Strategy to Deliver Evidence-Based Falls Prevention Programs to Older Adults with Behavioral Health and Chronic Conditions

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 and adults with disabilities 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.ACL’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’s efforts leverage and compliment national efforts to reduce falls and falls risk amongst older adults and address social isolation, such as the following:The Centers for Disease Control and Prevention’s (CDC) National Center for Injury Prevention and Control uses data to report the latest burden and health implications for various injuries including falls, the leading cause of both fatal and nonfatal injuries among older adults. Using this data, CDC is building partnerships with health systems, providers of health care, and those who pay for health care services. These partnerships will improve what is known about the burden of falls and the integration of effective fall prevention strategies and patient care. The CDC’s Stopping Elderly Accidents, Deaths & Injuries (STEADI) initiative provides resources and tools for health care providers. The CDC is also working with suppliers of electronic health records systems to facilitate the adoption and use of the STEADI tools in the clinic setting. The CDC supports 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 CampaignACL launched the Commit to Connect cross-sector initiative to address social isolation and loneliness by helping people connect and engage to build the social connections needed to thrive.Commit to ConnectFalls RiskFalls 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].Social Isolation and FallsEvidence suggests a relationship between social isolation and an increased risk of falls themselves [5]. These observed associations may be related to issues of social support [6]. Individuals who are isolated or have fewer social contacts may experience less support to encourage proactive fall prevention measures as compared to those with larger social networks.In a 2021 survey, almost half of older adults reported experiencing social isolation [7]. Certain populations are at increased risk of being socially isolated, to include minority populations, those with chronic conditions, and those with behavioral health conditions. The survey also found that “an estimated one in five older adults were currently experiencing depression, anxiety, insomnia, substance use, or another mental health disorder [7]”. Older adults with a behavioral health condition, such as depression, have a higher fall risk [8]. In addition, for older adults with chronic conditions, research found that the number of falls rises with the number of diseases [9]. Fall risk also varies by race and ethnicity, with American Indian/Alaska Natives having the highest fall risk for older adults, according to the Centers for Disease Control and Prevention [10].Fortunately, 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 [11]. Participation in evidence-based community falls prevention programs can improve confidence, decrease fear of falling, and result in fewer falls and injurious falls [12].Populations at a Greater Risk for FallsAs noted above, many behavioral health conditions and chronic conditions may lead to an increased fall risk. ACL has identified several behavioral health conditions and chronic conditions of special interest to ACL that are priorities for this funding opportunity due to their correlation to increased risk of social isolation and/or increased risk of falls:Priority Behavioral Health ConditionsDepressionSubstance Use DisorderAnxiety DisordersBipolar Disorder Priority Chronic ConditionsTraumatic Brain InjuryHIV/AIDSMultiple SclerosisParkinson’s Disease As noted above, minority populations and American Indian/Alaska Native (AI/AN) populations are at increased risk of increased falls and of being social isolated. Due to that evidence and in alignment with language stated in the Final Rule to Update Older Americans Act Regulations (released February 2024), which highlights the importance of Older Americans Act programs reaching those of greatest economic and social need and to improve the fall risk of racial and ethnic minority groups and American Indian/Alaska Native (AI/AN) populations, applicants shall ensure targeted population for recruitment and reach reflect state demographics including recruitment of minority populations and American Indian/Alaska Native/Native Hawaiians. Please note, nearly 70% of American Indian/Alaska Native/Native Hawaiians live off-reservation in cities and towns across the United States. These individuals are not eligible for services under Title VI programs. Throughout the rest of the announcement, the term “target population” will be used to refer to these two groups and applicants should reflect a statewide strategy to engage minority groups and American Indian/Alaska Native/Native Hawaiian individuals. Addressing Social Isolation and Risk for Falls Through Group ClassGroup Falls prevention classes can help address social isolation. As recent research has noted, “While 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 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” [13].Therefore, for the approach for this funding opportunity, only group classes will be listed as approved evidence-based programs to choose from in the appendix.PurposeThis section provides detail about the Target Population and Goals.The purpose of this funding opportunity is to develop and implement robust statewide strategy that support the delivery and sustainability of falls prevention evidence-based programs for older adults and adults with disabilities who are at risk of social isolation and falls.As discussed above, there are certain populations that have a higher risk of falls and social isolation. The intention of this funding opportunity is to address both risks with group-based evidence-based falls prevention programs on a statewide level.Target PopulationFor this project, the target population is:Applicants must target their reach to older adults (60 years and older) and adults with disabilities, with the majority being older adults, with greatest social and/or greatest economic needs from each of the populations of special interest below:Population 1Behavioral health conditions of special interest to ACL:Within this population the project must reach older adults (60 years and older) and adults with disabilities, with the majority being older adults, with greatest social and/or greatest economic needs with at least one of these specific conditions: depression, anxiety disorders, bipolar disorder, and substance use disorder.Population 2Chronic conditions of special interest to ACL:Within this population the project must reach older adults (60 years and older) and adults with disabilities, with the majority being older adults, with greatest social and/or greatest economic needs, with at least one of these specific conditions: Traumatic Brain Injury, HIV/AIDS, Multiple Sclerosis, and Parkinson’s Disease.While your project must serve the target population broadly and through a statewide initiative, grant recipients should also engage and recruit minority population and American Indian/Alaska Native/Native Hawaiian elders in Falls Prevention programs. Recruitment efforts can include engaging older adults and adults with disabilities in a federally recognized tribe, state-recognized tribe, or those living in urban communities across the state. Nearly 70% of American Indians and Alaskan Natives live off-reservation in cities in towns across the United States [14]. If partnering with a state recognized tribe, federally recognized tribe, or tribal consortium, the grant recipient should try to establish a collaborative agreement with tribal leaders to offer evidence-based Falls Prevention programs. Throughout the rest of the announcement, the term “target population” will be used to refer to these two groups and applicants should reflect a statewide strategy to engage minority groups and American Indian/Alaska Native/Native Hawaiian individuals.GoalsThis funding opportunity has two goals:Goal 1: On a statewide level, develop capacity (e.g., instructors, partnerships, and referral networks) to increase the number of older adults and adults with disabilities, identified from target population as listed above, who participate in group evidence-based falls prevention programs to empower them to reduce falls and/or their risk of falls. Goal 2: Develop and disseminate 508-compliant resources specific to grant learnings to enhance knowledge in the target population as listed above and aid in the sustainability of evidence-based falls prevention programs. To be considered for funding, the application must include the following components in the proposal to accomplish the goals of this funding opportunity.Applicants must identify the target number of older adults (60 years and older) and adults with disabilities, with the majority focus being older adults, throughout the state that will be reached with this funding, define which priority behavioral health conditions and which priority chronic conditions from the lists above will be prioritized, and clearly propose how the grantee will reach at least 50% of the program target number of older adults and adults with disabilities with those behavioral health conditions and with those chronic conditions by the end of the project period.Applicants must show a statewide approach to reach the target population noted above, that is inclusive of minority population and American Indian/Alaska Native/Native Hawaiian elders. If partnering with State or Federally recognized tribes or tribal consortiums, applicants must also establish a collaborative agreement with tribal health leaders from those tribes or tribal consortiums to offer evidence-based falls prevention programs to American Indian/Alaska Native/Hawaiian Native elders.The proposed project must include partnerships across the state to support this application (for example National Association of County and City Health Officials and Association of State and Territorial Health Officials, and other key organizations.) At a minimum two or more of those partnerships must specialize in serving older adults and adults with disabilities with the specifically identified behavioral health and chronic conditions.Delivery of the evidence-based falls prevention programs needs to be person-centered, trauma informed and culturally appropriate. To accomplish this, the awarded organization must provide training on these topics for grant staff and program leaders.Applicants for this funding opportunity must propose to deliver two or more group evidence-based falls prevention programs.These programs must be on the list of pre-approved interventions found in Appendix A.All applicants must propose to implement at least one of the identified programs in a remote format, e.g., by video conference or similar virtual modality. Phone calls are not an acceptable remote format for this funding opportunity. The National Council on Aging (NCOA) maintains a website that tracks remote program guidance Best Practices for Delivering Remote Falls Prevention Programming (ncoa.org)All applicants should contact the program developer/administrator(s) for any program(s) they are interested in delivering remotely to confirm that: 1) the program(s) are allowed for remote delivery as described above; and 2) that training is readily available for applicants who need it. Note that the NCOA website includes programs on the pre-approved list in Appendix A, as well as other programs not on the list. For this funding opportunity, applicants may ONLY propose programs on the pre-approved list in Appendix A.All applicants who do not have adequate existing capacity (trained leaders, licensing, program supplies, etc.) for any in-person and/or remote program(s) they are proposing must include a letter from the program developer/administrator(s) in their application indicating that they will be able to get training in the programs no later than three months after the start date of the grant (if selected for funding).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. 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