CDC Falls Prevention Activities

Research Studies

Collaborative activities with the Administration on Aging (AoA)
Under this interagency agreement, CDC is conducting three activities related to older adult falls:

• Supporting the collaborative initiative by the National Council on Aging (NCOA), the Archstone Foundation, the Home Safety Council, and other partners to address the growing problem of falls and fall-related injuries among adults aged 65 years and older. The Falls Free Coalition, formed in 2004 as a result of this initiative, includes more than 55 organizations and employs a collective approach to promoting a national fall prevention action plan.
• Assessing the long-term impact of Matter of Balance, a program designed to reduce fear of falling, increase self efficacy and a sense of control in relation to fall risk, and increase physical and social activity.
• Estimating the average program implementation and maintenance costs and comparing these costs across three AoA-funded fall prevention programs: Matter of Balance, Moving for Better Balance, and Stepping On.

Collaborative activities with the Centers for Medicare and Medicaid Services
CDC’s Injury Center and the Centers for Medicare and Medicaid Services have a shared interest in analyzing data from the Medicare Current Beneficiary Survey (MCBS) to better understand the magnitude of the problem of older adult falls, to determine the impact fall injuries have on our health care system, and to identify factors that could be modified to reduce falls in this population. Together we can expand current knowledge and inform public policies related to older adult fall prevention. 

Through this collaboration, we will conduct analyses of MCBS to assess reported falls and fall risk factors among the Medicare population.

Fall risk perception and risk assessment project
Researchers at the Veterans Affairs Greater Los Angeles Healthcare System are conducting a study to learn about older people’s perceptions of their own risk for falls. They also want to understand whether older people are willing and able to implement specific strategies to reduce their fall risk. This project was funded in 2005 through a grant to the VA Greater Los Angeles Healthcare System, a partner in the Fall Prevention Center of Excellence.

• Phase I:  Researchers conducted focus groups of 8 to 10 older adults at senior centers in Los Angeles County to learn about their knowledge of and beliefs about fall risk and fall prevention. The groups discussed perceived risk factors for falls, prevention efforts, barriers to performing recommended protective behaviors, and how to increase the chances that older adults would adopt changes to reduce their risk.
• Phase II:  A second set of focus groups discussed whether a newly developed self-assessment brochure was easy for older people to use. The goal was to create a user-friendly education tool and to test its validity as a risk predictor by comparing the risk scores from the brochure with an independent physician’s risk evaluation carried out on the same day.
• Phase III:  Researchers will revise the brochure, test its validity among a large group of community seniors, and then test its predictive accuracy by conducting follow-up phone interviews after 3 and 6 months to determine if the self-assessment tool was both useful and accurate.

Dissemination of a community Tai Chi fall prevention program
Previous research findings have demonstrated that Tai Chi exercise can improve balance and decrease falls among older adults. However, it is not clear whether the general community can readily adopt and implement this type of training.

CDC funded a researcher at Oregon Research Institute, Dr. Li, in October 2005 for three years to translate his evidence-based Tai Chi intervention into a user-friendly resource package for communities to be used with adults 60 years and older who are physically mobile, with or without assistive devices, such as walkers and canes.

A 12-week Tai Chi program for adults aged 60 and over, Moving for Better Balance, was developed and has been implemented in six local senior centers (140 people). The program consists of one-hour classes given twice a week. Participants are contacted 12 weeks after program ends to find out whether they’re continuing to practice Tai Chi. Dr. Li and his colleagues are evaluating the program’s feasibility and acceptability.

Based on feedback from senior service providers and seniors in the program, a user-friendly program package is being developed that includes:

• Instructor’s manual
• Instructor supplements, and
• Participant’s course book.

The results of this translation research will provide an effective, evidence-based fall prevention package for older adults that can be implemented in a community setting. This research will also provide important public health information about the most effective dissemination strategies for program reach, adoption, feasibility, and acceptability.

Resulting publication:
Li F, Peter Harmer P, Mack KA, Sleet D, Fisher KJ, Kohn MA, Lisa M. Millet LM, Xu J, Yang T, Sutton B, Tompkins Y. Tai Chi: Moving for Better Balance—Development of a Community-Based Falls Prevention Program. Journal of Physical Activity and Health 2008;5:445-455.

Dissemination research on fall prevention: Stepping On in a Wisconsin community
In Sept 2007, CDC funded a researcher at the University of Wisconsin for four years to translate the Australian program, Stepping On, for use in the United States while at the same time maintaining fidelity to the original program components. Dr. Mahoney and her colleagues will be evaluating uptake, reach, feasibility, fidelity, adherence, and outcomes related to implementation.

In this project, the research team will examine issues such as:

• The feasibility of implementing this program in rural compared to urban settings;
• Uptake of the program by different community organizations in different settings, such as parish nurses, senior housing and senior centers; and
• How effective this program is when delivered by a professional without a health degree.

State grants for fall prevention
NCIPC is funding four states (CA, NY, OR, WI) to work with partners in the aging network to implement either Tai Chi: Moving for Better Balance or Stepping On in at least three communities. The purpose of this pilot project is to determine the capabilities of state health departments and the type and amount of technical support required for them to implement proven community-based fall prevention programs. 

The Safe States Alliance, along with the program developers, will provide training to state coordinators and to program implementers. The organizations will also provide technical assistance with additional technical support from NCIPC.

This pilot effort will provide valuable information about how to effectively utilize state health departments as channels to successfully implement and disseminate fall prevention programs throughout the U.S.  It is the first step in developing a state-wide infrastructure to support training and wide-spread adoption of these programs.

A fall prevention pocket guide for physicians
Physicians have reported that they do not know how to assess fall risk or do not have adequate knowledge about fall prevention. This project will address physicians’ expressed concerns and fill the recognized knowledge gap. The purpose of this project is to develop a simplified pocket guide, based on the American Geriatrics Society guidelines, and supporting educational materials that will help physicians incorporate fall risk assessment and individualized fall interventions into their clinical practice.

CDC will develop educational materials and a draft “Falls Pocket Guide” based on the research literature with input from physician telephone interviews. These draft materials will be distributed to physicians, evaluated through telephone focus groups, and then revised. After printing, materials will be distributed through national and state professional medical organizations.