Expanding Strategies for Community Evidence-Based Falls Prevention Programming

BackgroundAdministration on AgingThis funding opportunity is funded through Administration for Community Living (ACL), Administration on Aging (AoA). The Administration on Aging (AOA) is the principal agency of the U.S Department of Health and Human Services designated to carry out the provisions of the Older Americans Act of 1965 (OAA), as amended (42 U.S.C.A. § 3001 et seq.).The OAA promotes the well-being of older individuals by providing services and programs designed to help them live independently in their homes and communities. All proposed activity funded by the Administration for Community Living, or “federal financial assistance” as it is referred to, must abide by the Final Rule Implementing Section 504 of the Rehabilitation Act of 1973.The Rule defines new compliance requirements of recipients of federal funding of the Administration for Community Living that services must be provided in the most integrated setting appropriate to meet the needs of individuals with disabilities. Therefore, recruitment of participants for the evidence-based falls prevention programs must include those older adults in greatest economic and social need (i.e., target population for this Notice of Funding) consistent with the language stated in the Final Rule to Update Older Americans Act Regulations released February 2024 (Reference Appendix B Glossary of Term).ACL’s Administration on Aging Falls Prevention program provides older adults (60+) and adults with disabilities access to local evidence-based programs that have been proven to reduce falls and the risk of falls.Facts about FallsFalls are the leading cause of fatal and nonfatal injuries among older adults [1] and have a widespread and serious impact on their health. An estimated one out of four older adults report falling each year [2]. Older adults who fall have an increased risk for injury and reduced physical function which may significantly reduce their ability to remain independent. Falls among adults 65 and older caused over 38,000 deaths in 2021, making it the leading cause of injury death for that group. Emergency departments recorded nearly 3 million visits for older adult falls in 2021. [3] In 2015, healthcare spending attributable to older adult falls was approximately $50 billion. By 2020 that number rose to $80 billion. [4].Risk FactorsFortunately, falls are preventable. There are known modifiable risk factors such as balance impairments, muscle weakness, gait deficits, medications, home hazards, problems with vision, and improper footwear [5]. Research has shown that falls and fall risks can be addressed through risk assessment and targeted intervention, including a combination of clinical intervention and community-based programs [6] that include interventions focused on home modification, exercise, strength and balance training, and education on how to prevent falls. Participation in evidence-based community falls prevention programs can improve confidence, decrease fear of falling, and result in fewer falls and injurious falls [7].History of ACL Falls Prevention ProgramACL’s AoA has built an infrastructure to increase access to, and the sustainability of, evidence-based disease prevention and health promotion programs, including falls prevention programs. Between 2014 and 2024, ACL/AoA awarded 103 discretionary grants to states, community-based organizations, and tribal organizations to implement evidence-based falls prevention programs. Between September 1, 2014, and September 1, 2024, over 247,000 individuals participated in an AoA-supported evidence-based falls prevention program. For more information about ACL’s Falls Prevention Program, including profiles of current grantees, please visit: https://www.acl.gov/programs/health-wellness/falls-prevention.ACL also encourages, leverages, and compliments other national efforts to reduce falls and falls risk amongst older adults, such as the following work:The CDC and ACL together support opportunities to broaden and improve the linkage between primary care providers and evidence-based community falls prevention programs supported by ACL. Related resources include:CDC STEADI InitiativeOlder Adult Fall PreventionCDC Compendium of Effective Fall Interventions: What Works for Community- Dwelling Older AdultsStill Going Strong Campaign Evidence-Based Approved InterventionsWhile these programs have directly benefited hundreds of thousands of older adults to address fall-related risk, the process-driven nature of these programs may provide other indirect benefits to older adult participants. The small-group, in-person nature of evidence-based fall prevention (EBFPP) workshops increase social support and promote social connection because they facilitate meaningful interactions and bonding among older adults by gathering participants for common purposes, facilitating interactive exchanges, and creating opportunities for frequent engagement with peers and trained lay leaders for multiple consecutive weeks.And, while evidence-based falls prevention programs have been proven to reduce the risk of falls, a more inclusive, person-centered, holistic approach to coordinated care using a combination of various community and clinical partnerships could further improve the outcome of reducing the risk for falls.Person-Centered ApproachPerson-centered care allows older adults to make informed decisions about services and interventions that could reduce their risk of falls, increase their health, and preserve their independence.[8] It includes developing supports that are guided and informed by the older adult’s goals, preferences, culture, and values. It is a personalized, coordinated and enabling approach that treats older adults as individuals. The person-centered approach recognizes that a person may need or want to choose one or more professional, program, service, and/or intervention to support them.[9]Everyone should be listened to and treated with respect and empathy. A person-centered approach empowers an individual by informing them of supports available and involving them in decisions on their health journey. It involves conversation in which the older adult can express their personal goals and agree on actions to achieve them.[9]Given that the cause of falls is multifactorial, a more person-centered approach to falls prevention would address the fact that each older adult may have a different set of fall risk factors, and care must be used to address each older adults’ unique needs.For this type of person-centered approach to be successful, it may require those organizations that work with older adults to develop unique partnerships across the community and acquire new skills, for instance, in active listening and motivational interviewing.PurposeThe intent of this funding opportunity is to award entities to focus on specific targeted partnerships and innovative strategies to reduce falls and/or falls risk among older adults (60 years and older) and adults with disabilities, with the majority focus being older adults, with greatest social and/or greatest economic needs (i.e., target population for this Funding) through the implementation of evidence-based falls prevention programs with an innovative person-centered approach.This funding opportunity has two goals:Goal 1: Develop an innovative fall prevention method that includes: Targeted partnerships and outreach to recruit the target population into small group in-person evidence-based falls prevention programs.The proposed project will include initial community partnerships to support this application in referral to and implementation of the selected evidence-based falls prevention programs along with a plan to develop further, unique partnerships as the project progresses to meet the individual needs of the participants.Delivery of two or more small-group, in-person EBFPP workshops evidence-based falls prevention programs. In addition, at least one of the identified programs must also be offered in a remote format, e.g., by video conference or similar virtual modality. These programs must be on the list of pre-approved interventions found in Appendix A.Delivery of the evidence-based falls prevention programs will be person-centered, trauma informed and culturally appropriate. The awarded organization will need to keep this in mind when considering the qualifications of grant staff and program leaders and whether training on these topics will be required.Formalized person-centered approach where participants take an active role and are involved in the steps toward their continued health, well-being, and independence. (See Appendix F for examples of what this could look like.) Goal 2: Design an evaluation of your intervention to assess the impact of the effort on reducing falls and/or the risk of falls, and develop and disseminate 508-compliant program results, resources, lessons learned, and process documents to inform practice, service delivery, program development and/or policymaking for other organizations to replicate this approach, to include a comprehensive list of partnerships developed.The proposal will include steps to design an assessment using at least three questions that focus on goal identification, goal follow-up, and goal achievement, to determine whether providing additional person-centered supports beyond the falls prevention evidence-based program lowers the risk of falls and increases the level of independence for older adults.The applicant will develop 508-compliant resources that can be used to disseminate project results and lessons learned to inform practice, service delivery, program development and policy making for organizations to replicate the service delivery model.All proposed activity funded by the Administration for Community Living, or “federal financial assistance” as it is referred to, must abide by the Final Rule Implementing Section 504 of the Rehabilitation Act of 1973. The Rule defines new compliance requirements of recipients of federal funding of the Administration for Community Living that services must be provided in the most integrated setting appropriate to meet the needs of individuals with disabilities.To help regulated entities and community members understand the new final rule, the Office of Civil Rights (OCR), as the agency charged with implementing and enforcing Section 504, has published a fact sheet providing a summary overview of the rule’s provisions. The Section 504 of the Rehabilitation Act of 1973 Final Rule: Section by Section Fact Sheet for Recipients of Financial Assistance from HHS can be found on the OCR website.REFERENCESWISQARS. Web-based Injury Statistics Query and Reporting System (WISQARS). National Center for Injury Prevention and Control, Centers for Disease Control and Prevention 2021 [cited 2021 June]; Accessed October 11, 2024, from: www.cdc.gov/injury/wisqarsBergen G, Stevens MR, Burns ER. Falls and Fall Injuries Among Adults Aged ≥65 Years — United States, 2014. MMWR Morb Mortal Wkly Rep 2016;65:993–998. Accessed October 11, 2024, from: https://www.cdc.gov/mmwr/volumes/65/wr/mm6537a2.htm?s_cid=mm6537a2_wCen… for Disease Control and Prevention. (2024) About Older Adult Fall Prevention. Accessed October 11, 2024, from https://www.cdc.gov/falls/about/index.htmlHaddad Y, Miller G, Kakara R, Florence C, Bergen G, Burns E R, Atherly A, Healthcare Spending for non-fatal falls among older adults, USA, 2024 July, Accessed October 11, 2024 from Healthcare spending for non-fatal falls among older adults, USA | Injury Prevention (bmj.com)Bergen G. Stevens MA. Kakara R. Burns EA. Understanding Modifiable and Unmodifiable Older Adult Fall Risk Factors to Create Effective Prevention Strategies. American Journal of Lifestyle Medicine. October 2019, Accessed October 11, 2024 form DOI:10.1177/1559827619880529Gillespie LD, Robertson MC,U.S. Centers for Disease Control and Prevention. (2015). Compendium of Effective Fall Interventions: What Works for Community-Dwelling Older Adults, accessed October 11, 2024 from: https://www.cdc.gov/homeandrecreationalsafety/pdf/falls/cdc_falls_compe… JS, Juarez G, Perera S, Cameron K, Vincenzo JL, Tripken J. Dissemination and Implementation of Evidence-Based Falls Prevention Programs: Reach and Effectiveness. The Journals of Gerontology: Series A, Volume 77, Issue 1, January 2022, Pages 164–171, Accessed October 11, 2024, from: https://doi.org/10.1093/gerona/glab197Person-Centered Care, Centers for Medicare and Medicaid Services, Accessed October 12, 2024 from https://www.cms.gov/priorities/innovation/key-concepts/person-centered-… A, Oldham J. Person-centred care: what is it and how do we get there? Future Hosp J. 2016 Jun;3(2):114-116. doi: 10.7861/futurehosp.3-2-114. PMID: 31098200; PMCID: PMC6465833. Accessed October 12, 2024 at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6465833/