The way we talk about falls matters. It’s particularly important to tailor messages to people who are at a higher risk for falling. Indigenous older adults are in this category, making them a priority for falls prevention outreach.  

During NCOA’s 2024 Falls Prevention Awareness Week, we worked with local partners to hold an event in Albuquerque, New Mexico, an area with a large Indigenous community. With thorough research, strong connections with Indigenous partner organizations, and conversations with older adults, NCOA learned specific strategies for reaching this population. 

A profile of indigenous older adults 

Indigenous older adults are more likely to experience a fall. In 2018, over one third reported a fall—the highest rate among any racial or ethnic group in the country. 

Many different factors contribute to this discrepancy, including the fact that over 90% of Indigenous older adults have at least one chronic condition. These conditions can increase falls risk due to decreased coordination or activity, increased depression or pain, or having to manage multiple medications. Lower access to high-quality health care resources also plays a role in the high rate of falls seen in Indigenous communities.^1-3 

Indigenous communities also have many unique strengths—particularly deep cultural and spiritual traditions and a tight-knit community. These qualities can support tailored falls prevention outreach efforts. 

Tips for thoughtful outreach and engagement 

Healthy aging programs, including many falls prevention initiatives, resonate best with Indigenous older adults when they incorporate Indigenous culture, ways of knowing, and community strengths. In the planning phases of your outreach, prioritize:

• Doing your research. When programs are created for the general U.S. population with limited input from the Indigenous community, members may not trust what’s being delivered. Try to research programs that are rooted in evidence and have been specifically developed or adapted for Indigenous communities. Specific adaptations identified in the literature include:
  • Using talking circles to engage participants 
  • Translating materials into Indigenous languages
  • Training Indigenous individuals to be program leaders
  • Beginning and ending class with a blessing
  • Having flexibility to start class late to accommodate participants emergencies
  • Allowing time for socializing, storytelling, and narrative discussions in class settings² 

This also includes researching the best way to talk about falls. NCOA’s message testing in Albuquerque revealed that messages centered around elders passing down their traditions and history to family and community members were most effective when talking about falls prevention. 

• Investing in meaningful partnerships. Engage Indigenous-led organizations in your outreach. For example, NCOA partnered with the Indian Pueblo Cultural Center in Albuquerque to hand out free coffee and food as an incentive for completing a Falls Free CheckUp®. Read more about how to build partnerships in your falls prevention work. 

• Using appropriate language. Through conversations with community members and partners, NCOA learned that using “elders” in place of “older adults” was preferred, as well as swapping “free” for “already paid for” when describing incentives provided at events or resources that are available.  

• Having a mindset of cultural humility. At the end of the day, remember that the best experts in falls prevention are trusted members of the community. Consider ways to integrate Indigenous older adults’ values and preferences into evidence-based curricula and other falls prevention efforts. 

Messaging is most effective when it speaks to your target audience. Know who you want to reach, what matters to them, and where they get trusted information. The answers to these questions form the foundation of a successful outreach effort.   

Sources

1. Briana Moreland, et al. Trends in Nonfatal Falls and Fall-Related Injuries Among Adults Aged ≥65 Years — United States, 2012–2018. Morbidity and mortality weekly report (MMWR). Found on the Internet at https://www.cdc.gov/mmwr/volumes/69/wr/mm6927a5.htm?s_cid=mm6927a5_w 

2. Collette Adamson and Becky Bendixon. Evidence-Based Health Promotion Programs Among American Indian, Alaska Native, and Native Hawaiian Communities: A Call to Action to Improve Cultural Relevance and Accessibility. Found on the Internet at https://www.nicoa.org/wp-content/uploads/2021/03/1-FINAL-REPORT-Evidence-Based-Health-Promotion-Among-AIANNH-Communities.pdf

3. Fall Prevention. National indian council on aging. Found on the Internet at https://www.nicoa.org/elder-resources/fall-prevention/