State Fall Prevention Coalitions as Systems Change Agents: An Emphasis on Policy.

BACKGROUND: Falls among older adults are an escalating public health issue, which requires a multidisciplinary and multilevel approach to affect systems change to effectively address this problem. The National Council on Aging established the Falls Free® Initiative, enfolding and facilitating statewide Fall Prevention Coalitions. Fall Free® activities included developing the State Policy Toolkit for Advancing Falls Prevention to promote sustainable change by supporting the dissemination and adoption of evidence-based strategies. PURPOSE: To (1) determine if the policies being implemented were recommended and supported by the Toolkit, (2) identify the perceived barriers and facilitators to implementing policies, and (3) identify Coalitions' current and future fall prevention policy activities. METHODS: A 63-item online survey was distributed to State Coalition Leads. Descriptive statistics (frequencies and counts) were used to describe Coalition characteristics and activities. RESULTS: Coalitions had several similarities, and varied greatly in their number of member organizations and members as well as meeting frequencies. Key activities included building partnerships, disseminating programs, and pursuing at least one of the eight National Council on Aging-recommended policy goals. The most commonly reported facilitator was active support from the Coalition Leads, whereas the lack of funding was the most cited barrier. CONCLUSION: This study serves as the first national census of empirical evidence regarding Falls Coalitions' composition, goals, and activities. Results indicate that Coalitions are actively pursuing evidence-based policies but could benefit from additional technical assistance and resources. Findings support the value of Toolkit recommendations by documenting what is feasible and being implemented. Knowledge about facilitators and barriers will inform future efforts to foster sustainable systems change in states with active Coalitions and encourage Coalitions in other states.

Effective fall-prevention demands a community approach.

Given the rapid aging of the population, we can expect the number of older adult falls and fall-related injuries and deaths to increase exponentially unless we make a serious commitment to providing evidence-based, fall risk screening and assessments, and appropriate interventions to those increasingly at risk. National, state, and local partners are coming together to address this growing public health issue through evidence-based interventions that promote collaboration between public health, health care, and aging service providers. Physical therapists are uniquely positioned to make a significant contribution to this effort and to promote older adult participation in programs and services that can augment or supplement the plan of treatment. The purpose of this special interest paper is to describe the efforts of the National Council on Aging's Falls Free Initiative and the role that physical therapists and other rehabilitation professionals can play in community-based programs aimed at reducing risk and occurrence of falls in later life.

Building the older adult fall prevention movement - steps and lessons learned.

BACKGROUND: Falls are the leading cause of older adult injuries and injury-related deaths. Until 2004, the growing public health issue of older adult falls received little national attention. To elevate and focus on the issue, the National Council on Aging launched the Falls Free(®) Initiative, a group of national and state agencies working collaboratively to address older adult falls with evidence-based solutions. Since then, attention to older adult falls has gained significant momentum. PURPOSE: To describe the steps taken to create the momentum around fall prevention and lessons learned that could be applied to supporting other older adult health-related issues. METHOD/OBJECTIVES: The Falls Free(®) Initiative took key steps to promote the older adult falls prevention movement, including initiating organized advocacy and supporting the development of state coalitions through increasing awareness of the issue, promoting evidence-based programs, instituting evaluation, implementing systems change, and providing tailored technical assistance. RESULTS: Through the support of the Falls Free(®) Initiative and many partners, advocacy efforts have increased federal funding for fall prevention, the majority of states have fall prevention coalitions, and thousands of stakeholders are now engaged in fall prevention. Select lessons learned include leveraging compelling data, choosing passionate leaders for the movement, aligning the cause with partner missions, and being inclusive of all stakeholders. CONCLUSION: Although much progress has been made in the fall prevention movement, the issue is growing along with the aging population. Efforts must continue to gain support from all affected stakeholders to reduce older adult falls and fall-related injuries.

The National Falls Free™ Initiative, working collaboratively to affect change.

INTRODUCTION: Since 2004 the National Council on Aging (NCOA) has been working in collaboration with a growing number of national, state, and local organizations through the Falls Free(©) Initiative to address the growing public health issue of falls and fall-related injuries among older adults. Through collaborative leadership, evidence-based interventions, practical lifestyle adjustments, and community partnerships we are working to reduce the number of older adult falls. IMPACT ON INDUSTRY: The many activities of the national and state coalitions have brought recognition to the issue of fall prevention, education, and training to providers and greater investment in programs and services resulting in tremendous momentum and community activism. While we have yet to realize an impact on rates of falls, this strategic investment in building the infrastructure needed to affect change is the first step toward reducing the growing number of falls among older adults.

A vision for older adults and health promotion.

Our rapidly aging population is expected to place heavy demands on all segments of society, particularly the health care resources needed to attend to health concerns associated with aging. Is this a looming crisis, as some predict, or a challenge to use resources more wisely and to help older adults and their caregivers share in the responsibility for health promotion and chronic disease self-management activities? Community-based organizations serving older adults are uniquely positioned to augment health care providers' health promotion counseling activities and to bridge the gap between the research and practice of health promotion in older adults. They already play a crucial role by providing appropriate health promotion education, screening and referral, service planning, and reinforcement to facilitate self-care activities and behavior changes that promote healthy aging. By increasing teamwork across the network of services for the aging, the health sector, public and private organizations, and academe, there is a great opportunity to enhance the health and well-being of all older Americans.