2024 Enhancing Statewide Falls Prevention Awareness, Strategy, and Collaboration

Background Falls are the leading cause of fatal and nonfatal injuries among older adults [1] and have a widespread and serious impact on their health. With an estimated one out of four older adults reporting falling each year [2], falls may significantly reduce the ability of our older adult population to remain independent. Each year an estimated 3 million older adults are treated in emergency departments for falls injuries and more than 800,000 of these patients are hospitalized [3]. In 2015, the estimated medical costs attributable to fatal and nonfatal falls totaled more than $50 billion [4]. Those who have fallen may become afraid to fall again, which may lead to reduction in their everyday activities, causing them to become weaker and increasing the likelihood of a future fall. 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 [5].ACL's funding opportunities provide individualized, person-centered home and community-based services and supports, as well as invest in research and best practices, to make community living a reality for millions of people.With collaboration of various stakeholders, the impact of falls prevention measures across entire states can be amplified. The goal of this funding opportunity is to award one entity which can subgrant awards to provide funding to state falls prevention coalitions or organizations that are developing or have the intent to develop a coalition in a state that currently does not have an active coalition in order to increase the impact of falls prevention efforts statewide at the community level, including implementing falls prevention interventions, leveraging resources, expanding awareness, and educating professionals, older adults, and caregivers about how they can reduce their risk of falling.State Falls Prevention CoalitionsFor the context of this funding opportunity, a coalition is defined as a group involving multiple sectors of the community coming together to address community needs and solve community problems [6]. State Falls Prevention Coalitions provide the framework, infrastructure, and guidance that can be shared with local communities collaborating to implement falls prevention interventions. They involve all members of a community, including consumers, clinical and community-based service providers, policy makers, older adults themselves, and others, who have a role to play in reducing the number of falls and falls related injuries among older adults. The intent is a joint effort among multiple stakeholders to implement an effective, coordinated approach to preventing older adults’ falls.In response to the National Falls Prevention Action Plan (originally created in 2005 and updated in 2015) there have been ongoing efforts to organize a state falls prevention coalition in each state. As a coordinated organization, a coalition can assist in streamlining opportunities for older adults who have been assessed as a high falls risk. The state coalition can provide opportunity for individuals in areas where there may not be falls prevention interventions by connecting them to available resources. It could also act as the avenue for continuum of care in falls prevention, connecting organizations that have not traditionally partnered or collaborated on falls prevention strategies and activities. For instance, participants in an evidence-based falls prevention exercise class may be connected to organizations offering home safety interventions. A list of the current coalitions is found here: State Falls Prevention Coalitions.Because states and communities are unique entities, state falls prevention coalitions can address the importance of using the state and local data to define the issues and their impact and to design strategies. They can assess what programming and partnerships already exist in the state or region that can be leveraged to identify state and community leaders and find opportunities to create and foster effective partnerships between health care providers and the aging services network. Coalitions have been recognized as a mechanism to create opportunities for communities to maximize resources they already have and to develop sustainable new approaches to societal problems while deterring duplication of effort [7].Although state falls prevention coalitions are different, there are common goals and activities, which include: Increasing the availability and accessibility of community-based falls prevention programs and services. Many state and local falls prevention coalitions are educating their members about evidence-based falls prevention programs that are available, helping to promote the programs, identifying locations to offer the programs, connecting partners that can make referrals to programs, and providing other support to increase the availability and accessibility of programs and services. Increasing awareness of the issue and of effective prevention strategies among stakeholders. To increase awareness, Falls Prevention Coalitions frequently sponsor Falls Prevention Awareness Day, host a falls prevention website, host falls prevention educational presentations, and promote falls prevention through traditional and social media. Building and leveraging an integrated, sustainable falls prevention network. Common activities to build and leverage state falls prevention networks include coalition members promoting falls prevention within their own organizations, promoting new internal and external partnerships, establishing partnerships with venues where older adults are served, and supporting the development of local/community falls prevention coalitions. Increasing healthcare provider organizations participation in falls prevention practices. Activities to increase healthcare provider participation in falls prevention practices might include promoting falls prevention screening to healthcare providers for all adults age 65 years and older, encouraging the implementation and dissemination of the CDC’s STEADI toolkit for health care providers, and working with professional associations to recognize and promote falls prevention intervention as a priority of professional practice. Enhancing data surveillance collection, analysis, and data systems. Activities to enhance data collection include producing user-friendly profiles about the impact and cost of falls among older adults in the state/community, identifying key data resources and partnering with data managers to improve the capture and quality of data that is important to falls prevention, tracking falls prevention programs implemented by various agencies across the state, and tracking the numbers of participants in falls prevention programs and services across the state. Improving falls prevention activities in places where older adults reside. Many states are focusing on improving falls prevention activities in nursing homes and assisted living facilities in addition to improving home safety for community-dwelling older adults. Activities might involve educating individuals and agencies about falls prevention programs, working with agencies to promote falls prevention programs in care facilities, and encouraging the appropriate use of vitamin D for residents. Instituting ongoing evaluation of state efforts and outcomes. Evaluating the efforts and outcomes of falls prevention activities helps to increase impact and address areas for improvement. In some states, the Department of Public Health is developing, implementing, and monitoring evaluation as a function of its epidemiological activities or the State Falls Prevention Coalition may have a mechanism (such as an evaluation committee or evaluator) to evaluate its efforts. Increasing funding opportunities and investments for falls prevention. Several states and community falls prevention coalitions have supported the pursuit of funding programs such as grants, use of Title IIID funds for evidence-based falls prevention activities, and encouragement of local health departments, trauma centers, or other stakeholder organizations to include falls prevention activities in their budgets [8].Coordinating Efforts on Falls Prevention and the Aging NetworkSince 2014, ACL has awarded more than $50 million in grants through the Prevention and Public Health Fund for falls prevention programs. These grants have been awarded to domestic public and private nonprofit entities, state agencies, community-based organizations, universities, and tribal organizations.ACL also funds a nonprofit organization to serve as the National Falls Prevention Resource Center. The purpose of the ACL Falls Prevention program is to empower older adults and adults with disabilities to reduce falls and/or the risk of falls by raising awareness of, developing capacity for, and sustaining evidence-based falls prevention programs and activity in the community.While this funding opportunity will sub-grant falls prevention on a statewide level, the applicant should plan to work closely with the ACL National Falls Prevention Resource Center to understand the current state of falls prevention coalition work and programs currently being delivered in the Aging Network, as well as strategies for collaborating with community-based aging and disability service organizations.Applicants should ensure they build upon, not duplicate, the work of the ACL Falls Prevention Program, ACL National Falls Prevention Resource Center, and other falls prevention efforts in the Aging Network.PurposeThrough this opportunity, AoA intends to fund a single entity to leverage and expand upon falls prevention efforts across the country and to work collaboratively, in partnership with the aging and disability network and other stakeholders, to accomplish the following goal:Award up to 12 subgrants to facilitate the development and enhancement of collaborative efforts of state falls prevention coalitions to reduce falls and/or the risk of falls among older adults, adults with disabilities and their families and caregivers.Program GoalsDevelop and Implement SubawardsA central deliverable, expected within six months of receipt of funds, will be the disbursement of subawards to state falls prevention coalitions or organizations that are developing or have the intent to develop a coalition in a state that currently does not have an active coalition as referenced here: State Falls Prevention Coalitions. The successful awardee is expected to use a transparent and open process for soliciting, reviewing, selecting, and making the required subawards to these organizations. Applicants should describe how the process will be designed and administered.Additionally, the awardee is responsible for the monitoring and oversight of all subawards, including tracking sub-recipient work plans and budget goals. Applicants should carefully consider and describe the subaward process. Further, the successful award recipient shall adhere to all requirements, including those for making and monitoring subawards, as outlined in 45 CFR Part 75.Guidance on Purpose and Intent of SubawardsThe applicant will fund a cohort of up to 12 sub-recipients that are a current or developing falls prevention coalition or have the capacity to become a falls prevention coalition over an 18-month timeframe with grants to initiate, expand, and improve falls prevention activity on a statewide level ensuring that the sub-recipients bring together a diverse group of stakeholders to collaboratively identify state and community needs, create and disseminate resources and education, and build infrastructure and sustainability. ACL will work with the recipient of this funding opportunity to determine the most appropriate number of sub-awards as well as the criteria for awards.The sub-recipients will have flexibility to address priority needs, including, but not limited to:Developing or expanding a state falls prevention coalition to coordinate falls reduction effortsBuilding partnerships across the state with the aging network and other key stakeholders such as healthcare provider organizations and emergency response unitsIncreasing the awareness of evidence-based programs and resources to grow availability and accessibilityCompiling state falls data for analysisRaising statewide awareness of falls risk through marketing and public service announcementsDeveloping a statewide website and/or online locator for evidence-based programsCreating a repository of professional and consumer resources that can be accessed by the aging network as well as consumersOrganizing state or regional falls prevention health fairsIncreasing fall risk screenings and referrals to falls prevention interventionsCollaborating within the aging network (for example, senior nutrition programs) to leverage infrastructure already in place to maximize the impact of falls prevention education, resources, and interventions with older adultsEach sub-recipient that is a developing state falls prevention coalition will be required to be documented as an active state coalition by the end of their project period.Organize Facilitated Technical AssistanceThe primary responsibility of the awardee will be to serve as a national focal point to provide technical assistance (TA) to scale and support new and existing state falls prevention coalitions, with an emphasis on organizations in the aging network. The awardee will ensure coordination and engagement with other relevant partners and have the capacity and expertise to work with multiple partners across the network to advance collaborative approaches.Delivery of technical assistance should be interactive and engaging, tailored to each coalition to enhance the quality, effectiveness, and proven outcomes of falls prevention activities proposed by the sub-recipients. ACL envisions that the awardee will collaborate with experts, as necessary, regarding the approach to coalition development and expansion and may include connecting coalitions to learn from each other, brainstorming new opportunities, and making recommendations for ongoing sustainability of the coalition.Technical assistance will be multi-faceted, including regular one-on-one meetings with the sub-recipients, cohort convenings on a quarterly basis and working with each sub-recipient to develop a capstone product to capture best practices and lessons learned.Evaluation of ImpactThe awardee of this funding opportunity will work with ACL to finalize the design and implementation of an evaluation to assess the impact of the sub-recipients efforts on the delivery and coordination of falls prevention services. This would involve evaluation of the metrics clearly defined by the sub-recipients in their workplans. Frequency of reporting and the range of metrics collected will be finalized by ACL and the recipient following award.PartnershipApplicants should clearly describe if or how they plan to partner with other organizations to address the expectations of this funding opportunity. 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 January 4, 2024, from: www.cdc.gov/injury/wisqarsBergen G, Stevens MR, Burns ER. Falls and Fall Injuries Among Adults Aged ≥65 Years — United States, 2014. MMWR Morb Mortal Wkly Rep 2016;65:993–998. Accessed January 4, 2024, from: https://www.cdc.gov/mmwr/volumes/65/wr/mm6537a2.htm?s_cid=mm6537a2_wCen… for Disease Control and Prevention. (2016) Facts About Falls. Accessed January 4, 2024, from https://www.cdc.gov/falls/facts.htmlFlorence CS, Bergen G, Atherly A, Burns ER, Stevens JA, Drake C. Medical costs of fatal and nonfatal falls in older adults. Journal of the American Geriatrics Society, 2018 March, DOI:10.1111/jgs.15304Bergen G. Stevens MA. Kakara R. Burns EA. Understanding Modifiable and Unmodifiable Older Adult Fall Risk Factors to Create Effective Prevention Strategies. American Journal of Lifestyle Medicine. October 2019 DOI:10.1177/1559827619880529Gillespie LD, Robertson MC,Berkowitz, B., & Wolff, T. (2000). The spirit of the coalition. Washington, DC: American Public Health Association.Beattie, B, Schneider, E. Falls and Fall-Related Injuries Among Older Adults: A Practical Guide to State Coalition Building to Address a Growing Public Health Issue. Accessed January 4, 2024, at https://www.ncoa.org/article/a-practical-guide-to-state-coalition-build…, B, Schneider, E. Falls and Fall-Related Injuries Among Older Adults: A Practical Guide to State Coalition Building to Address a Growing Public Health Issue. Accessed January 4, 2024, at https://www.ncoa.org/article/a-practical-guide-to-state-coalition-build…