older adults.
• In [your state/community], falls account for [X percentage] of deaths among
older adults.
(Contact your local hospital, agency on aging or county or state health
department for statistics on fall-related injuries and deaths.)

Bi ol ogi cal ri sk f act ors
9 Mobility problems due to muscle weakness or balance problems
9 Chronic health conditions such as arthritis and stroke
9 Vision changes and vision loss
9 Loss of sensation in feet

Behavi oral ri sk f act ors
9 Inactivity
9 Medication side effects and/or interactions
9 Alcohol use

Envi ronment al ri sk f act ors
9 Home and environmental hazards (clutter, poor lighting, etc.)
9 Incorrect size, type, or use of assistive devices (walkers, canes, crutches, etc.)
9 Poorly designed public spaces
93
Appendix K
Sustainability Plan
Template
Appendix K – Template for Developing a SUSTAINABILITY PLAN


***********************************************************************
Sust ai nabi l i t y Pl an f or {Your Program Name}

Program Summary
Descri be what your program of f ers, who i t serves, when i t operat es, how i t i s
f unded and who your communi t y part ners are.

Vi si on
What i s t he program’ s vi si on? What resul t s do you hope t o achi eve, and what
are t he act i vi t i es t hat wi l l l ead t o t he desi red resul t s? Who wi l l benef i t ?

Col l aborat ors
Who are your part ners? What are t hei r rol es, what resources do t hey
cont ri but e, and how do t hey f i gure i n your sust ai nabi l i t y pl an?

Advocat es
Who are your support ers? What are t hei r goal s and how are t hey provi di ng hel p?

Current Fundi ng Sources
Who i s provi di ng f undi ng f or your program? How l ong wi l l t hey cont i nue t hei r
cont ri but i ons?

New Pot ent i al Fundi ng Sources
Li st possi bl e f unders who coul d provi de addi t i onal support . Descri be a pl an t o
approach pot ent i al f unders. Get addi t i onal ref erral s f or bot h publ i c and
pri vat e f unders t hrough part ners.

Program Of f eri ngs
St at e speci f i cal l y how t he program addresses t he needs of t he ol der adul t
part i ci pant s, part ners, and t he communi t y. Remember t o i ncl ude how your
program i ncorporat es ef f ect i ve i nt ervent i on component s t o achi eve i t s goal s.

Management
Incl ude how you are managi ng your program’ s f i scal resources. Descri be
st af f i ng and i nf ormat i on management .

Eval uat i on
Descri be how you wi l l col l ect i nf ormat i on t o show resul t s. What t ool s wi l l you
use t o col l ect dat a? St at e how you wi l l adapt t he program t o ensure you are
mai nt ai ni ng t he vi si on and meet i ng your obj ect i ves.

95

Preventing Falls:
How to Develop Community-based Fall Prevention Programs for Older Adults

National Center for Injury Prevention and Control Atlanta, Georgia 2008

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 Julie L. Gerberding, MD, MPH, Director Coordinating Center for Environmental Health and Injury Prevention Henry Falk, MD, MPH, Director National Center for Injury Prevention and Control Ileana Arias, PhD, Director Division of Unintentional Injury Prevention David Wallace, MSEH, Acting Director Home and Recreation Injury Prevention Team Michael Ballesteros, PhD, Team Leader

Acknowledgements We acknowledge and appreciate the contributions of National Center for Injury Prevention and Control staff Judy Stevens, PhD, Michael Ballesteros, PhD, Michele Huitric, MPH, Amanda Tarkington, MC, Jane Mitchko, MEd, CHES, and Leslie Dorigo, MA. This project was assisted by Macro International Inc. Carol Freeman, BA, served as the Macro project director, Sally York, MN, RNC, and Mary E. Miller, MA, served as writer/editors and Lucinda Austin served as project assistant. Cover and text design by Monika Gullett, MA. We thank Thom Snyder, BA, MDiv, Ilene F. Silver, MPH, and Jane Mahoney, MD for their thorough review and valuable suggestions. Suggested Citation: National Center for Injury Prevention and Control. Preventing Falls: How to Develop Community-based Fall Prevention Programs for Older Adults. Atlanta, GA: Centers for Disease Control and Prevention, 2008.

...........................Contents Chapter 1 Introduction Why fall prevention is important ..............8 Who can deliver effective fall prevention program components.........22 Building Block 2: Progressive exercise programs to improve mobility......................10 Where to conduct fall prevention program components .......................................................................................................................................................................................................................................................................................................................................4 Chapter 2 Chapter 3 Planning an Effective Fall Prevention Program Key steps in developing a fall prevention program.........................19 Chapter 5 The 5 Building Blocks of Effective Community-based Fall Prevention Programs Building Block 1 Education programs for older adults and their caregivers ........................... strength..........................1 Understanding the risk factors for falls among older adults ..............30 Building Block 4: Vision exams and vision improvement ......................3 Purpose of this guide..2 Effective interventions can prevent older adult falls ........15 Partnership web resources ................33 Building Block 5: Home safety assessment and home modification............................................................................................................18 Education web resources ...................................................36 .........................................17 Public education .............13 How to maintain partnerships .......................24 Building Block 3: Medication review and management......11 The Important Role of Partnerships in Fall Prevention Programs How to develop partnerships ........................... and balance ..........................16 Chapter 4 Education: The Foundation of Effective Fall Prevention Programs Provider education ....................................................

47 Determining which stage to use ....62 Appendix B: Identifying Partners Worksheet.........................................................53 Working with the media ..................69 Appendix E: Sample Exercises................................90 Appendix J: Key Points .....................86 Appendix I: Sample Pitch Letter .......................................................................................77 Appendix H: Sample Program Evaluation Tool .Chapter 6 Evaluating Your Fall Prevention Program Methods for conducting evaluation.....................................................................................................................................................52 Chapter 7 Chapter 8 Promoting Your Fall Prevention Program Conducting a successful campaign ................66 Appendix D: Sample Fall Prevention Presentation ..........................................57 Promotional web resources..........................................64 Appendix C: Sample Fall Prevention Brochure ..................................................................................51 Evaluation web resources ..........42 The stages of evaluation ......................75 Appendix G: Sample Home Fall Prevention Safety Checklist ...............................................58 Sustaining Your Fall Prevention Program Establish your vision ......................................59 Advocate for support....................................................................................................72 Appendix F: Sample Medication Review Form ...................................................92 Appendix K: Sustainability Plan Template........................................................................................................................................................................................................94 ........60 Appendices Appendix A: Sample Individual Falls Risk Assessment .............................................59 Find funding...............................................59 Build collaboration ..................................

Why fall prevention is important Falls are a major threat to the health and independence of older adults. About one out of ten falls among older adults result in a serious injury. Many of the services provided by CBOs like yours help people of all ages maintain healthy lifestyles and improve their overall quality of life. such as a hip fracture or head injury. Some never return to their homes. your organization can reach out to the older members of your community and fulfill an increasingly important need for effective. community-based fall prevention programs. many people need to spend at least a year recovering in a long-term care facility. Falls can be deadly. In addition to the physical and emotional pain. people aged 65 and older. with the help of this new publication. 1 Injury Prevention . Falls are the leading cause of injury deaths among older adults.Chapter 1 Introduction Your community-based organization (CBO) plays an important role in promoting the health and well being of the residents in your community. Now. that requires hospitalization. Falls can be devastating. Each year in the United States. In 2004. Preventing Falls: How to Develop Community-based Fall Prevention Programs for Older Adults. nearly one-third of older adults experience a fall.900 deaths. falls were responsible for 14. The rate of fall-related deaths among older adults in the United States has risen significantly over the past decade.

are associated with substantial economic costs. poor lighting. but falls do occur more often among older adults because fall risk factors increase with age and are usually associated with health and aging conditions. etc. As the number of older adults increases dramatically over the next few decades. there are effective fall prevention interventions that can be used in community settings. so will the economic burden of falls. longer lives. canes. The opportunity to help reduce falls among older adults has never been better. Falls are preventable. Today. crutches.Falls are costly.) • Poorly designed public spaces 2 . etc. direct medical costs for fatal and nonfatal fall injuries totaled $19 billion. especially among older women. type. By offering effective fall prevention programs in our communities. Fall-related injuries among older adults. we can reduce falls and help older adults live better. In 2000. or use of assistive devices (walkers. These risk factors include: Biological risk factors • Mobility problems due to muscle weakness or balance problems • Chronic health conditions such as arthritis and stroke • Vision changes and vision loss • Loss of sensation in feet Behavioral risk factors • Inactivity • Medication side effects and/or interactions • Alcohol use Environmental risk factors • Home and environmental hazards (clutter. Understanding the risk factors for falls among older adults Falls are not an inevitable consequence of aging.) • Incorrect size.

which can cause a trip and fall going up a single step). A self-administered risk assessment form for older adults can be useful when the results are discussed with a healthcare provider who can help modify or manage identified risk factors. and are also unaware of what actions they can take to reduce their risk. Fall risk factor assessment is rarely a part of an older adult’s routine health care. are unaware of factors or behaviors that put them at risk of falling. researchers around the world have used descriptive studies to identify risk factors and randomized controlled trials to test fall interventions. The results of these studies show that reducing fall risk factors significantly reduces falls among community-dwelling older adults—those people living independently in the community. Understanding these risk factors is the first step to reducing older adult falls. especially older adults with a history of falls and/or with mobility or balance impairments who are at highest risk for falls. All older adults should be encouraged to seek an individual fall risk assessment from their healthcare provider. 3 . Many older adults. education. as well as their family members and caregivers. Home or environmental risk factors play a role in about half of all falls. Appendix A shows an example of a fall risk assessment developed by the Washington State Department of Health’s Injury and Violence Prevention Program for individuals to use when discussing fall prevention with a healthcare professional.Chapter 1 Usually two or more risk factors interact to cause a fall (such as poor balance and low vision. even if they have had a fall or fall injury. The Centers for Disease Control and Prevention (CDC) has reviewed and identified community-based fall prevention interventions that have strong scientific evidence of effectiveness. and safer living environments. Effective interventions can prevent older adult falls Effective fall interventions reduce fall risk factors through either exercise alone or by combining exercise with other risk reduction approaches such as medication review and management. vision screening and correction. Over the past two decades.

home health. program managers. such as: • Public health departments • Healthcare organizations that provide individual health care.. CDC would like to help CBOs move these proven fall interventions into communities to protect the health and independence of older adults. The main purpose of this guide is to: • Define the key elements of what makes fall prevention programs effective • Provide information to communities and CBOs on how to develop effective older adult fall prevention programs This guide is intended to be used by CBO decisionmakers. so they can begin developing effective fall prevention programs. A CDC Compendium of Effective Community-based Interventions from Around the World. Purpose of this guide CDC developed this guide for communities and CBOs. individual or group community programs. chore services) • Area Agencies on Aging 4 .g. meal-delivery services. community-dwelling older adults. the companion publication to this document. and partners in organizations that serve independent living.Introduction These interventions have been summarized and compiled in Preventing Falls: What Works. and home-based services • Hospital outpatient and community programs • Senior and community centers • Parks and recreation programs • Emergency medical services • Faith-based and parish nurse services and programs • Home-based services (e.

5 . or nursing home residents. assisted living residents. Alzheimer’s care programs and facilities. all of whom require programs and interventions that are specifically designed for their increased frailty and fall risk. residential.Chapter 1 • Independent/retirement living. and senior housing facilities/settings for older adults who live independently • Nonprofit organizations that provide direct services to older adults • Universities/community colleges that offer or work with community programs for community-dwelling older adults Note: The interventions and programs in this guide are not designed for hospital inpatients.

Introduction Notes: 6 .

Chapter 2

Planning an Effective Fall Prevention Program

When planning your fall prevention program, remember that the most effective programs address many of the risk factors described in Chapter 1. An effective fall prevention program should be offered by trained healthcare professionals and include education about falls and fall risk factors. (See the chart on page 10 for a list of professionals.) The main components that should be part of your fall prevention program include the following:
†

Education about older adult fall risk factors and prevention strategies for older adults, families, and caregivers. Information can be communicated on an individual, one-on-one basis, or in a group setting. Exercise that can be offered through group classes or individually. Exercise programs can be offered in a community setting, at home with supervision, or in a program that combines group classes or one-on-one training with home-based exercise. Appropriate types of exercises that effectively reduce falls in older adults include: • Tai Chi • Strengthening exercises combined with balance training • Balance exercises

†

†

† †

Medication review by a pharmacist or healthcare professional, with medication adjusted or modified by a physician or nurse practitioner. Vision assessment and vision correction by an optometrist or ophthalmologist. Home safety assessment including home modifications as needed. 7
Injury Prevention

These building blocks of an effective fall prevention program are discussed in more detail in Chapter 5, but keep them in mind during the planning process for your program.

Key steps in developing a fall prevention program
Follow this nine-step process in planning your fall prevention program. Step 1. Assess your community’s needs. Before deciding what type of fall prevention program to develop, use the following checklist to assess your community’s needs and identify appropriate resources:
† † †

†

† †

What are the fall prevention program needs in your community? What related programs or services are currently being offered by other organizations? What are your organization’s current and future goals and resources for providing services to independent older adults in your community? How much support for starting a fall prevention program is there at all levels of your organization—from the board and director, to the staff, volunteers, and older adult clients? What community resources exist that could provide services to address older adult fall risk factors? What community resources and organizations are potential partners?

Step 2. Establish your program’s purpose, goals, and objectives. Develop a purpose statement and determine the goals and objectives of your program. Ask questions such as, “Why are we developing this program?” and “What do we hope to accomplish both short term and long term?” Your purpose and goals should be specific, realistic, and clearly stated. Goals should be quantitative with objectives that can be easily measured. Think of the goal as a destination and the objectives as methods of getting you to your goal. With a clear set of objectives, you can easily measure the success of your program during the evaluation phase. With a solid purpose, concrete goals, and action-oriented objectives, you can build an effective fall prevention program for older adults. 8

Chapter 2

Step 3. Determine what risk factors your program will address. There are two types of effective fall prevention programs: single intervention and multifaceted intervention programs:
†

Single intervention programs Exercise is the only intervention that by itself reduces falls among older adults. Many organizations have developed group and/or individualized exercise programs for older adults that improve strength and balance. You can develop an exercise program by using the information in this guide and working with trained professionals in your community. See Chapter 5 on page 21 for examples of effective exercise programs and related resources.

†

Multifaceted intervention programs A multifaceted intervention combines exercise with other intervention components to reduce fall risk factors. Such a program might include exercise, vision assessment, and fall prevention education. To create the most effective fall prevention program, begin with exercise and incorporate at least one other intervention component.

Step 4. Collaborate with partners to address additional risk factors. Partnering with other organizations can help you develop a more comprehensive and effective fall prevention program. Chapter 3 will provide more detail on how to identify and work with fall prevention partners. Step 5. Decide who will implement the various program components. The following chart shows which healthcare providers and other professionals can deliver each type of intervention.

9

ramps. electrical work. rearrange furniture. in-depth Strength Exercise 1:1 balance alone 1:1 strength with balance training Group class Individualized exercise/PT Tai Chi Medication Medication review Medication management Vision Basic assessment Detailed assessment Vision correction Home Safety Assessment Basic modification** Skilled modification** Other Assistive device training   * * * * * * * *         * * Social Worker Occupational Therapist Optometrist Pharmacist Physician * * * * * * * * *      * * * *     * * *    * * * * * * * * * *             *  *  * * *  *     * *   * Additional specialized education and training required ** Basic modification includes clutter/throw rug removal. Note: Partnerships may facilitate delivering multifaceted programs in community settings.Planning An Effective Fall Prevention Program Who Can Deliver Fall Prevention Program Components? Nurse Practitioner/PA Exercise Sci/Phys Ed Degree Physical Therapist Certified Exercise Instructor Registered Nurse Tai Chi Instructor Program components Education Group Individual Assessment Gait Balance. skilled modification includes grab bars. 10 . simple Balance.

Chapter 2 Step 6. electrical work. Where to Conduct Fall Prevention Program Components Gym/Fitness Center/ Rec Center Senior/Community/ Rec Center Physician Office Senior Housing Facility Hospital/Clinic (outpatient) PT Facility Program components Education Group Individual Assessment Gait Balance. simple Balance. ramps. The following chart provides suggestions for each type of fall prevention component. rearrange furniture. skilled modification includes grab bars. When considering what type of program to develop. in-depth Strength Exercise 1:1 balance alone 1:1 strength with balance training Group class Individualized exercise/PT Tai Chi Medication Medication review Medication management Vision Basic assessment Detailed assessment Vision correction Home Safety Assessment Basic modification** Skilled modification** Other Assistive device training                       Pharmacy Home                                                                           ** Basic modification includes clutter/throw rug removal. 11 . Note: Partnerships may facilitate delivering multifaceted programs in community settings. consider the types of places where a program can be held. Find a location to conduct the program.

advocating for support. Making the community aware of your fall prevention program is crucial to its success. Promote your program. Chapter 7 will help you in developing a campaign to publicize your program and provide you with tips on working with your local media. This means keeping sight of your goals and maintaining momentum in building collaborations.Planning An Effective Fall Prevention Program Step 7. Sustain your program. Chapter 8 will help guide you through this process. To sustain your program. Chapter 6 will help you develop evaluation strategies to document your program’s effectiveness. Evaluation helps determine whether a program is appropriate and effective. No matter the size of your outreach effort. The results of the evaluation will guide you in maintaining or modifying any aspects of the program and tell you if the program is worth continuing. Step 8. Step 9. Evaluate your program. 12 . you will need to review and make modifications. and seeking new sources of funding.

it may be difficult for your organization. collaboration can be essential in developing your program. Because of its many benefits. Identify potential partners. and expertise. By collaborating with other community organizations and professionals that specialize in different types of services for older adults. home safety assessment. to develop a comprehensive program. Identify organizations that share your mission of improving health and safety for older adults or that have a vested interest in reducing falls among older adults. on its own. technology. 13 Injury Prevention † . facilities. Partnerships should be mutually beneficial. and education. For example. Determine how a collaboration will mutually support short. you can make your program more comprehensive and effective. funding.and long-term goals. This information clarifies when a potential partnership with another organization can support your program goals. or referral sources for your program. including staff.Chapter 3 The Important Role of Partnerships in Fall Prevention Programs Because falls are the result of multiple fall risk factors. Planning your prevention program involves a careful analysis of your organizational resources and needs. exercise. such as healthcare. outreach channels. a public health or healthcare organization may partner with a senior services or parks and recreation organization to create a program that includes exercise and fall prevention education. Collaborating with other CBOs can provide additional resources. How to develop partnerships † Assess your current situation.

These are useful for internal and external communications. • Underscore how your community will benefit from your efforts and how others are getting involved. † † Make contact. Create your messages and materials. • Describe how your programs and services can make a difference. Develop message points—short. This will vary based on the resources. Delivering mixed messages creates confusion and weakens your credibility. • Share information about the burden of falls and fall injuries. develop your “pitch. • Produce materials (computer-generated presentations. After strategically selecting potential partners. deliver your partnership proposal in person. and priorities of each organization. Seal the deal. • Develop a method for tracking partnerships and other outreach efforts. because different communication styles and demeanors can influence an encounter. Consider bringing at least one other person. Showcase the benefits for your potential partners. • Pretest your materials among potential partners. Whenever possible. for partnership. needs. Sharing the workload and presentation delivery reduces the pressure of thinking on your feet. concise statements that reflect your main messages. but these may not be enough to seal the deal. based on the messages you develop. as well as for presentations to partners.” or selling points. For these messages: • Develop themes or adapt materials that will engage your potential partners.) that will effectively convey your messages. However. make sure that your team speaks with one voice. Use your passion to make potential partners believe they should be involved. etc.† Develop your “pitch” for partnership. flyers. Being credible and offering incentives are important. † 14 .

Chapter 3 • Remind potential partners of their strengths and how even seemingly small contributions can help prevent injury and death. • Confirm how the proposed partnership is mutually beneficial. 15 . Look for creative ways to convey your gratitude to partners often and thank them publicly. Involving local organizations will be an ongoing effort. needs.” Acknowledge partnership agreements promptly. While commitment is important. How to maintain partnerships Relationships need to be maintained. so remember to engage as many facets of your community as you can. so is continuing to review your resources. • Be specific about what you are asking them to contribute and do. See Appendix B for an inventory form that can be useful for identifying community resources and potential program partners. and expectations as the program evolves. including: • • • • • • • Hospitals and healthcare centers Local and state government officials and offices Faith-based organizations Civic organizations Senior citizen groups Commercial establishments serving older adults Clubs that may have a large older-adult membership (such as the Veterans of Foreign Wars) • Universities or colleges that offer academic programs or services for older adults Never forget the power of the phrase “thank you.

The Important Role of Partnerships in Fall Prevention Programs Partnership web resources The National Council on Aging’s Partnering to Promote Healthy Aging: Creative Best Practice Community Partnerships www.ku.org/psat.cacsh. Australia Statewide Action Plan: Falls Prevention in Older People 2002-2006 www.org/cgi/viewcontent.cdlib.gov.qld.archstone.healthyagingprograms.org/publications2292/publications_show.doh.health.asp?sectionid= 92&ElementID=160 Falls Free: A National Falls Prevention Action Plan www.htm?doc_ id=246660 Queensland.html 16 .Falls Among Older Adults: Strategies for Prevention www.wa.pdf WA State Dept.asp?sectionid=98 California Blueprint For Falls Prevention www.healthyagingprograms.cgi?article=1003&context=iha Community Toolbox for Public Health Partnerships ctb.au/phs/Documents/shpu/13693.org/content.pdf Health care & public health partnerships repositories.gov/hsqa/emstrauma/injury/pubs/ FallsAmongOlderAdults.jsp?initiative_id=44 Partnership self-assessment tool www.edu/WST/initiatives_show.org/content. of Health Report .

Additional state and county data may be available from health departments. People in your community who are qualified to provide public and professional fall prevention education sessions include: • • • • Healthcare professionals Public health professionals Senior service providers Emergency medical service professionals Provider education Provider education is necessary to inform healthcare and senior service providers about the current state of knowledge in fall prevention for older adults. their families. and service providers to effectively prevent falls. Data on cost of falls may be available from local hospitals. National and some state data are available from CDC’s National Center for Injury Prevention and Control.Chapter 4 Education: The Foundation of Effective Fall Prevention Programs Increasing awareness about fall risk factors and ways to reduce fall risk is crucial in helping older adults. caregivers. 17 Injury Prevention . local emergency services. There are two types of audiences for fall prevention education: the professionals who will implement the fall prevention program and older adults and their caregivers. Key aspects of professional education include: • National. and fire departments. state. and county data on fatal and nonfatal fall injuries and healthcare costs.

et al. et al. • Information about effective fall prevention interventions (see the web resources at the end of this chapter and the Compendium). Preventing Falls: What Works.) The SAFE Health Behavior and Exercise Intervention (Hornbrook. 18 . When promoting your fall prevention program. You can find more information in Chapter 7 about promoting fall prevention and your fall prevention program. et al.) Simplified Tai Chi (Wolf. et al. Fall Intervention Studies that Include Education Stay Active. et al. Educating older adults about individual risks and methods of prevention is an important building block of every fall prevention program.) PROFET (Prevention of Falls in the Elderly Trial) (Close.) The Otago Exercise Program (Campbell. et al.) Tai Chi: Moving for Better Balance (Li.• Information about fall risk factors among older adults (see the web resources at the end of this chapter). et al. • Tools and resources to train professional staff to deliver fall prevention information tailored to their audience (see the web resources at the end of each chapter and the Compendium).) Falls-HIT (Home Intervention Team) Program (Nikolaus.) Australian Group Exercise Program (Lord. A CDC Compendium of Effective Community-based Interventions from Around the World Public education Public education includes communicating the importance of fall prevention to the general public and directly informing older adults how to maintain a healthy lifestyle that reduces the risk of falls. et al. et al. et al. you will also be creating awareness for the necessity of fall prevention in your community.) For more details. More information on educating older adults about the risk of falls and fall prevention activities will follow in the next chapter. et al.. Robertson. et al.) A Multifactorial Program (Wagner.) Home Visits by an Occupational Therapist (Cumming.) The NoFalls Intervention (Day. refer to the companion publication. et al. Stay Safe (Barnett.) Yale FICSIT (Frailty and Injuries: Cooperative Studies of Intervention Techniques) (Tinetti. et al.) Stepping On (Clemson.

cdc.org/publications2292/publications_show.americangeriatrics.gov/ncipc/duip/fallsmaterials.cdc.org/issues/fallstop.htm Center of Excellence for Fall Prevention www.htm “Getting Up From a Fall” handout from the American Academy of Orthopaedic Surgeons orthoinfo.niapublications.org California Blueprint for Falls Prevention www.gov/ncipc/duip/preventadultfalls.shtml Center for Healthy Aging Falls Free Electronic News www.archstone.nsc.stopfalls.htm CDC Falls Prevention page www.org National Institute on Aging.org/products/positionpapers/abstract.org/topic. AgePage: Preventing Falls and Fractures www.pdf The American Geriatrics Society Guideline for the Prevention of Falls in Older Persons www.Chapter 4 Education web resources CDC’s “What You Can Do To Prevent Falls” and “Home Safety Checklist” brochures for older adults www.aaos.healthyagingprograms.cfm?topic=A00098 19 .org/agepages/PDFs/preventing_Falls_and_ Fractures.htm?doc_ id=246660 National Safety Council www.

Education: The Foundation of Effective Fall Prevention Programs Notes: 20 .

Medication management—adjustments to or changes in medications—should be provided by physicians. The five main building blocks of an effective community-based fall prevention program are: † † Education about falls and fall risk factors. and that are taught by trained. The reviews should be conducted by pharmacists or healthcare providers. 21 Injury Prevention † † . strength.Chapter 5 The 5 Building Blocks of Effective Community-based Fall Prevention Programs The most effective fall prevention programs address many of the risk factors described in Chapter 1. to identify and modify home hazards that can increase older adults’ risk of falling. you can start your program using one building block and then expand its effectiveness by adding more blocks over time. Exercise programs include: • • • • Tai Chi Individualized exercise sessions Group exercise classes Home exercise programs with supervision until the older adult can exercise independently † Medication review to identify side effects or drug interactions that may contribute to falls. Home safety assessment and home modification by occupational therapists or other healthcare professionals with specialized training. Exercises that improve mobility. Vision exams by trained healthcare professionals with vision correction by an optometrist or ophthalmologist. Based on your resources. and balance. nationally certified exercise instructors or physical therapists.

While education alone has not proven to effectively reduce falls among older adults. Education for older adults and their caregivers can be delivered to individuals or to groups. 22 † † † † † † † . Group sessions provide the benefits of social interactions. The length of the education session should depend on the individual characteristics of the older adult. Sessions should be tailored to the attention span and cognitive ability of older adults. Individual education sessions may work better for people who are hearing or vision impaired or have special needs. etc. it is important to include an educational component. Group vs. and checklists will help facilitate the education session. Materials should reflect literacy levels and be culturally appropriate. hearing or visual impairment. Visual aids such as brochures. Tips for developing an effective education component † † Education should be delivered by trained professionals. individual education may be determined based on which other bulding block is being offered in combination.Building Block 1: Education programs for older adults and their caregivers When developing a fall prevention program. Materials should be designed with a high contrast background and large lettering. it is typically combined with one of the other building blocks. Group teaching saves time and helps spread the information more quickly to more people. fact sheets. Visual aids are valuable tools in increasing comprehension. Presentations and materials should not contain abbreviations and jargon. such as concentration. Informal group discussions that include sharing personal experiences may reduce anxiety and increase motivation to adopt new behaviors. Education is most effective when offered on an ongoing basis. Education should include problem solving and goal setting on the part of the learner.

Chapter 5

There is a wealth of educational materials available on the Internet. You can find visual aids, including posters, videos and presentations, brochures, and checklists, or you can develop your own materials. See Appendices C and D for an example of a brochure and a presentation. A set of fall prevention posters is also available through the CDC website listed below. Use the following websites for additional education materials.

Education web resources
CDC’s “What You Can Do To Prevent Falls” and “Home Safety Checklist” brochures for older adults www.cdc.gov/ncipc/pub-res/toolkit/brochures.htm CDC Falls Prevention page www.cdc.gov/ncipc/duip/preventadultfalls.htm Center of Excellence for Fall Prevention www.stopfalls.org National Institute on Aging, AgePage: Preventing Falls and Fractures www.niapublications.org/agepages/PDFs/preventing_Falls_and_ Fractures.pdf The American Geriatrics Society Guideline for the Prevention of Falls in Older Persons www.americangeriatrics.org/products/positionpapers/abstract.shtml Center for Healthy Aging Falls Free Electronic News www.healthyagingprograms.org California Blueprint for Falls Prevention www.archstone.org/publications2292/publications_show.htm?doc_ id=246660 American Academy of Orthopaedic Surgeons orthoinfo.aaos.org/menus/safety.cfm National Safety Council www.nsc.org/issues/fallstop.htm

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The 5 Building Blocks of Effective Community-Based Fall Prevention Programs

Building Block 2: Progressive exercise programs to improve mobility, strength, and balance
Among older adults, strength and balance exercises, such as Tai Chi, can reduce falls by improving mobility, strength, and balance. These programs focus on exercises that are specifically designed or adapted for older adults. Tips for developing an effective exercise component
Fall Intervention Studies that Include Exercise
Stay Active, Stay Safe (Barnett, et al.) The Otago Exercise Program (Campbell, et al., Robertson, et al.) Tai Chi: Moving for Better Balance (Li, et al.) Australian Group Exercise Program (Lord, et al.) Veterans Affair Group Exercise Program (Rubinstein, et al.) Simplified Tai Chi (Wolf, et al.) Home Visits by an Occupational Therapist (Cumming, et al.) Falls-HIT (Home Intervention Team) Program (Nikolaus, et al.) Stepping On (Clemson, et al.) The NoFalls Intervention (Day, et al.) The SAFE Health Behavior and Exercise Intervention (Hornbrook, et al.) Yale FICSIT (Frailty and Injuries: Cooperative Studies of Intervention Techniques) (Tinetti, et al.) A Multifactorial Program (Wagner, et al.)
For more details, refer to the companion publication, Preventing Falls: What Works. A CDC Compendium of Effective Community-based Interventions from Around the World

†

To be safe and effective, older adult exercise programs (one-on-one or group classes) must be taught by one or more of the following professionals: • Nationally certified fitness/exercise instructors with specialized training in working with older adults. Because exercise instructors are not licensed, having a national certification or accreditation is the minimum qualification requirement for teaching fall prevention exercise programs to older adults. • Exercise science/physiology professionals with a bachelor’s degree or master’s degree in this field. • Physical therapists. • Occupational therapists. • Recreational therapists with a bachelor’s or master’s degree. • Tai Chi instructors, masters or grand masters, who have completed a Tai Chi course taught by a Tai Chi master or grand master, have a national certification in older adult physical activity, and have experience in teaching exercise to older adults. • Physical, occupational, and recreational therapy assistants who are under the direct supervision of a physical, occupational, or recreational therapist.

24

Chapter 5

PROGRAMS IN ACTION

Stay Active and Independent for Life (SAIL): A strength and balance fitness class for adults 65+ The SAIL program combines health information with exercises specifically designed to safely and easily improve endurance, strength, and balance in adults aged 65 and older. The program was researched and developed as a community-based fall prevention program by the Washington State Department of Health. The SAIL program helps older adults to stay active and independent. It helps to prevent falls, through group exercise classes that meet for 1 hour, three times a week. The classes are held at community sites, such as senior centers, parks and recreation facilities, and community fitness centers that often work in partnership with community healthcare and senior service organizations to offer the program. Classes are led by certified fitness instructors who have attended the 2-day SAIL Instructor Training Program, which was designed by physical therapists and a registered nurse. The program name and its key messages were developed through older adult focus groups to emphasize a specific description of the program and its positive benefits: • “It works…you’ll be stronger, have better balance, feel better, and this will help you stay independent, active, and prevent falls.” • “It’s safe…the instructors are experienced and skilled, and exercises have been tested with seniors.” • “It’s fun…you’ll meet other seniors and make new friends.” The SAIL class exercises are designed to be done either sitting or standing, and at individually adjustable paces. The class includes aerobic and balance exercises, strength training with wrist and ankle weights, and flexibility exercises. The class participants also receive brief “Fitness Checks” when they start the classes for measuring progress and improvement after they start the classes. These measurements of walking speed and arm and leg strength, are repeated every 3 to 6 months throughout the year, enabling class participants to monitor their individual progress. In addition to the exercises, health information is included in the classes, which addresses topics such as exercising safely, medication and home safety, and footwear and foot care. The education information is provided in a booklet published by the Washington State Department of Health: “Stay Active and Independent for Life: An Information Guide for Adults 65+.” All class participants receive a free copy of the booklet. For more information contact: www.cdc.gov/ncipc/profiles/core_state/wa/default.htm or www.doh.wa.gov/hsqa/emstrauma/injury/pubs/default.htm#seniorfalls

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Additional exercise examples can be found in the Preventing Falls: What Works. Short-term programs that have a set number of sessions should provide written instructions so participants can continue to do the exercises at home. Ideally. A CDC Compendium of Effective Community-based Interventions from Around the World. Assess older adults’ strength.The 5 Building Blocks of Effective Community-Based Fall Prevention Programs † All professionals who teach exercise to older adults must have a current CPR/AED certification. obtain feedback from the program participants. either in one-on-one home sessions or in group sessions. and fitness at the beginning and end of each new exercise program. 26 . asp?sectionid=32&ElementID=439 Appendix E provides examples of strengthening and balance exercises from the Stay Safe Stay Active Daily Exercise Program. exercises must be performed at least twice weekly on an ongoing basis and progress in difficulty throughout the program. Participants should be taught the exercises under the direct supervision of a trained exercise instructor or physical or occupational therapist. Limit the number of participants in group classes to no more than 15 to allow the instructor the ability to closely observe and supervise participants during the class session. Also. To be effective in reducing falls. before performing them independently at home. or Tai Chi professionals. balance.org/content. Use process evaluation methods to ensure that the exercises are being taught properly and consistently. Evaluate how the program instructor delivers the exercise program. † † † † † † † The National Council on Aging’s Center for Healthy Aging has developed a detailed checklist for fall prevention programs in Evidence-based Healthy Aging Programming: Tools and Checklists at healthyagingprograms. Base program content on current published materials specifically developed for older adults by exercise science. the exercise classes should be offered on an ongoing basis for long-term attendance. physical therapy.

gov/nccdphp/dnpa/physical/growing_stronger National Institutes of Health: NIH Publication No.com/resources/IssueBrief_ PhysicalActivity.com/resources/PRC-HAN_conference_ monograph. Issue Brief #4. 01-4256.com/resources/IssueBrief_ KeepCurrentPA.Chapter 5 Exercise program web resources CDC Physical Activity Resources www. Conduct and Maintain Effective Community-based Physical Activity Programs for Older Adults www.nia. 2001 Exercise: A Guide from the National Institute on Aging www. Issue Brief #2. 2005.htm Growing Stronger: Strength Training for Older Adults—a web based strength training exercise program www.gov/HealthInformation/Publications/ExerciseGuide National Council on Aging: Center for Healthy Aging.seniorfitness.healthyagingprograms. Winter 2004 Designing Safe and Effective Physical Activity Programs www.net/international_curriculum_guidelines_for_ preparing_physical_activity_instructors_of_older_adults.cdc.org International Curriculum Guidelines for Preparing Physical Activity Instructors of Older Adults www.healthyagingprograms.pdf National Council on Aging: Center for Healthy Aging. Fall 2005 Keeping Current on Research and Practice in Physical Activity for Older Adults www.healthyagingprograms. Evidence-based Healthy Aging Programming: Tools and Checklists www.pdf National Council on Aging: Center for Healthy Aging.healthyagingprograms.cdc. Moving Ahead: Strategies and Tools to Plan.gov/nccdphp/dnpa/physical National Council on Aging: Center for Healthy Aging.nih.pdf 27 .

The 5 Building Blocks of Effective Community-Based Fall Prevention Programs American College of Sports Medicine’s Physical Activity Guidelines for adults over age 65 www.org/AM/Template.com/products/showproduct. 2004:328.240-246. IL.com Exercise and Older Adults nihseniorhealth. A. Human Kinetics: Champaign. RT. Morton SC. Arthritis Foundation: Atlanta.acsm. Gillespie WJ.cfm?isbn= 9780736033589 American Council on Exercise and AARP Fitness Resources www. All you need to know about back pain.cfm?Section=Home_Page& TEMPLATE=/CM/HTMLDisplay. Interventions for the prevention of falls in older adults: Systematic review and meta-analysis of randomized clinical trials.humankinetics. Davis Company: Philadelphia. 2003:4.A. Robertson MC. Cotton. Herdman. 1989:41. Cumming RG. Br Med Journal.html References Berg K. Rowe BH.gov/exercise/toc.2002. Chang JT. Cochrane Database Syst Rev.1998. Rubenstein LZ. Physiother. GA. Vestibular Rehabilitation. Canada.cfm&CONTENTID= 7764#Over_65_or_50_64 Human Kinetics’ Senior Fitness Test Manual and Software: manual and software for testing and tracking functional fitness measures in older adults www. et al. PA. F. Dunkin. S. Interventions for preventing falls in elderly people. Lamb SE. 28 . Exercise for older adults: American Council on Exercise’s guide for fitness professionals.680-683.aarpfitness.CD000340. Balance and its measure in the elderly: A review. Gillespie LD.2000.

29 .2007. In: Haas. Rikli RE. Jones CJ. IL. ed.142-148. 2000:80. Rose.2001. Nelson M.Chapter 5 Haas EN ed. Handbook of Injury and Violence Prevention. GA:Springer. Brauer S. et al. D. ME. Atlanta. Physical activity and public health in older adults: Recommendations from the American College of Sports Medicine and the American Heart Association. Tinetti ME. Fall Proof: A comprehensive balance and mobility training program human kinetics: Champaign. Journal of the Am Geriatr Soc. IL.” Phys Ther. 2007:39(8). 1991:39. Shumway-Cook A. Springer 2007 Author of chapter. The timed up and go: A test of basic functional mobility for frail elderly persons. Strong women stay young.119-126. Senior fitness test manual human kinetics: Champaign. EN. Chapter 3: Interventions to prevent falls among older adults.1435-1445. Woollacott M.2003.2000. Nelson.896-903. J Am Geriatr Soc. Am J Sports Med. Handbook of Injury and Violence Prevention Atlanta GA. 1986:34. Bantam Books: New York. Performance-oriented assessment of mobility problems in elderly patients. Predicting the probability of falls in community-dwelling older adults using the “Timed Up and Go Test. NY. Podsaidlo D. Richardson S.

Drug side effects that can contribute to falling include blurred vision. Fall risk increases with the total number of prescription and over-the-counter medications. and elimination of medications. and painkillers. antipsychotics. compromised neuromuscular function. Clinical practice recommendations include medication reviews by healthcare providers for older adults who have fallen. Psychoactive medications (drugs that alter brain function) increase fall risk. hypotension leading to dizziness and lightheadedness. distribution. decreased alertness.) A Multifactorial Program (Wagner. Many older adults are unaware that their daily medications may increase their fall risk. Age can also increase sensitivity to potential side effects. cholesterol-lowering medications. Other medications that may cause problems include those prescribed to treat seizure disorders. delirium. Aging affects the absorption. Older adults may get prescriptions from multiple doctors. and anxiety. These include antidepressants. et al. metabolism. refer to the companion publication. Fall Intervention Studies that Include Medication Review and Management PROFET (Prevention of Falls in the Elderly Trial) (Close. such as dizziness or drowsiness. et al.) For more details. Review and modification of the medication regimen by a healthcare provider can frequently reverse or minimize these effects. et al. sedation. antianxiety drugs. A CDC Compendium of Effective Community-based Interventions from Around the World 30 .The 5 Building Blocks of Effective Community-Based Fall Prevention Programs Building Block 3: Medication review and management The purpose of medication review and management is to identify and eliminate medication side effects and interactions. confusion and impaired judgment. tranquilizers. blood pressure-lowering medications. Preventing Falls: What Works. that can increase the risk of falls. A medication review checklist is included in Appendix F. and sleep medications. heart medications.) Yale FICSIT (Frailty and Injuries: Cooperative Studies of Intervention Techniques) (Tinetti.

• Distribution of brochures related to medication management. • Automated medication dispensers for frail and/or blind clients in their home. vitamin. Older adults can take the books with them to share with their doctors and pharmacist. • Information provided at Senior Health Fairs. The following are examples of the community-based activities and partnerships in this program: • Pharmacists’ or pharmacy students’ presentations on how older adults can manage their medications. through home delivered meal programs and at other appropriate sites.Chapter 5 PROGRAMS IN ACTION California Department of Aging’s Medication Management Program The Medication Management Program is an evidence-based. at congregate meal sites. The pharmacists also encourage older adults to communicate with their doctors so they will be better informed about what medicines are being prescribed. and taking medications properly. and supplements. The target population for this program included individuals aged 60 years and over who live in an area of greatest economic need. and what results and/or side effects to expect. For more information. are following directions.html 31 . why. through an Info Van. and counsel older adults to assure they understand. Funds are distributed to California Area Agencies on Aging to provide a wide variety of community-based services and information at multipurpose senior centers. The purpose of the Medication Management Program is to improve the quality of life for older adults and prevent premature institutionalization by working with them to manage their use of over the counter and prescription medications. mineral. The presentation may include a personalized medication review to identify expired medications. drug-nutrient interactions. • Distribution of passport size books for older adults to keep records of health and medications. • Distribution of pill minders in various languages to help older adults manage their prescriptions. who live in a medically underserved area of the region.ca. federally funded program under Title IIID of the Older Americans Act.aging. and through the Information and Assistance Program. visit www. or who have a chronic medical conditions that can improve with education and non-medical intervention.gov/html/programs/medication_ management. and herbal supplements. • Partnerships with community-based organizations to provide “Rx Check Up” clinics. answer client questions.

The 5 Building Blocks of Effective Community-Based Fall Prevention Programs Tips for developing an effective medication review and management component † Medication reviews are recommended for older people taking four or more medications and those taking any psychoactive medications.americangeriatrics.pdf 32 .pdf Medications and falls in the elderly www. Medication review and management may include assessing the need for vitamin D and calcium supplements as well as osteoporosis treatment.pharmacists.org/products/positionpapers/Falls. Medication reviews can be done by a pharmacist or a healthcare provider.ca/content/cpjpdfs/julaug04/July-AugustFocusonPatientCareRevised. and doctors’ offices.pdf “10 questions to ask your doctor or pharmacist about your medications” www. † † † † Medication review and management web resources National Institutes of Health Senior Health nihseniorhealth. Medication reviews can be done in screening clinics.gov/takingmedicines/toc. Coordinated medication management that involves changing or reducing types or dosages of medications. hospital programs.com/Ten_Questions_to_Ask_Your_Doctor_or_ Pharmacist_Outreach__2_. home visits by home health professionals.a4aa. should be done by the older adult’s healthcare provider. pharmacies. The amount and frequency of alcohol use should be included in a medication review.html American Geriatrics Society Clinical Guidelines for Prevention of Falls in Older Persons www.

Medicare provides coverage for dilated eye exams. † † 33 . et al. and occupational therapists.Chapter 5 Building Block 4: Vision exams and vision improvement Vision changes and vision loss associated with aging are common fall risk factors among older adults. A CDC Compendium of Effective Community-based Interventions from Around the World Limited basic or simple vision screening can be performed by trained healthcare professionals such as physicians.) The NoFalls Intervention (Day. However.) For more details. if these conditions are diagnosed early. Tips for developing an effective vision component † Fall Prevention Intervention Studies that Include Vision Assessment PROFET (Prevention of Falls in the Elderly Trial) (Close. and macular degeneration. and by referring older adults to community vision care services and resources. Comprehensive vision exams must be performed using specialized equipment. CBOs can play an important role by providing information about and encouraging regular vision exams and care. nurse practitioners. are gradual and painless. these must be done by an optometrist or ophthalmologist. such as cataracts. they can be managed to minimize vision loss. refer to the companion publication. Therefore. Many vision conditions. et al. physicians’ assistants. Preventing Falls: What Works. which are considered comprehensive vision exams. glaucoma. et al. However. Vision loss can contribute to falls by disturbing balance and by obscuring tripping and slipping hazards. registered nurses. basic vision screening does not identify all types of vision problems that need to be corrected.) A Multifactorial Program (Wagner. Older adults may have difficulty learning about and/or accessing community programs that offer vision care services.

or hearing loss.871. and Education Vision Loss Resources is an independent nonprofit 501 C(3) agency in Minneapolis. comprehensive. and test their ability to focus and coordinate their eyes. or e-mail at cleach@vlrw.com. For more information. Ophthalmologists are physicians who perform detailed. on the web at www. and color perception.org Vision care is provided primarily by the following professionals: † Optometrists examine people’s eyes to diagnose vision problems and eye diseases. and resources for maintaining independence Community and professional education about vision loss and resources Outreach and special projects providing resources and services for individuals and groups. vision loss. with emphasis on special needs and cultural diversity.2222. they examine eyes and prescribe eyeglasses and contact lenses. Its mission is to assist people who are blind or visually impaired achieve their full potential and to enrich the lives of all persons affected by blindness. † 34 . test patients’ visual acuity. and dilated vision exams and eye surgery. Programs include: • • • • • • • • • In-home assessment with service and resource plan development In-home vision evaluation for adaptive vision aids Hearing assessments with advocacy and resources for adaptive equipment Volunteers for assisting vision impaired clients to live independently Peer counseling and support and growth groups Leisure opportunities at the Vision Loss Resources’ Community Center Life skills classes. They prescribe eyeglasses and contact lenses and provide vision therapy and low vision rehabilitation. depth. They also diagnose and treat eye diseases and injuries. Vision Loss Resources can be contacted by phone at 612. Vision Loss Resources provides programs to enhance independent living and educate the community about vision loss. visionlossresources. training.The 5 Building Blocks of Effective Community-Based Fall Prevention Programs PROGRAMS IN ACTION Vision Loss Resources Vision Screening. Like optometrists. Resource. Minnesota.

Local Area Agencies on Aging and state ophthalmology and optometry associations can provide information about community vision programs for older adults.pdf catalog. and eyeglass prescriptions.org Opticians Association of America www.org/index.nih.oaa.html Medicare benefits for vision exams and vision care www.shtml National Eye Institute: Glaucoma—Resources for Patients and the Public www.aoa. and financial assistance for vision needs.gov/listoftopics. may fit contact lenses according to prescriptions written by ophthalmologists or optometrists.org/Colenbrander/Images/Low_Vision_Exam.org The American Optometric Association www. † † † Vision web resources National Institutes of Health Senior Health: Vision conditions and low vision topics nihseniorhealth. for vision screening and/or exams. medications.nei.medicare.aao.asp?idCategory=78 35 . and more frequently if an eye condition has been diagnosed. After the age of 60.gov The American Academy of Ophthalmology www.gov/productcart/pc/viewCat_L. in some states.ski. Detailed eye exams by an optometrist or ophthalmologist are recommended at least once every 2 years for managing vision conditions and for corrective eye procedures.Chapter 5 † Dispensing opticians fit and adjust eyeglasses and. vision assessments are recommended at least every 2 years.

) Yale FICSIT (Frailty and Injuries: Cooperative Studies of Intervention Techniques) (Tinetti. Home assessments can be combined with or included with other direct one-on-one services that are provided by community service programs to residents in their homes. Local Area Agencies on Aging (AAA) can provide information and referrals to local home modification programs. et al.) The NoFalls Intervention (Day.) Falls-HIT (Home Intervention Team) Program (Nikolaus.) For more details. The senior must meet the home health reimbursement criteria.) A Multifactorial Program (Wagner. and ramps. Adult Fall Prevention Interventions with Home Safety Assessment & Modification Research Study Components Home Visits by an Occupational Therapist (Cumming. Falls can be caused by slipping and tripping hazards. refer to the companion publication. 36 . et al. et al.) PROFET (Prevention of Falls in the Elderly Trial) (Close. Preventing Falls: What Works.The 5 Building Blocks of Effective Community-Based Fall Prevention Programs Building Block 5: Home safety assessment and home modification Environmental factors play a part in approximately half of all falls that occur at home. and these home services must be prescribed by a doctor.) The SAFE Health Behavior and Exercise Intervention (Hornbrook. For an older adult who has been injured in a fall. et al. et al. handicapped showers. Medicare may cover a home safety assessment and home modification if it is performed by an occupational or physical therapist. A Home Fall Prevention Checklist is provided in Appendix G. stair railings. A home safety assessment can identify factors that may put an individual at risk for falling. et al. AAA can also provide information about state and federal programs that offer services and financial assistance to low-income seniors. nurse practitioner.) Stepping On (Clemson. or physician assistant. et al. but those with a history of falls and/ or with mobility or balance difficulties have the greatest need for such an assessment. et al. A CDC Compendium of Effective Community-based Interventions from Around the World A self-administered home safety assessment checklist can be helpful if there is a plan for follow-up review with a trained professional to follow up and if information and referrals to home modification programs and resources are provided. or the lack of needed home modifications such as bathroom grab bars. Older adults may have difficulty learning about and/or accessing home safety and home modification information and resources. poor lighting. Many older adults can benefit from home safety assessments.

each low-income older adult who qualifies for the fall prevention/home safety program is educated about fall prevention strategies and provided with the necessary equipment and home modifications. aged 60+. aging network providers.) and are continuing to increase as the community becomes more aware of the program. If the individual meets the criteria for the SPICE program and grant funding is available. please call (252) 752-1717 37 . Fall risk factors typically addressed include: • • • • • Home and environmental safety Medications Vision Mobility Lighting Referrals for the program are called into the Pitt County Council on Aging (PCCOA) or are identified by PCCOA social workers. Prevention. Intervention. and Community Education This North Carolina fall prevention program’s target population is low-income older adults. etc.Chapter 5 PROGRAMS IN ACTION Pitt County Council on Aging: SPICE for Life Senior Safety. Community partnerships and involvement are critical elements of this program’s success. When necessary. a referral is sent to the program’s lead occupational therapist (OT). Referral sources are varied (physicians. home health providers. The OT then further assesses eligibility and sets up an appointment for a home visit to perform a home modification and fall risk assessment. To contact the Pitt County Council on Aging. referrals for additional services are made to other service providers and agencies. who are at high risk for loss of independence due to a decreased ability to function within the home. SPICE makes use of two assessment tools that are standard to the program: • A fall interview questionnaire to assess the individual • A home safety modification assessment tool Once the needs are identified.

† † † † 38 . An occupational or physical therapist can provide the training needed to use these devices properly.The 5 Building Blocks of Effective Community-Based Fall Prevention Programs Occupational therapists can conduct environmental assessments. Tips for developing an effective home safety component † Home safety assessments and modifications are most effective when they are done in the home by an occupational therapist and when they include education. and suggest adaptations or modifications that can help older adults with limited physical function or low vision prevent falls and live independently. and a follow-up home visit to assess the need for additional modifications. and physical therapists can also effectively carry out home assessments and modifications. Occupational therapists are specifically trained to help individuals adapt their living environments to their physical needs. assess how the older adult interacts with their home environment. Home assessments and modifications by an occupational therapist are especially effective in reducing falls among older adults who have already had a fall. In addition to home modifications. and caregivers. so they can perform their daily activities as independently and safely as possible. recommendations. some older adults may need to use personal assistive safety and mobility devices. their family members. Occupational therapists are also trained to provide education to older adults. registered nurses. in collaboration with occupational therapists. Trained professionals such as a Certified Aging in Place Specialist (certified by the National Association of Home Builders).

gov/resources/home_housing/home_safety_checklist. Chinese.htm National Resource Center on Supportive Housing and Home Modification www.org/Consumers/WhatisOT/FactSheets/ Conditions/39478.cdc.aging.org/fact/thr_report.gov/ncipc/duip/fallsmaterial.org Home Safety Council: State of Home Safety’s Facts About Safety in the Home homesafetycouncil.cfm?Thread_ ID=92&topcategory=Injury%20Prevention 39 . Spanish.pdf Home Safety Checklist (in English.org/state_of_home_safety/sohs_2004_p017.homemods.aaos.ca.aspx CDC’s “Check for Safety: A Home Fall Prevention Checklist for Older Adults” brochure www.aota. Russian.html Ladder Safety Information Sheets orthoinfo. Italian.Chapter 5 Home safety web resources American Occupational Therapy Association’s Fact Sheet on Occupational Therapy and Prevention of Falls www. Tagalog) www.

The 5 Building Blocks of Effective Community-Based Fall Prevention Programs Notes: 40 .

it continues throughout the life of the program.cdc. program managers and staff can: • • • • Show that their program is benefiting the community Show funding agencies that their program is successful Produce facts and figures to demonstrate positive outcomes Share the results in publications and presentations to be more likely to receive continued funding Evaluation should begin while the program is in the earliest development stages. Goal setting is crucial to the evaluation of your program whether you measure the number of participants who complete an exercise program or the percent change in participants’ knowledge about fall risk factors.htm. 41 Injury Prevention . With objective evaluation. More complete and detailed information can be found in Demonstrating Your Program’s Worth: A Primer on Evaluation for Programs to Prevent Unintentional Injury The full text of this publication can be found in pdf or html format at www. not after the program is complete. and these can be adapted for fall prevention programs. Evaluation is an ongoing process that begins as soon as someone decides to develop and implement a program.gov/ncipc/pub-res/demonstr.Chapter 6 Evaluating Your Fall Prevention Program CDC’s National Center for Injury Prevention and Control has developed recommended approaches for evaluating injury prevention programs. This chapter summarizes the key elements of these approaches. and it ends with a final assessment of how well the program met or is meeting its goals.

not only to your own program. However. evaluation must be an integral part of its design and operation and evaluation activities must be part of the program activities. The results will be extremely useful. counting. and supervise evaluation consultants. The following sections will help clarify: • Why evaluation is worth the resources and effort involved • How to conduct an evaluation. Methods for conducting evaluation There are two methods of program evaluation: • Qualitative methods (information or opinions collected in narrative form. or measuring) The basic information in this chapter provides enough information for you to conduct simple evaluations. If a program is well designed and well run. but to other community partners. Refer to Appendix H for a complete program evaluation checklist. and • How to incorporate evaluation into fall prevention programs. These guidelines will help program managers conduct basic evaluations. the fewer mistakes are made and the greater the likelihood of success. and injury prevention programs.The earlier evaluation begins. The Demonstrating Your Program’s Worth: A Primer on Evaluation for Programs to Prevent Unintentional Injury publication also provides detailed information to enable you to communicate with. similar organizations. such as through open-ended questions or interviews) • Quantitative methods (information collected objectively or in number form through tracking. In fact. 42 . hire. for an injury prevention program to show success. some organizations may choose to hire an evaluation consultant. evaluating the final results will be a straightforward task of analyzing information that is gathered while the program is in operation.

• One-on-one interviews can lead participants to bias their answers toward “socially acceptable” responses. • Can probe individual experience in depth. To have individual. • Can be done by telephone. Resources Required: • • • • • Trained interviewers Written guidelines for interviewer Recording equipment A transcriber A private location Advantages: • Can be used to discuss sensitive subjects that the interviewee may be reluctant to discuss in a group. 43 . open-ended discussion on a range of issues. 2. Disadvantages: • Time consuming to conduct interviews and analyze data. To obtain in-depth information from individuals about their perceptions and concerns. the more people must be interviewed.Chapter 6 Summary of qualitative evaluation methods— personal interview Method: Personal interviews Purpose: 1. Number of People to Interview or Events to Observe: The larger and more diverse the target population. • Transcription can be time-consuming and expensive.

Because of group pressure. participants may give “socially acceptable” responses. Focus groups are harder to coordinate than individual interviews. 44 . 2. Disadvantages: • • • • • Individual responses can be influenced by group.Evaluating Your Fall Prevention Programs Summary of qualitative evaluation methods— focus group Method: Focus Groups Purpose: 1. • Response from one group member can stimulate ideas of another. Resources Required: • Trained moderator(s) • Appropriate meeting room • Audio and/or visual recording equipment Advantages: • Can interview many people at once. Number of People to Include: 4 to 8 participants per group. Participants choose to attend and may not be representative of target population. Transcription can be expensive. To obtain in-depth information about perceptions and concerns from a group. To have an open-ended group discussion on a range of issues.

Resources Required: • Trained observers Advantages: • Provides firsthand knowledge of a situation. However. • Can determine whether products are being used properly (e. 45 . • Can be labor intensive. to see if grab bars are installed correctly may require observing many events (installations). • Can discover problems the people involved are unaware of (e. Disadvantages: • Can affect the activity being observed..g. whether a walking device is being adjusted and used correctly). Number of Events to Observe: The number of events to observe depends on the purpose. To evaluate people’s behavior during a meeting may require observing only one event (meeting).g.. that their own actions in particular situations cause others to react negatively).Chapter 6 Summary of qualitative evaluation methods— participant-observation Method: Participant-Observation Purpose: To see firsthand how an activity operates. • Can be time consuming. • Can produce information from people who have difficulty verbalizing their points of view.

g.. brochures and fact sheets). To measure changes in people’s knowledge. To estimate the amount spent on delivering your program. To record the number of items a program distributes or receives (e. 3.Evaluating Your Fall Prevention Programs Summary of quantitative evaluation methods— counting system Method: Counting systems Purpose: 1. 4.g.g. 5. number of meetings with partners). 46 . attitudes. To record the number of contacts with program participants (e. To record the number of contacts with people outside the program (e. 2. or behaviors by collecting the same information at the beginning and end of the program... beliefs. number of people attending each exercise class).

. and participant observation.g. Why it is useful: • Allows programs to make revisions before the full effort begins. or ways of distributing information (e. (For details. a physician or local celebrity). with a new population. to be understood by.g...g. that seniors have difficulty reaching the location where classes are being held).Chapter 6 The stages of evaluation There are four stages of program evaluation: • • • • Formative Process Impact Outcome The appropriate time to conduct each stage and the most suitable methods to use are outlined below. • Details that program developers may have overlooked about materials. • Maximizes the likelihood that the program will succeed. • How people in the target population get information (e. and to be accepted by the people you are trying to serve (e. see page 25 of Demonstrating Your Program’s Worth: A Primer on Evaluation for Programs to Prevent Unintentional Injury) 47 . Methods to use: • Qualitative methods such as personal interviews with open-ended questions. When to use: • During the development of a new program. shows the strengths and weaknesses of proposed educational materials). • When an existing program 1) is being modified.g. • Whom the target population respects as a spokesperson (e. focus groups. 2) has problems with no obvious solutions. strategies. or to target a new problem or behavior. which newspapers they read or radio stations they listen to). or 3) is being used in a new setting.. Stage 1: Formative evaluation What it shows: • Whether proposed messages are likely to reach.

the nature of the direct contacts. or other organizations who are sharing information with older adults). When to use: • As soon as the program begins operation. such as: – Tracking direct contacts with all who are served by the program (older adults who have had direct contact with the program. Methods to use: • Quantitative methods. number of educational brochures distributed). • Identifies early any problems that occur in reaching the target population. procedures. Why it is useful: • Allows programs to make revisions before the full effort begins. and materials are working and to make adjustments before logistical or administrative weaknesses become entrenched. – Tracking indirect contacts (through health care providers.. see page 27 of Demonstrating Your Program’s Worth: A Primer on Evaluation for Programs to Prevent Unintentional Injury) 48 . activities. (For details. adult children of older adults.g. • Maximizes the likelihood that the program will succeed.Evaluating Your Fall Prevention Programs Stage 2: Process evaluation What it shows: • How well a program is working (e. how many people are participating in the program and how many people are not). • Allows programs to evaluate how well their plans.

see page 29 of Demonstrating Your Program’s Worth: A Primer on Evaluation for Programs to Prevent Unintentional Injury) 49 . Measurements can be made using surveys and/or objective participant assessments. • Changes in the target population’s knowledge. Why it is useful: • Allows management to modify materials or move resources from a nonproductive to a productive area of the program.. (For details. attitudes. how awareness about the value of exercise or home safety has changed among program participants). • Progress measurement: measuring the target population’s knowledge. or measurable fall risk factors. attitudes. using surveys and/or objective participant assessments. beliefs. behaviors. attitudes. • Tells programs whether they are moving toward achieving their goals.g. Methods to use: • Baseline measurement: measuring the target population’s knowledge. behaviors or health risk factors (such as muscle strength or balance) at a predetermined amount of time such as at the end of a 3-month exercise class or at regular intervals in an ongoing program. When to use: • When the program is being implemented and has made contact with at least one person or one group of people in the target population. or health risk factor (such as muscle strength or balance) before beginning the program or receiving services. beliefs. beliefs.Chapter 6 Stage 3: Impact evaluation What it shows: • The degree to which a program is meeting its intermediate goals (e.

how much an exercise and education program has improved a person’s ability to carry out daily activities and reduce fall risks). • Provides evidence of success for use in future budget development and requests for funding. Methods to use: • Generally the same methods used in impact evaluation are used in outcome evaluation. (For details.Evaluating Your Fall Prevention Programs Stage 4: Outcome evaluation What it shows: • The degree to which the program has met its ultimate goals (e. group exercise classes offered throughout the year) at appropriate intervals.g... When to use: • For ongoing programs (e. Why it is useful: • Allows programs to learn from their successes and failures and to incorporate what they have learned into the program or into their next project..g. • For one-time programs (e.g. a 6-month program to conduct home safety assessments and distribute home modification equipment or devices) when program is complete. see page 32 of Demonstrating Your Program’s Worth: A Primer on Evaluation for Programs to Prevent Unintentional Injury) 50 .

Your program is now in operation. read the next question. If no to all criteria. completed one exercise class). begin process evaluation. If yes to any of the four criteria. • It has just been adapted for a new setting. you are ready for impact evaluation. Q. Q. If you believe you have had enough encounters to allow you to measure your success in meeting your overall program goals. Is your program complete? If yes. Read the next question.Chapter 6 Determining which stage to use To find out which stage of evaluation your program is ready for. Q. • It has just been modified and you want to know whether the modifications work. who is not being served. you are ready for outcome evaluation. Does your program meet any of the following criteria? • It is just being planned and you want to determine how best to operate. problem. and how much service you are providing? If yes. If you are still uncertain. Have you measured the results of that encounter? If yes. You may also be ready for impact evaluation. consult a professional. If no. Your program has completed at least one encounter with one member or one group in the target population (e. answer the questions below. If no. Then follow the directions provided after the answer. population. • It has some problems you do not know how to solve. Do you have information on who is being served. reread the above questions or refer to the publication in Demonstrating Your Program’s Worth: A Primer on Evaluation for Programs to Prevent Unintentional Injury.g. If no. read the next question.. read the next question. Q. 51 . or behavior. read the next question. begin formative evaluation.

org/2003/commleader.re-aim.ca/Publications/Reports/ProgEvalMan%20 Report.cdc.gov/ncipc/pub-res/demonstr.asp?sectionid=32&ElementID=439 CDC Evaluation Working Group: resources for project evaluation www. Atlanta: Centers for Disease Control and Prevention.org/content.pdf National Council on Aging’s Evidence-based Healthy Aging Programming: Tools and Checklists healthyagingprograms.bc.gov/eval/resources.htm British Columbia Research Institute for Children’s & Women’s Health. National Center for Injury Prevention and Control.htm 52 . revised March 2000. 1998.Evaluating Your Fall Prevention Programs Evaluation web resources Thompson NJ.cdc.injuryresearch. McClintock HO. Demonstrating Your Program’s Worth: A Primer on Evaluation for Programs To Prevent Unintentional Injury.managementhelp.org/evaluatn/outcomes.htm RE-AIM Evaluation Framework www. Injury Prevention Program Evaluation Manual www.html Basic Guide to Outcomes Based Evaluation for Nonprofit Organizations with Very Limited Resources www. www.

you still need to determine the who. what. from concept through evaluation. when. visit the CDC National Center for Health Marketing website shown at the end of this section. and distributed so that it will effectively reach your target audience. designed. how. For more detailed information on the theory and application of health communication.Chapter 7 Promoting Your Fall Prevention Program Publicizing your fall prevention program to older adults. 53 Injury Prevention . Even if you are only developing a flyer to announce your new home-based exercise program for older adults. and others in the community will be critical to its success. the media. This section provides an overview of campaign development. The eight steps outlined below will help you make the best use of your limited time and resources in developing a successful community outreach campaign. and why of getting the flyer written. printed. This chapter provides tips and techniques that you can use to engage your community in fall prevention by: • Conducting a successful community outreach campaign • Working with the media Conducting a successful campaign The word “campaign” applies to a public health education effort of any size. where.

Take a realistic look at your community and ask pertinent questions. † Do the older adults you wish to reach see themselves as active and youthful? Are they committed to living independently? Should you reach out to adult children of older adults or healthcare providers in your campaign? † † The more you know about your target audience. For example. Set realistic and measurable objectives. TV. Step 3: Identify the target audiences your campaign should reach. values. Learn as much as you can about them.Step 1: Assess your current situation. websites) would support your campaign? What resources do you have that can help your efforts? Would a campaign be easier to mount if you partnered with other organizations in your community who serve older adults? † † † Step 2: Set your campaign goal and objectives. and expectations of target audiences vary. An objective is a specific outcome that you can use to measure progress toward your goal. the Internet may not be an effective way to reach certain groups of older adults. Remember that the needs. Identify the groups of people you need to reach to meet the goal you set in Step 2. † Is your community concerned about fall prevention or will you need to lay some educational groundwork? Do you believe your local media (radio. Identify the goals and objectives for your outreach campaign. the more effectively you can tailor your promotional efforts. Increase the percentage of older adults served by your organization who have installed grab bars or railings. such as reducing falls among older adults in your community. 54 . A goal is the overall health improvement you hope to achieve. newspaper. For example: † † Double the enrollment of your exercise classes for seniors. beliefs.

or be persuasive and alter attitudes or change behavior. and then eventually act on it. their physicians. If the older adults you want to reach perceive themselves as youthful. libraries. Messages aimed at people aged 60 to 70 should be framed differently from those for individuals over 70. Sometimes they are both. 55 . When asking a partner to help with promotional activities. they may ignore a message about the health problems of aging. Messages can be informative and convey new facts. Consider gender. Use audience feedback to make adjustments before launching your campaign. See Appendix I for a sample letter to healthcare providers to solicit referrals. † † † Step 5: Identify message outlets.” Pretest your messages with a sample of the audience and see if your message appeals to them. and age groups. Providers also can directly refer high-risk adults to your program. † Many messages begin by raising awareness about an issue or program so people can agree with it. Answers to the following questions can help you identify the best outlets for your message. Decide how you can deliver your message most effectively.Chapter 7 Step 4: Develop your messages for the campaign. emphasize the connection between their work and your program goal. or faith-based organizations such as churchs or synagogues? † Partnerships offer unique opportunities to reach complementary target audiences. their peers. † Where does your audience get information that they trust? Is it from the media. or children? Where does your audience spend time? Do they spend time at senior centers. A message focused on “staying healthy and independent” may generate more positive response than one focused on “preventing hip fractures and other injuries. believe it. understand it. Healthcare providers can publicize your fall prevention program to older adults. culture.

investigate the reasons why. For example. older adults may prefer larger type. If not. † † Keep your wording simple and direct. evaluate. and languages. Use what you learn to improve your campaign. determine if you are moving toward your goal. In developing materials. Pretest any materials you develop as part of your campaign with members of your target audience group and make modifications based on their feedback. † † 56 . Step 8: Implement. pay attention to reading level. † This crucial step can make the difference between success and failure in a community outreach campaign. † See what barriers are preventing the message from reaching the target audience. Consider design as well as content. Determine what you can do to remove these obstacles. Create an action plan that demonstrates good time and resource management. As you carry on your outreach campaign.Promoting Your Fall Prevention Programs Step 6: Develop an action plan for the campaign. While it can be simple or complex. print size. at a minimum your action plan should identify: † † † Major activities and tasks Target date for completing each task The person responsible for ensuring that each task is completed Step 7: Develop and pretest campaign materials. and modify your campaign.

and they provide public access and outreach for you. and television stations. Develop key points to include in the media materials. Appendix J has key points that include facts and national statistics about falls among older adults. and business trade publications in your community. Local organizations such as faith-based. television stations. offer key points to guest speakers in advance so they can include them in their remarks. radio. Check with your library or bookstore to find media directories that list daily and weekly newspapers. If you’re hosting a community event. newsletters. so they should welcome the opportunity to make the community aware of your organization’s fall prevention program. Internet news outlets.Chapter 7 Working with the media You can use media such as local newspapers. especially the health reporter.) Don’t overlook community newspapers as potential news outlets. to enhance your promotion activities. you provide useful and timely information for their audiences. Highlight the importance of your fall prevention program. † † † † 57 . (These web links can be found at the end of this section. try to include statistics about falls among older adults in your state or community. newswire services. See your relationship with the media as one of mutual advantage. Some examples of media directories include Bacon’s MediaSource and the News Media Yellow Book. magazines. and senior citizen groups that publish their own newsletters may be eager to publicize your prevention program. For a greater effect. These statistics may be available from state and county health departments and local hospitals. radio stations. † Start with your local telephone directory and create a list of media names and contact information for local reporters. The media has a mandate to be of public service.

htm 58 .gov/healthmarketing CISION us.leadershipdirectories.Promoting Your Fall Prevention Programs Promotional web resources CDC National Center for Health Marketing www.com News Media Yellow Book www.cdc.cision.com/products/nmyb.

other CBOs. consider the following: Establish your vision Determine the vision of your program. 59 Injury Prevention . Write it down and share it with all involved. Expanding your base of support is crucial to sustaining your program and providing its benefits to the older adults in your community. A common vision unifies all of your program’s sustainability efforts. In developing your plan. The process of creating a written sustainability plan can strengthen community partners’ commitment and understanding of the efforts needed to keep your program operating and improving. and government representatives who will speak up and take action on behalf of your program. Build collaboration Continue to look for new community partners who possess unique skills and resources that will contribute to your program. Advocate for support Seek advocates for your program among business leaders. A tangible document that describes your sustainability plan helps you and your community partners monitor progress on sustainability efforts.Chapter 8 Sustaining Your Fall Prevention Program Create a written sustainability plan to provide a road map to guide you and your program’s community partners as you work on sustainability efforts. Keeping your vision in sight will serve to strengthen your program’s sustainability.

the health department. they can provide ongoing community support and referrals. or national (public or private) grant funders Program participant fees Use your program evaluation results to promote sustainability. your partners. and the local Area Agency on Aging. Find funding Secure diversified funding streams from public and private sources to increase your program’s sustainability. your current and potential funding sources.Integrate your program into community healthcare and senior services by linking with senior service providers. Share your evaluation results with your target audience. Demonstrate the benefits of your program. Study your program goals and evaluation results to identify areas for improvement or change that might make your program more sustainable. and stakeholders. Sources of funding include: • • • • • • • Medicare Health Maintenance Organizations Private or managed care insurers Private organizations Federal/state/local government or agency Local. state. 60 . healthcare organizations. the community. See Attachment K for a template to help you create a sustainability plan for your fall prevention program.

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Appendix A Sample Individual Falls Risk Assessment .

the greater your chance of having a fall. Review your medications with your doctor(s) and your pharmacist at each visit. Tell your doctor(s) if you have any pain. Reviewed by: ___________________ 63 . swelling. Be aware of what can cause falls. stiffness. and with each new prescription. Schedule an eye exam every two years to protect your eyesight and your balance. but many falls can be prevented. please credit the Washington State Department of Health. Ask your doctor(s) what you should do to stay healthy and active with your health conditions. etc. or do your family or friends say you have a hearing problem? Do you usually exercise less than two days a week? (for 30 minutes total each of the days you exercise) Do you drink any alcohol daily? Do you have more than three chronic health conditions? (such as heart or lung problems. Exercise at least two or three times a week for 30 min. or numbness in your legs or feet—don’t ignore these types of health problems. Schedule a hearing test every two years. Use this to learn what to do to stay active. gradual health changes and some medications can cause falls. Show this checklist to your doctor(s) to help understand and treat your risks. Limit your alcohol to one drink per day to avoid falls. Ask your doctor(s) what types of exercise would be good for improving your strength and balance. Report any health changes that cause weakness or illness as soon as possible. Review all of your medications with your doctor(s) or pharmacist if you notice any of these conditions. or weakness as a side effect. diabetes. walker. Do you take four or more prescription or over-the-counter medications daily? Do you have any difficulty walking or standing? Do you use a cane. Ask your doctor for training from a physical therapist to learn what type of device is best for you. learn how to use them to help protect and restore your hearing. Tell your doctor. Check “Yes” if you experience this (even if only sometimes) Have you had any falls in the last six months? No Yes What to do if you checked “Yes” Talk with your doctor(s) about your falls and/or concerns. weakness. arthritis. or have to hold onto things when you walk? Do you have to use your arms to be able to stand up from a chair? Do you ever feel unsteady on your feet.) The more “Yes” answers you have. Injury & Violence Prevention Program. If hearing aids are recommended. dizziness. and protect yourself from falls. If you use or adapt this material. or crutches. Ask your doctor(s) if you are unsure. Tell your doctor(s) about any difficulty walking to discuss treatment. weak. independent. Ask which of your medications can cause drowsiness. Talk with your doctor about anything that could be a medication side effect or interaction. Ask your doctor(s) if physical therapy or treatment by a medical specialist would be helpful to your problem. Find some activities that you enjoy and people to exercise with two or three days/week for 30 min. and take care of yourself to stay independent and falls-free! This material is in the public domain and may be reproduced without permission. Ask your doctor for a physical therapy referral to learn exercises to strengthen your leg muscles. soreness. and ask if treatment by a specialist or physical therapist would help improve your condition. and falls-free. high blood pressure. or dizzy? Has it been more than two years since you had an eye exam? Has your hearing gotten worse with age. and how to safely use it. which helps improve and protect your balance. See your doctor(s) as often as recommended to keep your health in good condition.My Falls-Free Plan Appendix A – Risk Assessment Name: ____________________________ Date: _________ As we grow older. aching.

Appendix B Identifying Partners Worksheet .

simple • Balance. Gym/fitness center Health Department Home health agency Home modification resources Library system Local service organization(s) Other resources Parks and recreation Pharmacy Physical/occupat ional therapy clinics University/ Community College YMCA 65 .Appendix B – Identifying Potential Partners Fall Prevention Intervention Components Community Partners/ Resources Education • Group • Individual Assessment • Gait • Balance. in-depth • Strength Exercise • 1:1 balance alone • 1:1 strength with balance training • Group class • Individualized exercise/PT • Tai Chi Medication • Medication review • Medication management Vision • Basic assessment • Detailed assessment • Vision correction Home Safety • Assessment • Basic modification** • Skilled modification** Other • Assistive device training Area Agency on Aging Community health care providers Community hospital (s) outpatient programs and services EMS/Trauma Injury Prevention Coordinator Fire Depts.

Appendix C Sample Fall Prevention Brochure .

Appendix C – Sample Fall Prevention Brochure 67 .

Appendix C – Sample Fall Prevention Brochure 68 .

Appendix D Sample Fall Prevention Presentation .

Q: Are there papers. 1 FLOORS: Look at the floor in each room. YOU can lower your chances of falling.” STAIRS AND STEPS: Q: Are you missing a light over the stairway? Have an electrician put in an overhead light at the top and bottom of the stairs. magazines. By making some changes. 3 4 Make your home safer… “Last Saturday our son helped us move our furniture. Make sure handrails are on both sides of the stairs. blankets or other objects on the floor? Pick up things on the floor. BEDROOMS: Q: Is the light near the bed hard to reach? Place a lamp close to the bed where it’s easy to reach. Can Do To YOU Four Things Begin a regular exercise program. Q: When you walk through a room.Appendix D – Fall Prevention PPT Thumbnails Preventing Falls What YOU Can Do To Prevent Falls Many falls can be prevented. do you have to walk around furniture? Ask someone to move furniture so your path is clear. Q: Is the path from your bed to the bathroom dark? Put in a night-light so you can see where you’re walking. 70 1 . Q: Do you have throw rugs on the floor? Remove rugs or use a non-slip backing so rugs won’t slip. books. Falls Prevent 2 Have your healthcare provider review your medicines. Some night-lights go on by themselves after dark. Always keep objects off the floor. Q: Is the carpet on the steps loose or torn? Make sure carpet is firmly attached to every step. Have your vision checked. Look at all your bedrooms. Now all the rooms have clear paths. Look at the stairs you use both inside and outside your home. shoes. boxes. towels. Q: Are the handrails loose or broken? Photo courtesy of Jake Pauls Fix loose rails or put in new ones.

It’s safest to have uniform lighting in a room. Put in brighter bulbs. get one with a bar to hold on to. Q: Are the things you use often on high shelves? Move items in your cabinets. Exercise makes you stronger and improves your balance and coordination.INFO www.800. Keep things you use often on the lower shelves (above waist level). Other Things Can Do To YOU Get up slowly after you sit or lie down. Q: Do you need some support when you get in and out of the tub or up from the toilet? Have a carpenter put grab bars inside the tub and next to the toilet. Have your vision checked at least once a year by an eye doctor. contact: Centers for Disease Control and Prevention National Center for Injury Prevention and Control 1. Add lighting to dark areas.gov/injury “Making changes in our home to prevent falls is good for us and good for our granddaughter when she comes to visit. Never use chairs as step stools. Improve the lighting in your home. Avoid going barefoot or wearing slippers. KITCHEN: Look at your kitchen and eating area. Q: Is your step stool unsteady? If you must use a step stool. Look at all your bathrooms. Fluorescent bulbs are bright and cost less to use. More Safety Tips Exercise regularly. Wear shoes both inside and outside the house. Poor vision can increase your risk of falling.cdc.” Department of Health and Human Services Centers for Disease Control and Prevention 71 2 .Appendix D – Fall Prevention PPT Thumbnails BATHROOMS: Q: Is the tub or shower floor slippery? Put a non-slip rubber mat or self-stick strips on the floor of the tub or shower. Falls Prevent You Can Prevent Falls For more information. Hang lightweight curtains or shades to reduce glare.CDC. Keep emergency numbers in large print near each phone.

Appendix E Sample Exercises .

Warm up t t 2.Barnett Exercise Intervention Stay Safe Stay Active Daily Exercise Program 1. Calf (stretch) a Calf (streich) \ Thank you Sally Castell for your diagrams \ 73 .Appendix E . Shoulder rolls (Flexibility) 3. Ankle (strength) 5. Knee bend (strength) 6. Sillo SIand (strength) 7. March on spot (moblllty) 4.

Knees in and out •• 7.Boston University** for allowing us to use your diagrams 74 . Thank you to Stay on Your Feel* and Roybal.. Lift leg backwards' 4. Arm cur'" 6. Shoulder blade exercises'" 5. Hip to the side' 2. 8. Ankle Pumps .Appendix E . Hip extension .. Foot Circles' 3.Barnett Exercise Intervention Stay Safe Stay Active Daily Exercise Program (Stage 2) 1.

Appendix F Sample Medication Review Form .

. Barbiturates. if possible (especially if taking more than four medications). □ Decrease number of medications. Tricyclic Antidepressants. Selective Serotonin Uptake Inhibitors (SSRIs) . especially psychotropic drugs.e.Benzodiazepines • Narcotics with psychotropics • More than one psychotropic Notes: □ Avoid combination of certain drugs Courtesy of the Michigan Fall Prevention Project Michigan Department of Community Health 76 . Butyrophenones) Sedative/hypnotics (i. Hydroxyzine) .. Notes: □ Investigate lower dosages of medications.e. Notes: □ Consider withdrawal of digoxin: Notes: In patients with stable CHF If CHF is due to valvular disease or hypertension If there is no response to digoxin after one month with decreased heart size..e. Phenothiazines. or increased exercise capacity □ Stop or decrease number of psychotropic medications Notes: Neuroleptics (i. diuretics and cardiovascular drugs.Antidepressants (i.Appendix F – Fall Prevention Medication Review Checklist Patient Name: ______________________Review Date: _______ Number of medications patient was taking: ________ Please indicate which of the following recommendations were made/actions taken when reviewing the above patient’s medication intake.

Appendix G Sample Home Fall Prevention Safety Checklist .

Appendix G – Sample Home Fall Prevention Safety Checklist P 78 .

P P 79 .

P P 80 .

P P 81 .

P P 82 .

P P 83 .

P P 84 .

P P 85 .

Appendix H Sample Program Evaluation Tool .

staff. Decide where you will seek financial support. 1. Find out which federal. or local government agencies give grants for the type of program you envision. or local government agencies provide technical assistance for the type of program you envision. Evaluate the outline.Appendix H – Program Evaluation Checklist Program Evaluation Checklist This is a checklist of tasks that organizations developing fall prevention programs can follow to make sure no evaluation steps are omitted during program development. begin evaluation. Program Development As soon as you or someone in your organization has the idea for a fall prevention program. Decide where you will seek non-financial support. conduct personal interviews or focus groups with a small number of the people you will try to reach with your fall prevention program. state. or other non-financial support. operation. Investigate to make sure an effective program similar to the one you envision does not already exist in your community. Consult people who have experience with programs similar to the one you envision. Develop an outline of a plan for your fall prevention program. 87 . modify your ideas for the program so that you can fill a need that is not being met. Find out which businesses and community groups are likely to support your goals and provide funds to achieve them. For example. Find out which federal. state. Include in the outline the methods you will use to provide the program service to participants and the methods you will use to evaluate your program’s impact and outcome. and ask them to review your plan. Modify your plan on the basis of evaluation results. and completion. Find out which businesses and community groups support your goals and are likely to provide technical assistance. If a similar program does exist and if it is fully meeting the needs of your proposed target population.

program supporters. Modify the plan on the basis of evaluation results. Or if you did not receive grant funds for which you believed you were qualified. contact the funding agency to find out why your proposal was rejected. For example. businesses. Include in the design a mechanism for evaluating the program’s impact and outcome. and all contacts with participants. and research. conduct personal interviews with business leaders in your community. and activities. 88 . attitudes. materials. if businesses are contributing much less than you had good reason to expect. supporters. or other people outside the program. and behaviors that relate to your program goals. For example. conduct focus groups within your target population. re-evaluate your plan or the aspect of your plan that seems to be the source of the problem. For example. Develop forms to keep track of program participants.Appendix H – Program Evaluation Checklist Develop a plan to enlist financial and non-financial support from all the agencies. expand on the outline of your plan for the fall prevention program. and continue seeking support. Keep track of all contacts you make with potential supporters. Measure the target population’s knowledge. The results are your baseline measurements. Use the outline of your plan for the injury prevention program to demonstrate your commitment. and community organizations you have decided are likely sources of support. Put your plan for obtaining support into action. When you have enough support for your program. Modify your plan according to your reevaluation results. beliefs. then seek feedback from businesses that are contributing and those that are not. Modify your plan on the basis of evaluation results. If unexpected problems arise while you are seeking support. Evaluate the plan for obtaining support. Evaluate your program’s procedures. expertise.

Keep meticulous records. exercise and education classes) at suitable intervals to see how well the program is meeting its goal of reducing fall related morbidity and mortality.cdc.Appendix H – Program Evaluation Checklist 2. re-evaluate (using qualitative methods) to find the cause and solution.g. and (if appropriate) behaviors. or your assessment of program participants might show that their knowledge is not increasing. your records might show that not as many people as expected are responding to your program’s message. A Primer on Evaluation for Programs to Prevent Unintentional Injury (CDC NCIPC. supporters. www. publish the results of your program in a scientific journal. a book designed to help program staff understand the processes involved in planning. Use the results of this evaluation to justify continued funding and support for your program. attitudes. and implementing evaluation of programs to prevent unintentional injuries.gov/ncipc/pub-res/demonstr. to reduce the rate of falls and fall injuries. This tool was based on guidelines from the Demonstrating Your Program's Worth. Track all items either distributed to or collected from participants. If appropriate. As soon as the program has completed its first encounter with the target population. Program Operation Put your program into operation. For example. Evaluate ongoing programs (e. or others).htm 89 . Track all program-related contacts (participants. If unexpected problems arise while the program is in operation. 3. assess any changes in program participants’ knowledge. Program Completion Use the data you have collected throughout the program to evaluate how well the program met its goals: to increase behaviors that prevent falls and. 2000). designing.. consequently. Continue tracking and assessing program-related changes in participants throughout the life of the program. Modify the program on the basis of evaluation results. beliefs.

Appendix I Sample Pitch Letter .

We are offering a [free/low-cost] fall prevention [exercise class. program details. beginning March 1. from 9 to 10 a. led by a trained fitness instructor. Please recommend our service. We will hold 37 weekly classes of moderate exercise. slow reaction time. home visits. described in more detail below. [Recommended step: (Program) fliers to distribute to high-risk patients are available. More than one-third of people aged 65 and older fall each year. etc. muscle strength. poor balance.Appendix I – Sample Letter to Health Care Referral Source [Title] [Name of organization] [Address] Dear [Name]: Our organization needs your help in preventing falls among older adults—the leading cause of injury deaths and nonfatal injuries for persons aged 65 and older.] to individuals whose current health status places them at increased risk of falling. counseling. [Your name and title] 91 . or a combination of these symptoms. reaction time.] Sincerely. and aerobic capacity while reducing their likelihood of falling or being injured in a fall.m. Please call me at [telephone number] if you would like further information. Help your patients maintain their health and independence by learning how to avoid falls. Participants will improve their balance and coordination. Anytown.” an evidence-based exercise program for older adults at risk of falling due to lower limb weakness. Our program is [name and description of program. Stay Active. at the YMCA at 321 Main Street. We will also provide participants with fall prevention strategies and exercises to do at home. For example: “Stay Safe.. to your patients who would benefit from it.] The Centers for Disease Control and Prevention has identified this intervention as effective in preventing falls.

Appendix J Key Points .

Falls are the leading cause of injury deaths and the most common cause of nonfatal injuries and hospital admissions for persons aged 65 and older. In 2004. one adult died from a fall every 35 minutes. In 2000.900 people aged 65 or older died of a fall-related injury. type. agency on aging or county or state health department for statistics on fall-related injuries and deaths. falls account for [X percentage] of deaths among older adults. or use of assistive devices (walkers. more than 14. falls account for [X percentage] of emergency room visits by people aged 65 or older. canes. falls account for [X percentage] of hospital admissions for injuries among older adults. In [your state/community]. In [your state/community].Appendix J – Key Points Regarding Falls Among Older Adults Health Consequences of Falls (age 65+) • Falls are a major threat to the health and independence of older adults.) Poorly designed public spaces • • • • • • 93 . 211 older adults were treated in emergency rooms for fall-related injuries. etc. Another 1.) Biological risk factors Mobility problems due to muscle weakness or balance problems Chronic health conditions such as arthritis and stroke Vision changes and vision loss Loss of sensation in feet Behavioral risk factors Inactivity Medication side effects and/or interactions Alcohol use Environmental risk factors Home and environmental hazards (clutter. (Contact your local hospital. • • • Each year in the United States. Every hour. About one out of ten falls among older adults results in a serious injury (such as a hip fracture or head injury) that requires hospitalization. nearly one-third of older adults experience a fall. In [your state/community]. etc. direct medical costs totaled $179 million for fatal falls and $19 billion for nonfatal fall injuries. In 2004.85 million were treated in emergency departments for nonfatal injuries related to falls.) Incorrect size. crutches. poor lighting.

Appendix K Sustainability Plan Template .

and the community. and how do they figure in your sustainability plan? Advocates Who are your supporters? What are their goals and how are they providing help? Current Funding Sources Who is providing funding for your program? How long will they continue their contributions? New Potential Funding Sources List possible funders who could provide additional support. What tools will you use to collect data? State how you will adapt the program to ensure you are maintaining the vision and meeting your objectives. Describe staffing and information management. Management Include how you are managing your program’s fiscal resources. Describe a plan to approach potential funders. when it operates.Appendix K – Template for Developing a SUSTAINABILITY PLAN *********************************************************************** Sustainability Plan for {Your Program Name} Program Summary Describe what your program offers. Vision What is the program’s vision? What results do you hope to achieve. who it serves. 95 . Remember to include how your program incorporates effective intervention components to achieve its goals. Evaluation Describe how you will collect information to show results. and what are the activities that will lead to the desired results? Who will benefit? Collaborators Who are your partners? What are their roles. how it is funded and who your community partners are. what resources do they contribute. Get additional referrals for both public and private funders through partners. partners. Program Offerings State specifically how the program addresses the needs of the older adult participants.

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