The article New Law, Falls Free Initiative Help Stop Seniors' Free Fall was written by Bonita Lynn Beattie, Vice President, Injury Prevention for NCOA.

The full text is reproduced from Aging Today, July-August 2008 by permission of the American Society on Aging.

A sense of urgency is growing in the United States to address the issue of falls and fall-related injuries among the rapidly expanding population of older adults. Several reports by the National Center for Injury Prevention and Control and its Traumatic Brain Injury Awareness campaign have heightened recent interest in this issue. In 2004, the National Council on Aging (NCOA), with support from the Archstone Foundation and the Home Safety Council, launched the national Falls Free Initiative, which resulted in a consensus document titled the National Action Plan; strategies contained within are intended to minimize falls among elders and maximize their independence and quality of life.

Experts and advocates in aging have long known that well-researched interventions can reduce falls and related injuries. Interventions can address such risk factors as physical mobility limitations, inactivity, poor medication management, vision impairment and safety hazards in homes and communities. For instance, inadequate interior lighting or broken sidewalks may be just annoyances to most people but are dangerous for frail elders.

New Federal Law 

One major challenge is the need to bring healthcare providers and the aging-services network together with community leaders to promote evidence-based fall-risk screening initiatives and appropriate interventions for adults at all levels of risk.

Aging members of Congress are not immune to falls, as has been evidenced by recent injuries sustained by Sen. Robert Byrd, D-W.V., and Rep. Edward Markey, D-Mass., as well as the fall-related death of Rep. Paul E. Gillmor, R-Ohio, last autumn. Not surprisingly, the Safety of Seniors Act had nearly unanimous support as it made its way through the House and the Senate, and was signed into law in April 2008.

This statute addresses one aspect of the national action plan and the Falls Free Coalition. (For information about FFC, see article on page 10). The legislation articulates specific strategies to bring about change and includes provisions for a public-awareness campaign, provider education programs and community demonstration projects to provide access to evidence-based screening and prevention programs for millions of elders. However, the bill passed without funding, and FFC members have petitioned Congress to appropriate adequate funds to realize the provisions of the law.

Several surveys have revealed a widespread lack of understanding about the growing public-health issue of falls. In an article published earlier this year in the American Journal of Public Health (98: 351.357), Karen Hughes and coauthors reviewed data from several international surveys conducted to inform fall-prevention campaigns and found that more than 60% of participants rated their risk as low. yet that impression flies in the face of the national statistics on falls among U.S. elders. Lucy Yardley and colleagues concluded in a 2006 article in The Gerontologist (46: 650.660) that such denial led many older people to reject addressing issues of risk or participating in fall-prevention interventions.

More alarming is the prevalent fear of falling documented among community-dwelling older adults, a concern that can affect elders' daily functioning and quality of life. In a review published in the Canadian journal Geriatrics and Aging (2003, 6:15.17), Nadine Gagnon and Alastair Flint noted that the fear of falling affects 20%.60% of community-dwelling older adults but skyrockets to as high at 83% in elders who have already fallen. They also found that 70% of older adults who have fallen report making significant changes in their daily activities, limiting their mobility -- and their quality of life -- because they fear losing independence. Family members are also worried. That is why advocates for elders -- and the new law -- call for a public-awareness campaign that combines education with strategies to reduce risk. Such strategies can empower older adults and family members to seek help and make appropriate behavioral and environmental changes.

The Safety of Seniors Act also recognizes the need to educate healthcare and aging-service providers to incorporate evidence-based clinical decision making, whether they assess older adults for their risk of falls, treat elders who have fallen or adopt community fall-prevention programs. A 2005 survey in Connecticut exposed a general lack of fall-prevention awareness and the need for clinical training in fall-prevention assessment and intervention among healthcare providers. Many professional associations are beginning to address this need, including FFC members such as the American Physical Therapy Association, which is now offering online training in assessment tools and intervention strategies. Most professional-association efforts are focusing on building skills in clinical assessment and providing research-based interventions, tools and clinical guidelines.

These efforts, however, are not enough. More and more healthcare providers are treating older adults without training them to effectively address issues of geriatric health promotion, such as fall-risk reduction. Too many older individuals are being discharged from emergency rooms for fall-related issues without an appropriate intervention follow-up. Statistically, a person who has already fallen, with or without resulting injury, is two to three times more likely to fall again than someone who hasn't fallen. Equally strong evidence shows that community-based programs for fall prevention offered through the aging-services network can improve balance and reduce falls among elders. Furthermore, studies have found that many community-based physical activity programs can improve balance and flexibility in older adults, reducing their risk of falling.

Not surprisingly, evidence-based interventions are particularly effective when fall-prevention programs include both healthcare and community components working collaboratively to implement a multifactor approach. Demonstration projects under the new federal law may well serve to bring healthcare, aging and community leaders together on this issue.

At NCOA, our work includes bringing community leaders together to design and implement evidence- based, cost-effective models in a collaborative, integrated approach that strives to link the healthcare and the aging-services networks to maximize program reach and impact. But more work is needed. The Safety of Seniors Act has provisions for project grants to help more communities design and test program models for national dissemination. The goal of this work will be to empower communities to implement and sustain cost-effective, comprehensive, collaborative interventions that can reduce falls and fall-related injuries in older adults.

Bonita Lynn Beattie is a vice president of the National Council on Aging and directs its Injury Prevention Center for Healthy Aging, in Washington, D.C.

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