Preventing Falls:

How to Develop Community-based 

Fall Prevention Programs for Older Adults

2008 Injury Prevention

·
Preventing Falls:

How to Develop Community-based

Fall Prevention Programs for Older Adults

National Center for Injury Prevention and Control

Atlanta, Georgia

2008
This document is a publication of the

National Center for Injury Prevention and Control

of the Centers for Disease Control and Prevention:

Centers for Disease Control and Prevention

Julie L. Gerberding, MD, MPH, Director

Coordinating Center for Environmental Health and Injury Prevention

Henry Falk, MD, MPH, Director

National Center for Injury Prevention and Control

Ileana Arias, PhD, Director

Division of Unintentional Injury Prevention

David Wallace, MSEH, Acting Director

Home and Recreation Injury Prevention Team

Michael Ballesteros, PhD, Team Leader

Acknowledgements

We acknowledge and appreciate the contributions of National Center for Injury Prevention 

and Control staff Judy Stevens, PhD, Michael Ballesteros, PhD, Michele Huitric, MPH, 

Amanda Tarkington, MC, Jane Mitchko, MEd, CHES, and Leslie Dorigo, MA. This project 

was assisted by Macro International Inc. Carol Freeman, BA, served as the Macro project 

director, Sally York, MN, RNC, and Mary E. Miller, MA, served as writer/editors and 

Lucinda Austin served as project assistant. Cover and text design by Monika Gullett, MA. 

We thank Thom Snyder, BA, MDiv, Ilene F. Silver, MPH, and Jane Mahoney, MD 

for their thorough review and valuable suggestions.

Suggested Citation: National Center for Injury Prevention and Control. Preventing Falls: 

How to Develop Community-based Fall Prevention Programs for Older Adults. Atlanta, GA: 

Centers for Disease Control and Prevention, 2008.
Chapter 1 Introduction

Why fall prevention is important........................................................1

Understanding the risk factors for falls among older adults .................2

Effective interventions can prevent older adult falls.............................3

Purpose of this guide ......................................................................4

Chapter 2 Planning an Effective Fall Prevention Program

Key steps in developing a fall prevention program ...........................8

Who can deliver effective fall prevention program components.........10

Where to conduct fall prevention program components ...............11

Chapter 3 The Important Role of Partnerships in Fall 

Prevention Programs 

How to develop partnerships ........................................................13

How to maintain partnerships ......................................................15

Partnership web resources ..............................................................16

Chapter 4 Education: The Foundation of Effective Fall 

Prevention Programs

Provider education .......................................................................17

Public education ...........................................................................18

Education web resources ...............................................................19 

Chapter 5 The 5 Building Blocks of Effective Community-based 

Fall Prevention Programs

Building Block 1 Education programs for older adults and 

 their caregivers ..........................................................................22 

Building Block 2: Progressive exercise programs to improve 

 mobility, strength, and balance ..................................................24

Building Block 3: Medication review and management ................30

Building Block 4: Vision exams and vision improvement ..............33 

Building Block 5: Home safety assessment and 

 home modification ....................................................................36 

Contents
Chapter 6 Evaluating Your Fall Prevention Program 

Methods for conducting evaluation .............................................42 

The stages of evaluation ...............................................................47

Determining which stage to use ....................................................51

Evaluation web resources ..................................................................52

Chapter 7 Promoting Your Fall Prevention Program

Conducting a successful campaign ...............................................53

Working with the media ...............................................................57

Promotional web resources ............................................................58

Chapter 8 Sustaining Your Fall Prevention Program

Establish your vision .....................................................................59

Build collaboration .......................................................................59

Advocate for support.........................................................................59

Find funding .................................................................................60

Appendices

Appendix A: Sample Individual Falls Risk Assessment ......................62 

Appendix B: Identifying Partners Worksheet .....................................64

Appendix C: Sample Fall Prevention Brochure ..............................66 

Appendix D: Sample Fall Prevention Presentation .........................69 

Appendix E: Sample Exercises .......................................................72 

Appendix F: Sample Medication Review Form .............................75 

Appendix G: Sample Home Fall Prevention Safety Checklist .........77 

Appendix H: Sample Program Evaluation Tool .................................86 

Appendix I: Sample Pitch Letter ..................................................90 

Appendix J: Key Points ................................................................92

Appendix K: Sustainability Plan Template.........................................94
Injury Prevention 1

Your community-based organization (CBO) plays an 

important role in promoting the health and well being 

of the residents in your community. Many of the services 

provided by CBOs like yours help people of all ages 

maintain healthy lifestyles and improve their overall 

quality of life. Now, with the help of this new publication, 

Preventing Falls: How to Develop Community-based Fall 

Prevention Programs for Older Adults, your organization 

can reach out to the older members of your community 

and fulfill an increasingly important need for effective, 

community-based fall prevention programs.

Why fall prevention is important

Falls are a major threat to the health and independence of older 

adults, people aged 65 and older. Each year in the United States, 

nearly one-third of older adults experience a fall. 

Falls can be devastating. About one out of ten falls among older 

adults result in a serious injury, such as a hip fracture or head 

injury, that requires hospitalization. In addition to the physical and 

emotional pain, many people need to spend at least a year recovering 

in a long-term care facility. Some never return to their homes.

Falls can be deadly. Falls are the leading cause of injury deaths 

among older adults. The rate of fall-related deaths among older 

adults in the United States has risen significantly over the past 

decade. In 2004, falls were responsible for 14,900 deaths.

Chapter 1

 Introduction
2

Falls are costly. Fall-related injuries among older adults, especially 

among older women, are associated with substantial economic costs. 

In 2000, direct medical costs for fatal and nonfatal fall injuries totaled 

$19 billion. As the number of older adults increases dramatically over 

the next few decades, so will the economic burden of falls.

Falls are preventable. The opportunity to help reduce falls among 

older adults has never been better. Today, there are effective fall 

prevention interventions that can be used in community settings. By 

offering effective fall prevention programs in our communities, we 

can reduce falls and help older adults live better, longer lives.

Understanding the risk factors for falls among 

older adults

Falls are not an inevitable consequence of aging, but falls do occur 

more often among older adults because fall risk factors increase with 

age and are usually associated with health and aging conditions. 

These risk factors include:

Biological risk factors

•	 Mobility problems due to muscle weakness or balance 

•	

•	

•	

problems 

Chronic health conditions such as arthritis and stroke 

Vision changes and vision loss 

Loss of sensation in feet 

Behavioral risk factors

•	 Inactivity 

•	

•	

Medication side effects and/or interactions 

Alcohol use 

Environmental risk factors

•	 Home and environmental hazards (clutter, poor lighting, etc.)

•	

•	

Incorrect size, type, or use of assistive devices (walkers, canes, 

crutches, etc.) 

Poorly designed public spaces
3

Chapter 1

Usually two or more risk factors interact to cause a fall (such as poor 

balance and low vision, which can cause a trip and fall going up a 

single step). Home or environmental risk factors play a role in about 

half of all falls. 

Understanding these risk factors is the first step to reducing older 

adult falls. Over the past two decades, researchers around the world 

have used descriptive studies to identify risk factors and randomized 

controlled trials to test fall interventions. The results of these 

studies show that reducing fall risk factors significantly reduces 

falls among community-dwelling older adults—those people living 

independently in the community.

Many older adults, as well as their family members and caregivers, 

are unaware of factors or behaviors that put them at risk of falling, 

and are also unaware of what actions they can take to reduce their 

risk. Fall risk factor assessment is rarely a part of an older adult’s 

routine health care, even if they have had a fall or fall injury. All 

older adults should be encouraged to seek an individual fall risk 

assessment from their healthcare provider, especially older adults 

with a history of falls and/or with mobility or balance impairments 

who are at highest risk for falls. 

A self-administered risk assessment form for older adults can be 

useful when the results are discussed with a healthcare provider who 

can help modify or manage identified risk factors. 

Appendix A shows an example of a fall risk assessment developed by 

the Washington State Department of Health’s Injury and Violence 

Prevention Program for individuals to use when discussing fall 

prevention with a healthcare professional.

Effective interventions can prevent older adult falls

Effective fall interventions reduce fall risk factors through either 

exercise alone or by combining exercise with other risk reduction 

approaches such as medication review and management, vision 

screening and correction, education, and safer living environments.

The Centers for Disease Control and Prevention (CDC) has 

reviewed and identified community-based fall prevention 

interventions that have strong scientific evidence of effectiveness. 
4

Introduction

These interventions have been summarized and compiled in 

Preventing Falls: What Works. A CDC Compendium of Effective 

Community-based Interventions from Around the World, the 

companion publication to this document.

CDC would like to help CBOs move these proven fall 

interventions into communities to protect the health and 

independence of older adults. 

Purpose of this guide

CDC developed this guide for communities and CBOs, so they 

can begin developing effective fall prevention programs. The main 

purpose of this guide is to:

• Define the key elements of what makes fall prevention 

•

programs effective

Provide information to communities and CBOs on how to 

develop effective older adult fall prevention programs

This guide is intended to be used by CBO decisionmakers, program 

managers, and partners in organizations that serve independent 

living, community-dwelling older adults, such as: 

•	 Public health departments

•	

•	

•	

•	

•	

•	

•	

•	

Healthcare organizations that provide individual health 

care, individual or group community programs, and 

home-based services

Hospital outpatient and community programs

Senior and community centers

Parks and recreation programs

Emergency medical services 

Faith-based and parish nurse services and programs

Home-based services (e.g., home health, meal-delivery 

services, chore services)

Area Agencies on Aging
5

Chapter 1

•	

•	

•	

Independent/retirement living, residential, and senior housing 

facilities/settings for older adults who live independently

 Nonprofit organizations that provide direct services to 

older adults

 Universities/community colleges that offer or work with 

community programs for community-dwelling older adults

Note: The interventions and programs in this guide are not designed for 

hospital inpatients, assisted living residents, Alzheimer’s care programs 

and facilities, or nursing home residents, all of whom require programs 

and interventions that are specifically designed for their increased frailty 

and fall risk. 
6

Introduction

Notes:
Injury Prevention 7

When planning your fall prevention program, remember that the 

most effective programs address many of the risk factors described 

in Chapter 1. An effective fall prevention program should be offered 

by trained healthcare professionals and include education about 

falls and fall risk factors. (See the chart on page 10 for a list of 

professionals.) The main components that should be part of your fall 

prevention program include the following:

Education about older adult fall risk factors and prevention 

strategies for older adults, families, and caregivers. Information

can be communicated on an individual, one-on-one basis, or 

in a group setting.

Exercise that can be offered through group classes or 

individually. Exercise programs can be offered in a 

community setting, at home with supervision, or in a 

program that combines group classes or one-on-one training 

with home-based exercise. Appropriate types of exercises that 

effectively reduce falls in older adults include:

•	 Tai Chi

•	

•	

Strengthening exercises combined with balance training

Balance exercises

Medication review by a pharmacist or healthcare professional, 

with medication adjusted or modified by a physician or 

nurse practitioner. 

Vision assessment and vision correction by an optometrist 

or ophthalmologist.

Home safety assessment including home modifications 

as needed.

Chapter 2

 Planning an Effective

Fall Prevention Program
8

These building blocks of an effective fall prevention program are 

discussed in more detail in Chapter 5, but keep them in mind 

during the planning process for your program.

Key steps in developing a fall prevention program

Follow this nine-step process in planning your fall prevention program.

Step 1. Assess your community’s needs. 

Before deciding what type of fall prevention program to develop, 

use the following checklist to assess your community’s needs and 

identify appropriate resources:

What are the fall prevention program needs in your 

community? 

What related programs or services are currently being offered 

by other organizations? 

What are your organization’s current and future goals and 

resources for providing services to independent older adults 

in your community?

How much support for starting a fall prevention program is 

there at all levels of your organization—from the board and 

director, to the staff, volunteers, and older adult clients?

What community resources exist that could provide services 

to address older adult fall risk factors?

What community resources and organizations are 

potential partners?

Step 2. Establish your program’s purpose, goals, and objectives.

Develop a purpose statement and determine the goals and objectives 

of your program. Ask questions such as, “Why are we developing 

this program?” and “What do we hope to accomplish both short 

term and long term?” Your purpose and goals should be specific, 

realistic, and clearly stated. Goals should be quantitative with 

objectives that can be easily measured. Think of the goal as a 

destination and the objectives as methods of getting you to your 

goal. With a clear set of objectives, you can easily measure the 

success of your program during the evaluation phase. With a solid 

purpose, concrete goals, and action-oriented objectives, you can 

build an effective fall prevention program for older adults.
Chapter 2

Step 3. Determine what risk factors your program will address.

There are two types of effective fall prevention programs: single 

intervention and multifaceted intervention programs:





Single intervention programs

Exercise is the only intervention that by itself reduces falls 

among older adults. Many organizations have developed 

group and/or individualized exercise programs for older 

adults that improve strength and balance. You can develop 

an exercise program by using the information in this guide 

and working with trained professionals in your community. 

See Chapter 5 on page 21 for examples of effective exercise 

programs and related resources.

Multifaceted intervention programs

 A multifaceted intervention combines exercise with other 

intervention components to reduce fall risk factors. Such a 

program might include exercise, vision assessment, and 

fall prevention education. To create the most effective fall 

prevention program, begin with exercise and incorporate at 

least one other intervention component. 

Step 4. Collaborate with partners to address additional risk 

factors. Partnering with other organizations can help you develop 

a more comprehensive and effective fall prevention program. 

Chapter 3 will provide more detail on how to identify and work 

with fall prevention partners.

Step 5. Decide who will implement the various program 

components. The following chart shows which healthcare providers 

and other professionals can deliver each type of intervention.

9
Planning An Effective Fall Prevention Program

10

Who Can Deliver Fall Prevention Program Components?

Program componentsPhysicianOptometristNurse Practitioner/PAPharmacistRegistered NursePhysical TherapistOccupational TherapistSocial WorkerCertified Exercise InstructorExercise Sci/Phys Ed DegreeTai Chi Instructor

Education

Group     * * * *

Individual      * * * *

Assessment

Gait * * 

Balance; simple * * *  * * * *

Balance; in-depth * * *  * 

Strength * * *  * * * *

Exercise

1:1 balance alone   * * *

1:1 strength with balance training    *

Group class *   * 

Individualized exercise/PT      

Tai Chi * * 

Medication

Medication review   *

Medication management 

Vision

Basic assessment   * *

Detailed assessment 

Vision correction  

Home Safety

Assessment * * *  *

Basic modification**    *

Skilled modification** 

Other

Assistive device training  

* Additional specialized education and training required

** Basic modification includes clutter/throw rug removal, rearrange furniture; skilled modification includes grab bars, ramps, electrical work.

 Note: Partnerships may facilitate delivering multifaceted programs in community settings.
11

Chapter 2

Program componentsHomePhysician OfficeHospital/Clinic (outpatient)PT FacilityPharmacySenior/Community/Rec CenterGym/Fitness Center/ Rec CenterSenior Housing Facility

Education

Group    

Individual        

Assessment

Gait       

Balance; simple       

Balance; in-depth       

Strength       

Exercise

1:1 balance alone      

1:1 strength with balance training      

Group class   

Individualized exercise/PT      

Tai Chi   

Medication

Medication review       

Medication management   

Vision

Basic assessment     

Detailed assessment  

Vision correction  

Home Safety

Assessment  

Basic modification**  

Skilled modification**  

Other

Assistive device training       

** Basic modification includes clutter/throw rug removal, rearrange furniture; skilled modification includes grab bars, ramps, 

electrical work.

 Note: Partnerships may facilitate delivering multifaceted programs in community settings.

Where to Conduct Fall Prevention Program Components

Step 6. Find a location to conduct the program. When 

considering what type of program to develop, consider the types of 

places where a program can be held. The following chart provides 

suggestions for each type of fall prevention component.
Planning An Effective Fall Prevention Program

12

Step 7. Evaluate your program. Evaluation helps determine 

whether a program is appropriate and effective. The results of the 

evaluation will guide you in maintaining or modifying any aspects 

of the program and tell you if the program is worth continuing. 

Chapter 6 will help you develop evaluation strategies to document 

your program’s effectiveness.

Step 8. Promote your program. Making the community aware of 

your fall prevention program is crucial to its success. No matter the 

size of your outreach effort, Chapter 7 will help you in developing 

a campaign to publicize your program and provide you with tips on 

working with your local media. 

Step 9. Sustain your program. To sustain your program, you will 

need to review and make modifications. This means keeping sight 

of your goals and maintaining momentum in building 

collaborations, advocating for support, and seeking new sources of 

funding. Chapter 8 will help guide you through this process.
Injury Prevention 13

Chapter 3

 The Important Role of 

Partnerships in Fall 

Prevention Programs

Because falls are the result of multiple fall risk factors, it may 

be difficult for your organization, on its own, to develop a 

comprehensive program. By collaborating with other community 

organizations and professionals that specialize in different types 

of services for older adults, such as healthcare, exercise, home 

safety assessment, and education, you can make your program 

more comprehensive and effective. For example, a public health 

or healthcare organization may partner with a senior services or 

parks and recreation organization to create a program that includes 

exercise and fall prevention education.

Collaborating with other CBOs can provide additional resources, 

outreach channels, or referral sources for your program. Because 

of its many benefits, collaboration can be essential in developing 

your program.

How to develop partnerships

 Assess your current situation. Planning your prevention 

program involves a careful analysis of your organizational 

resources and needs, including staff, funding, facilities, 

technology, and expertise. This information clarifies when a 

potential partnership with another organization can support 

your program goals. 

 Identify potential partners. Partnerships should be 

mutually beneficial. Identify organizations that share your 

mission of improving health and safety for older adults or 

that have a vested interest in reducing falls among older 

adults. Determine how a collaboration will mutually support 

short- and long-term goals.
14

 Develop your “pitch” for partnership. After strategically 

selecting potential partners, develop your “pitch,” or selling 

points, for partnership. This will vary based on the resources, 

needs, and priorities of each organization. Showcase the 

benefits for your potential partners.

 Create your messages and materials. Develop message 

points—short, concise statements that reflect your main 

messages. These are useful for internal and external 

communications, as well as for presentations to partners. 

For these messages:

•	 D evelop themes or adapt materials that will engage your 

potential partners.

•	 Produce materials (computer-generated presentations, 

flyers, etc.) that will effectively convey your messages.

•	 Pretest your materials among potential partners. 

•	 Develop a method for tracking partnerships and other 

outreach efforts. 

 Make contact. Whenever possible, deliver your partnership 

proposal in person. Consider bringing at least one other 

person, because different communication styles and 

demeanors can influence an encounter. Sharing the workload 

and presentation delivery reduces the pressure of thinking on 

your feet. However, make sure that your team speaks with 

one voice, based on the messages you develop. Delivering 

mixed messages creates confusion and weakens your credibility. 

 Seal the deal. Being credible and offering incentives are 

important, but these may not be enough to seal the deal. Use 

your passion to make potential partners believe they should 

be involved. 

•	 Describe how your programs and services can make a 

difference. 

•	 Share information about the burden of falls and fall injuries.

•	 Underscore how your community will benefit from your 

efforts and how others are getting involved. 
15

Chapter 3

•	 R emind potential partners of their strengths and how 

even seemingly small contributions can help prevent 

injury and death. 

•	 Confirm how the proposed partnership is mutually 

beneficial. 

•	 Be specific about what you are asking them to contribute 

and do.

How to maintain partnerships

Relationships need to be maintained. While commitment is 

important, so is continuing to review your resources, needs, and 

expectations as the program evolves. Involving local organizations 

will be an ongoing effort, so remember to engage as many facets of 

your community as you can, including:

•	 Hospitals and healthcare centers 

•	 Local and state government officials and offices 

•	 Faith-based organizations 

•	 Civic organizations

•	 Senior citizen groups

•	 Commercial establishments serving older adults

•	 Clubs that may have a large older-adult membership (such as 

the Veterans of Foreign Wars)

•	 Universities or colleges that offer academic programs or 

services for older adults

Never forget the power of the phrase “thank you.” Acknowledge 

partnership agreements promptly. Look for creative ways to convey 

your gratitude to partners often and thank them publicly. See 

Appendix B for an inventory form that can be useful for identifying 

community resources and potential program partners. 
The Important Role of Partnerships in Fall Prevention Programs

16

Partnership web resources

The National Council on Aging’s Partnering to Promote 

 Healthy Aging: Creative Best Practice Community 

 Partnerships

www.healthyagingprograms.org/content.asp?sectionid= 

92&ElementID=160

Falls Free: A National Falls Prevention Action Plan

www.healthyagingprograms.org/content.asp?sectionid=98

California Blueprint For Falls Prevention

www.archstone.org/publications2292/publications_show.htm?doc_

id=246660

Queensland, Australia Statewide Action Plan: Falls Prevention 

 in Older People 2002-2006

www.health.qld.gov.au/phs/Documents/shpu/13693.pdf 

WA State Dept. of Health Report - Falls Among Older Adults: 

 Strategies for Prevention

www.doh.wa.gov/hsqa/emstrauma/injury/pubs/

FallsAmongOlderAdults.pdf

Health care & public health partnerships

repositories.cdlib.org/cgi/viewcontent.cgi?article=1003&context=iha

Community Toolbox for Public Health Partnerships

ctb.ku.edu/WST/initiatives_show.jsp?initiative_id=44

Partnership self-assessment tool 

www.cacsh.org/psat.html
Injury Prevention 17

Increasing awareness about fall risk factors and ways to reduce fall 

risk is crucial in helping older adults, their families, caregivers, and 

service providers to effectively prevent falls.

There are two types of audiences for fall prevention education: the 

professionals who will implement the fall prevention program and 

older adults and their caregivers.

People in your community who are qualified to provide public and 

professional fall prevention education sessions include:

•	 Healthcare professionals 

•	 Public health professionals

•	 Senior service providers

•	 Emergency medical service professionals

Provider education

Provider education is necessary to inform healthcare and 

senior service providers about the current state of knowledge in fall 

prevention for older adults. Key aspects of professional 

education include:

•	 National, state, and county data on fatal and nonfatal 

fall injuries and healthcare costs. National and some state 

data are available from CDC’s National Center for Injury 

Prevention and Control. Additional state and county data 

may be available from health departments, local emergency 

services, and fire departments. Data on cost of falls may be 

available from local hospitals.

Chapter 4

 Education: The Foundation 

of Effective Fall 

Prevention Programs
18

 Information about fall risk factors among older adults (see •	

•	

•	

Public education

Public education includes communicating the 

importance of fall prevention to the general 

public and directly informing older adults how to 

maintain a healthy lifestyle that reduces the risk 

of falls. When promoting your fall prevention 

program, you will also be creating awareness 

for the necessity of fall prevention in your 

community. You can find more information in 

Chapter 7 about promoting fall prevention and 

your fall prevention program. 

Educating older adults about individual risks and 

methods of prevention is an important building 

block of every fall prevention program. More 

information on educating older adults about 

the risk of falls and fall prevention activities will 

follow in the next chapter. 

Fall Intervention Studies that Include Education

Stay Active, Stay Safe (Barnett, et al.)

The Otago Exercise Program (Campbell, et al., Robertson, et al.)

Tai Chi: Moving for Better Balance (Li, et al.)

Australian Group Exercise Program (Lord, et al.)

Simplified Tai Chi (Wolf, et al.)

Home Visits by an Occupational Therapist (Cumming, et al.)

Falls-HIT (Home Intervention Team) Program (Nikolaus, et al.)

Stepping On (Clemson, et al.)

PROFET (Prevention of Falls in the Elderly Trial) (Close, et al.)

The NoFalls Intervention (Day, et al.)

The SAFE Health Behavior and Exercise Intervention 

 (Hornbrook, et al.)

Yale FICSIT (Frailty and Injuries: Cooperative Studies of 

 Intervention Techniques) (Tinetti, et al.)

A Multifactorial Program (Wagner, et al.) 

For more details, refer to the companion publication, 

Preventing Falls: What Works. A CDC Compendium of 

Effective Community-based Interventions from Around 

the World
19

Chapter 4

Education web resources

CDC’s “What You Can Do To Prevent Falls” and 

 “Home Safety Checklist” brochures for older adults

www.cdc.gov/ncipc/duip/fallsmaterials.htm 

CDC Falls Prevention page 

www.cdc.gov/ncipc/duip/preventadultfalls.htm

Center of Excellence for Fall Prevention 

www.stopfalls.org 

National Institute on Aging, AgePage: Preventing 

 Falls and Fractures 

www.niapublications.org/agepages/PDFs/preventing_Falls_and_

Fractures.pdf 

The American Geriatrics Society Guideline for the Prevention of 

 Falls in Older Persons

www.americangeriatrics.org/products/positionpapers/abstract.shtml

Center for Healthy Aging Falls Free Electronic News 

www.healthyagingprograms.org

California Blueprint for Falls Prevention 

www.archstone.org/publications2292/publications_show.htm?doc_

id=246660

National Safety Council 

www.nsc.org/issues/fallstop.htm

“Getting Up From a Fall” handout from the American Academy 

 of Orthopaedic Surgeons 

orthoinfo.aaos.org/topic.cfm?topic=A00098
20

Notes:

Education: The Foundation of Effective Fall Prevention Programs
Injury Prevention 21

The most effective fall prevention programs address many of the risk 

factors described in Chapter 1. Based on your resources, you can 

start your program using one building block and then expand its 

effectiveness by adding more blocks over time. 

The five main building blocks of an effective community-based fall 

prevention program are:

Education about falls and fall risk factors.

Exercises that improve mobility, strength, and balance, 

and that are taught by trained, nationally certified exercise 

instructors or physical therapists. Exercise programs include:

Tai Chi

Individualized exercise sessions 

Group exercise classes

 Home exercise programs with supervision until the older 

adult can exercise independently

Medication review to identify side effects or drug 

interactions that may contribute to falls. The reviews should 

be conducted by pharmacists or healthcare providers. 

Medication management—adjustments to or changes in 

medications—should be provided by physicians. 

Vision exams by trained healthcare professionals with vision 

correction by an optometrist or ophthalmologist.

Home safety assessment and home modification by 

occupational therapists or other healthcare professionals with 

specialized training, to identify and modify home hazards 

that can increase older adults’ risk of falling. 

•	

•	

•	

•	

Chapter 5

 The 5 Building Blocks of 

Effective Community-based 

Fall Prevention Programs
22

Building Block 1: Education programs for older 

adults and their caregivers

When developing a fall prevention program, it is important to 

include an educational component. While education alone has not 

proven to effectively reduce falls among older adults, it is typically 

combined with one of the other building blocks. Education for 

older adults and their caregivers can be delivered to individuals or 

to groups. Individual education sessions may work better for people 

who are hearing or vision impaired or have special needs. Sessions 

should be tailored to the attention span and cognitive ability of 

older adults. Visual aids such as brochures, fact sheets, and checklists 

will help facilitate the education session.

Group sessions provide the benefits of social interactions. Informal 

group discussions that include sharing personal experiences may 

reduce anxiety and increase motivation to adopt new behaviors. 

Group teaching saves time and helps spread the information more 

quickly to more people. 

Tips for developing an effective education component

 Education should be delivered by trained professionals.

 Education should include problem solving and goal setting 

on the part of the learner.

 The length of the education session should depend on 

the individual characteristics of the older adult, such as 

concentration, hearing or visual impairment, etc.

 Group vs. individual education may be determined based on 

which other bulding block is being offered in combination.

 Visual aids are valuable tools in increasing comprehension.

 Materials should be designed with a high contrast 

background and large lettering.

 Materials should reflect literacy levels and be culturally 

appropriate.

 Presentations and materials should not contain abbreviations 

and jargon.

 Education is most effective when offered on an ongoing basis.
23

Chapter 5

There is a wealth of educational materials available on the Internet. 

You can find visual aids, including posters, videos and presentations, 

brochures, and checklists, or you can develop your own materials. 

See Appendices C and D for an example of a brochure and a 

presentation. A set of fall prevention posters is also available through 

the CDC website listed below. Use the following websites for 

additional education materials. 

Education web resources

CDC’s “What You Can Do To Prevent Falls” and 

 “Home Safety Checklist” brochures for older adults

www.cdc.gov/ncipc/pub-res/toolkit/brochures.htm 

CDC Falls Prevention page 

www.cdc.gov/ncipc/duip/preventadultfalls.htm

Center of Excellence for Fall Prevention 

www.stopfalls.org 

National Institute on Aging, AgePage: Preventing 

 Falls and Fractures 

www.niapublications.org/agepages/PDFs/preventing_Falls_and_

Fractures.pdf 

The American Geriatrics Society Guideline for the Prevention of 

 Falls in Older Persons

www.americangeriatrics.org/products/positionpapers/abstract.shtml

Center for Healthy Aging Falls Free Electronic News 

www.healthyagingprograms.org

California Blueprint for Falls Prevention 

www.archstone.org/publications2292/publications_show.htm?doc_

id=246660

American Academy of Orthopaedic Surgeons

orthoinfo.aaos.org/menus/safety.cfm

National Safety Council 

www.nsc.org/issues/fallstop.htm
The 5 Building Blocks of Effective Community-Based Fall Prevention Programs

24

Building Block 2: Progressive exercise programs to 

improve mobility, strength, and balance

Among older adults, strength and balance exercises, such as Tai Chi, 

can reduce falls by improving mobility, strength, and balance. These 

programs focus on exercises that are specifically designed or adapted 

for older adults.

Tips for developing an effective exercise component

 T o be safe and effective, older adult exercise 

programs (one-on-one or group classes) must 

be taught by one or more of the following 

professionals: 

•	 N ationally certified fitness/exercise 

instructors with specialized training in 

working with older adults. Because exercise 

instructors are not licensed, having a 

national certification or accreditation is the 

minimum qualification requirement for 

teaching fall prevention exercise programs 

to older adults.

•	 Exercise science/physiology professionals 

with a bachelor’s degree or master’s degree 

in this field.

•	 Physical therapists.

•	 Occupational therapists.

•	 R ecreational therapists with a bachelor’s 

or master’s degree.

•	 Tai Chi instructors, masters or grand 

masters, who have completed a Tai Chi 

course taught by a Tai Chi master or grand 

master, have a national certification in older

adult physical activity, and have experience 

in teaching exercise to older adults.

•	 P hysical, occupational, and recreational 

therapy assistants who are under the direct 

supervision of a physical, occupational, or 

recreational therapist.

Fall Intervention Studies that Include Exercise

Stay Active, Stay Safe (Barnett, et al.)

The Otago Exercise Program (Campbell, et al., Robertson, et al.)

Tai Chi: Moving for Better Balance (Li, et al.)

Australian Group Exercise Program (Lord, et al.)

Veterans Affair Group Exercise Program (Rubinstein, et al.)

Simplified Tai Chi (Wolf, et al.)

Home Visits by an Occupational Therapist (Cumming, et al.)

Falls-HIT (Home Intervention Team) Program (Nikolaus, et al.)

Stepping On (Clemson, et al.)

The NoFalls Intervention (Day, et al.)

The SAFE Health Behavior and Exercise Intervention 

 (Hornbrook, et al.)

Yale FICSIT (Frailty and Injuries: Cooperative Studies of 

 Intervention Techniques) (Tinetti, et al.)

A Multifactorial Program (Wagner, et al.) 

For more details, refer to the companion publication, 

Preventing Falls: What Works. A CDC Compendium of 

Effective Community-based Interventions from Around 

the World
25

Chapter 5

PROGRAMS IN ACTION

Stay Active and Independent for Life (SAIL): 

A strength and balance fitness class for adults 65+

The SAIL program combines health information with exercises specifically designed 

to safely and easily improve endurance, strength, and balance in adults aged 65 

and older. The program was researched and developed as a community-based fall 

prevention program by the Washington State Department of Health. 

The SAIL program helps older adults to stay active and independent. It helps to 

prevent falls, through group exercise classes that meet for 1 hour, three times a 

week. The classes are held at community sites, such as senior centers, parks and 

recreation facilities, and community fitness centers that often work in partnership 

with community healthcare and senior service organizations to offer the program. 

Classes are led by certified fitness instructors who have attended the 2-day SAIL 

Instructor Training Program, which was designed by physical therapists and a 

registered nurse. 

The program name and its key messages were developed through older adult focus 

groups to emphasize a specific description of the program and its positive benefits: 

• “It works...you’ll be stronger, have better balance, feel better, and this will help 

you stay independent, active, and prevent falls.”

• “It’s safe...the instructors are experienced and skilled, and exercises have been 

tested with seniors.”

• “It’s fun...you’ll meet other seniors and make new friends.” 

The SAIL class exercises are designed to be done either sitting or standing, and 

at individually adjustable paces. The class includes aerobic and balance exercises, 

strength training with wrist and ankle weights, and flexibility exercises. The 

class participants also receive brief “Fitness Checks” when they start the classes 

for measuring progress and improvement after they start the classes. These 

measurements of walking speed and arm and leg strength, are repeated every 

3 to 6 months throughout the year, enabling class participants to monitor their 

individual progress. In addition to the exercises, health information is included 

in the classes, which addresses topics such as exercising safely, medication and 

home safety, and footwear and foot care. The education information is provided 

in a booklet published by the Washington State Department of Health: “Stay 

Active and Independent for Life: An Information Guide for Adults 65+.” All class 

participants receive a free copy of the booklet. 

For more information contact:

www.cdc.gov/ncipc/profiles/core_state/wa/default.htm or

www.doh.wa.gov/hsqa/emstrauma/injury/pubs/default.htm#seniorfalls
The 5 Building Blocks of Effective Community-Based Fall Prevention Programs

26

















All professionals who teach exercise to older adults must have 

a current CPR/AED certification. 

To be effective in reducing falls, exercises must be performed 

at least twice weekly on an ongoing basis and progress in 

difficulty throughout the program. 

Ideally, the exercise classes should be offered on an ongoing 

basis for long-term attendance. Short-term programs that have 

a set number of sessions should provide written instructions so 

participants can continue to do the exercises at home. 

Participants should be taught the exercises under the direct 

supervision of a trained exercise instructor or physical or 

occupational therapist, either in one-on-one home sessions or in 

group sessions, before performing them independently at home.

Evaluate how the program instructor delivers the exercise 

program. Use process evaluation methods to ensure that the 

exercises are being taught properly and consistently. Also, 

obtain feedback from the program participants.

Base program content on current published materials 

specifically developed for older adults by exercise science, 

physical therapy, or Tai Chi professionals.

Assess older adults’ strength, balance, and fitness at the 

beginning and end of each new exercise program.

Limit the number of participants in group classes to no more 

than 15 to allow the instructor the ability to closely observe 

and supervise participants during the class session. 

The National Council on Aging’s Center for Healthy 

Aging has developed a detailed checklist for fall prevention 

programs in Evidence-based Healthy Aging Programming: 

Tools and Checklists at healthyagingprograms.org/content.

asp?sectionid=32&ElementID=439

Appendix E provides examples of strengthening and balance 

exercises from the Stay Safe Stay Active Daily Exercise Program. 

Additional exercise examples can be found in the Preventing Falls: 

What Works. A CDC Compendium of Effective Community-based 

Interventions from Around the World. 
27

Chapter 5

Exercise program web resources

CDC Physical Activity Resources

www.cdc.gov/nccdphp/dnpa/physical

National Council on Aging: Center for Healthy Aging, 2005. 

 Evidence-based Healthy Aging Programming: Tools 

 and Checklists

www.healthyagingprograms.org

International Curriculum Guidelines for Preparing Physical 

 Activity Instructors of Older Adults

www.seniorfitness.net/international_curriculum_guidelines_for_

preparing_physical_activity_instructors_of_older_adults.htm

Growing Stronger: Strength Training for Older Adults—a web 

 based strength training exercise program

www.cdc.gov/nccdphp/dnpa/physical/growing_stronger

National Institutes of Health: NIH Publication No. 01-4256, 2001 

 Exercise: A Guide from the National Institute on Aging

www.nia.nih.gov/HealthInformation/Publications/ExerciseGuide

National Council on Aging: Center for Healthy Aging, 

 Issue Brief #2, Winter 2004 Designing Safe and Effective 

 Physical Activity Programs

www.healthyagingprograms.com/resources/IssueBrief_

PhysicalActivity.pdf

National Council on Aging: Center for Healthy Aging, 

 Issue Brief #4, Fall 2005 Keeping Current on Research and 

 Practice in Physical Activity for Older Adults

www.healthyagingprograms.com/resources/IssueBrief_

KeepCurrentPA.pdf

National Council on Aging: Center for Healthy Aging, Moving 

 Ahead: Strategies and Tools to Plan, Conduct and Maintain 

 Effective Community-based Physical Activity Programs for 

 Older Adults

www.healthyagingprograms.com/resources/PRC-HAN_conference_

monograph.pdf
The 5 Building Blocks of Effective Community-Based Fall Prevention Programs

28

American College of Sports Medicine’s Physical Activity 

 Guidelines for adults over age 65

www.acsm.org/AM/Template.cfm?Section=Home_Page& 

TEMPLATE=/CM/HTMLDisplay.cfm&CONTENTID= 

7764#Over_65_or_50_64

Human Kinetics’ Senior Fitness Test Manual and Software: 

 manual and software for testing and tracking functional 

 fitness measures in older adults

www.humankinetics.com/products/showproduct.cfm?isbn= 

9780736033589

American Council on Exercise and AARP Fitness Resources

www.aarpfitness.com

Exercise and Older Adults

nihseniorhealth.gov/exercise/toc.html

References

Berg K. Balance and its measure in the elderly: A review. 

 Physiother, Canada. 1989:41;240-246.

Chang JT, Morton SC, Rubenstein LZ, et al. Interventions for 

 the prevention of falls in older adults: Systematic review and 

 meta-analysis of randomized clinical trials. Br Med Journal. 

 2004:328;680-683.

Cotton, RT. Exercise for older adults: American Council on 

 Exercise’s guide for fitness professionals. Human Kinetics: 

 Champaign, IL;1998.

Dunkin, A. All you need to know about back pain.

 Arthritis Foundation: Atlanta, GA;2002.

Gillespie LD, Gillespie WJ, Robertson MC, Lamb SE, Cumming 

 RG, Rowe BH. Interventions for preventing falls in elderly 

 people. Cochrane Database Syst Rev. 2003:4;CD000340.

Herdman, S. Vestibular Rehabilitation. F.A. Davis Company: 

 Philadelphia, PA;2000.
29

Chapter 5

Haas EN ed; Handbook of Injury and Violence Prevention 

 Atlanta GA, Springer 2007 Author of chapter. Chapter 3: 

Interventions to prevent falls among older adults. In: Haas, 

EN, ed. Handbook of Injury and Violence Prevention. 

Atlanta, GA:Springer;2007.

Nelson M, et al. Physical activity and public health in older 

 adults: Recommendations from the American College of Sports 

Medicine and the American Heart Association. Am J Sports Med.

2007:39(8);1435-1445.

Nelson, ME. Strong women stay young. Bantam Books: 

 New York, NY;2000.

Podsaidlo D, Richardson S. The timed up and go: A test of 

 basic functional mobility for frail elderly persons. Journal of the 

 Am Geriatr Soc. 1991:39;142-148.

Rikli RE, Jones CJ. Senior fitness test manual human kinetics: 

 Champaign, IL;2001.

Rose, D. Fall Proof: A comprehensive balance and mobility 

 training program human kinetics: Champaign, IL;2003.

Shumway-Cook A, Brauer S, Woollacott M. Predicting the 

 probability of falls in community-dwelling older adults using the 

“Timed Up and Go Test.” Phys Ther. 2000:80;896-903.

Tinetti ME. Performance-oriented assessment of mobility problems 

 in elderly patients. J Am Geriatr Soc. 1986:34;119-126.
The 5 Building Blocks of Effective Community-Based Fall Prevention Programs

30

Building Block 3: Medication review and 

management

The purpose of medication review and management is to identify 

and eliminate medication side effects and interactions, such as 

dizziness or drowsiness, that can increase the risk of falls.

Many older adults are unaware that their daily medications may 

increase their fall risk. Aging affects the absorption, distribution, 

metabolism, and elimination of medications. Age can also 

increase sensitivity to potential side effects. Older adults may get 

prescriptions from multiple doctors. Fall risk increases with the total 

number of prescription and over-the-counter medications.

Psychoactive medications (drugs that alter brain function) increase 

fall risk. These include antidepressants, tranquilizers, antipsychotics, 

antianxiety drugs, and sleep medications. Other medications 

that may cause problems include those prescribed to treat seizure 

disorders, blood pressure-lowering medications, cholesterol-lowering 

medications, heart medications, and painkillers. A medication review 

checklist is included in Appendix F.

Drug side effects that can contribute to falling include blurred 

vision, hypotension leading to dizziness and lightheadedness, 

sedation, decreased alertness, confusion and impaired judgment, 

delirium, compromised neuromuscular function, and anxiety. 

Review and modification of the medication regimen by a healthcare 

provider can frequently reverse or minimize these effects.

Clinical practice recommendations include medication reviews by 

healthcare providers for older adults who have fallen. 

Fall Intervention Studies 

that Include Medication 

Review and Management

PROFET (Prevention of Falls in the 

 Elderly Trial) (Close, et al.)

Yale FICSIT (Frailty and Injuries: 

 Cooperative Studies of Intervention 

 Techniques) (Tinetti, et al.)

A Multifactorial Program (Wagner, et al.)

For more details, refer to 

the companion publication, 

Preventing Falls: What Works. A 

CDC Compendium of Effective 

Community-based Interventions 

from Around the World
31

Chapter 5

PROGRAMS IN ACTION

California Department of Aging’s Medication Management Program

The Medication Management Program is an evidence-based, federally funded 

program under Title IIID of the Older Americans Act. Funds are distributed to 

California Area Agencies on Aging to provide a wide variety of community-based 

services and information at multipurpose senior centers, at congregate meal sites, 

through home delivered meal programs and at other appropriate sites.

The purpose of the Medication Management Program is to improve the quality 

of life for older adults and prevent premature institutionalization by working 

with them to manage their use of over the counter and prescription medications, 

vitamin, mineral, and herbal supplements.

The target population for this program included individuals aged 60 years and 

over who live in an area of greatest economic need, who live in a medically 

underserved area of the region, or who have a chronic medical conditions that can 

improve with education and non-medical intervention. 

The following are examples of the community-based activities and partnerships in 

this program:

• Pharmacists’ or pharmacy students’ presentations on how older adults can manage 

their medications, drug-nutrient interactions, and supplements. The presentation may 

include a personalized medication review to identify expired medications, answer 

client questions, and counsel older adults to assure they understand, are following 

directions, and taking medications properly. The pharmacists also encourage older 

adults to communicate with their doctors so they will be better informed about what 

medicines are being prescribed, why, and what results and/or side effects to expect.

• Partnerships with community-based organizations to provide “Rx Check Up” clinics. 

• Distribution of passport size books for older adults to keep records of health 

and medications. Older adults can take the books with them to share with their 

doctors and pharmacist.

• Distribution of brochures related to medication management.

• Distribution of pill minders in various languages to help older adults manage 

their prescriptions.

• Information provided at Senior Health Fairs, through an Info Van, and through 

the Information and Assistance Program.

• Automated medication dispensers for frail and/or blind clients in their home. 

For more information, visit www.aging.ca.gov/html/programs/medication_

management.html
The 5 Building Blocks of Effective Community-Based Fall Prevention Programs

32

Tips for developing an effective medication review and 

management component

 Medication reviews are recommended for older people taking 

four or more medications and those taking any psychoactive 

medications.

 Medication reviews can be done in screening clinics, 

hospital programs, home visits by home health professionals, 

pharmacies, and doctors’ offices.

 Medication reviews can be done by a pharmacist or a 

healthcare provider. Coordinated medication management 

that involves changing or reducing types or dosages of 

medications, should be done by the older adult’s 

healthcare provider.

 Medication review and management may include assessing 

the need for vitamin D and calcium supplements as well as 

osteoporosis treatment. 

 The amount and frequency of alcohol use should be included 

in a medication review.

Medication review and management 

web resources 

National Institutes of Health Senior Health 

nihseniorhealth.gov/takingmedicines/toc.html

American Geriatrics Society Clinical Guidelines for Prevention 

 of Falls in Older Persons

www.americangeriatrics.org/products/positionpapers/Falls.pdf

Medications and falls in the elderly

www.pharmacists.ca/content/cpjpdfs/julaug04/July-AugustFocusonPatientCareRevised.pdf

“10 questions to ask your doctor or pharmacist about 

 your medications”

www.a4aa.com/Ten_Questions_to_Ask_Your_Doctor_or_

Pharmacist_Outreach__2_.pdf
33

Chapter 5

Building Block 4: Vision exams and vision 

improvement 

Vision changes and vision loss associated with aging are common 

fall risk factors among older adults. Vision loss can contribute 

to falls by disturbing balance and by obscuring tripping and 

slipping hazards. 

Many vision conditions, such as cataracts, glaucoma, and macular 

degeneration, are gradual and painless. However, if these conditions

are diagnosed early, they can be managed to minimize vision loss.

Older adults may have difficulty learning about and/or accessing 

community programs that offer vision care services. CBOs can 

play an important role by providing information about and 

encouraging regular vision exams and care, and by referring older 

adults to community vision care services and resources.

Tips for developing an effective vision component

 Limited basic or simple vision screening can be performed 

by trained healthcare professionals such as physicians, nurse 

practitioners, physicians’ assistants, registered nurses, and 

occupational therapists. However, basic vision screening 

does not identify all types of vision problems that need to 

be corrected.

 Comprehensive vision exams must be performed using 

specialized equipment. Therefore, these must be done by an 

optometrist or ophthalmologist. 

 Medicare provides coverage for dilated eye exams, which are 

considered comprehensive vision exams.

Fall Prevention Intervention 

Studies that Include Vision 

Assessment

PROFET (Prevention of Falls in the 

 Elderly Trial) (Close, et al.)

The NoFalls Intervention (Day, et al.)

A Multifactorial Program (Wagner, et al.)

For more details, refer to 

the companion publication, 

Preventing Falls: What Works. A 

CDC Compendium of Effective 

Community-based Interventions 

from Around the World
The 5 Building Blocks of Effective Community-Based Fall Prevention Programs

34

PROGRAMS IN ACTION

Vision Loss Resources

Vision Screening, Resource, and Education 

Vision Loss Resources is an independent nonprofit 501 C(3) agency in 

Minneapolis, Minnesota. Its mission is to assist people who are blind or visually 

impaired achieve their full potential and to enrich the lives of all persons affected 

by blindness, vision loss, or hearing loss. Vision Loss Resources provides programs 

to enhance independent living and educate the community about vision loss. 

Programs include:

• In-home assessment with service and resource plan development

• In-home vision evaluation for adaptive vision aids

• Hearing assessments with advocacy and resources for adaptive equipment

• V olunteers for assisting vision impaired clients to live independently

• P eer counseling and support and growth groups

• Leisure opportunities at the Vision Loss Resources’ Community Center

• Life skills classes, training, and resources for maintaining independence

• Community and professional education about vision loss and resources

• Outreach and special projects providing resources and services for individuals 

and groups, with emphasis on special needs and cultural diversity.

For more information, Vision Loss Resources can be contacted by phone 

at 612.871.2222, on the web at www. visionlossresources.com, or 

e-mail at cleach@vlrw.org

Vision care is provided primarily by the following professionals:

 Optometrists examine people’s eyes to diagnose vision 

problems and eye diseases, test patients’ visual acuity, 

depth, and color perception, and test their ability to focus 

and coordinate their eyes. They prescribe eyeglasses 

and contact lenses and provide vision therapy and 

low vision rehabilitation.

 Ophthalmologists are physicians who perform detailed, 

comprehensive, and dilated vision exams and eye surgery. 

Like optometrists, they examine eyes and prescribe eyeglasses 

and contact lenses. They also diagnose and treat eye diseases 

and injuries. 
35

Chapter 5

 Dispensing opticians fit and adjust eyeglasses and, in some 

states, may fit contact lenses according to prescriptions 

written by ophthalmologists or optometrists. 

 Local Area Agencies on Aging and state ophthalmology 

and optometry associations can provide information 

about community vision programs for older adults, for 

vision screening and/or exams, and financial assistance for 

vision needs.

 After the age of 60, vision assessments are recommended at 

least every 2 years, and more frequently if an eye condition 

has been diagnosed.

 Detailed eye exams by an optometrist or ophthalmologist are 

recommended at least once every 2 years for managing vision 

conditions and for corrective eye procedures, medications, 

and eyeglass prescriptions.

Vision web resources 

National Institutes of Health Senior Health: Vision conditions 

 and low vision topics

nihseniorhealth.gov/listoftopics.html

Medicare benefits for vision exams and vision care

www.medicare.gov

The American Academy of Ophthalmology

www.aao.org

The American Optometric Association

www.aoa.org

Opticians Association of America

www.oaa.org/index.shtml

National Eye Institute: Glaucoma—Resources for Patients 

 and the Public

www.ski.org/Colenbrander/Images/Low_Vision_Exam.pdf

catalog.nei.nih.gov/productcart/pc/viewCat_L.asp?idCategory=78
The 5 Building Blocks of Effective Community-Based Fall Prevention Programs

36

Building Block 5: Home safety assessment and 

home modification 

Environmental factors play a part in approximately half of all falls 

that occur at home. Falls can be caused by slipping and tripping 

hazards, poor lighting, or the lack of needed home modifications 

such as bathroom grab bars, handicapped showers, stair railings, 

and ramps.

A home safety assessment can identify factors that may put an 

individual at risk for falling. Many older adults can benefit from 

home safety assessments, but those with a history of falls and/

or with mobility or balance difficulties have the greatest need for 

such an assessment. Home assessments can be combined with or 

included with other direct one-on-one services that are provided by 

community service programs to residents in their homes.

A self-administered home safety assessment 

checklist can be helpful if there is a plan for 

follow-up review with a trained professional to 

follow up and if information and referrals to 

home modification programs and resources are 

provided. A Home Fall Prevention Checklist is 

provided in Appendix G.

Older adults may have difficulty learning 

about and/or accessing home safety and home 

modification information and resources. Local 

Area Agencies on Aging (AAA) can provide 

information and referrals to local home 

modification programs. AAA can also provide 

information about state and federal programs 

that offer services and financial assistance to 

low-income seniors.

For an older adult who has been injured in a fall, Medicare may

cover a home safety assessment and home modification if it is 

performed by an occupational or physical therapist. The senior 

must meet the home health reimbursement criteria, and these 

home services must be prescribed by a doctor, nurse practitioner, 

or physician assistant.

Adult Fall Prevention Interventions with 

Home Safety Assessment & Modification 

Research Study Components

Home Visits by an Occupational Therapist (Cumming, et al.)

Falls-HIT (Home Intervention Team) Program (Nikolaus, et al.)

Stepping On (Clemson, et al.)

PROFET (Prevention of Falls in the Elderly Trial) (Close, et al.)

The NoFalls Intervention (Day, et al.)

The SAFE Health Behavior and Exercise Intervention 

 (Hornbrook, et al.)

Yale FICSIT (Frailty and Injuries: Cooperative Studies of 

 Intervention Techniques) (Tinetti, et al.)

A Multifactorial Program (Wagner, et al.) 

For more details, refer to the companion publication, 

Preventing Falls: What Works. A CDC Compendium of 

Effective Community-based Interventions from Around 

the World
37

Chapter 5

PROGRAMS IN ACTION

Pitt County Council on Aging: SPICE for Life

Senior Safety, Prevention, Intervention, and Community Education

This North Carolina fall prevention program’s target population is low-income 

older adults, aged 60+, who are at high risk for loss of independence due to a 

decreased ability to function within the home. Fall risk factors typically 

addressed include:

• Home and environmental safety

• Medications

• Vision

• Mobility

• Lighting

Referrals for the program are called into the Pitt County Council on Aging (PCCOA) 

or are identified by PCCOA social workers. If the individual meets the criteria 

for the SPICE program and grant funding is available, a referral is sent to the 

program’s lead occupational therapist (OT). The OT then further assesses eligibility 

and sets up an appointment for a home visit to perform a home modification and 

fall risk assessment. 

SPICE makes use of two assessment tools that are standard 

to the program: 

• A fall interview questionnaire to assess the individual 

• A home safety modification assessment tool 

Once the needs are identified, each low-income older adult who qualifies for the 

fall prevention/home safety program is educated about fall prevention strategies 

and provided with the necessary equipment and home modifications. When 

necessary, referrals for additional services are made to other service providers and 

agencies. Referral sources are varied (physicians, home health providers, aging 

network providers, etc.) and are continuing to increase as the community becomes 

more aware of the program. Community partnerships and involvement are critical 

elements of this program’s success. 

To contact the Pitt County Council on Aging, please call 

(252) 752-1717
The 5 Building Blocks of Effective Community-Based Fall Prevention Programs

38

Occupational therapists can conduct environmental assessments, 

assess how the older adult interacts with their home environment, 

and suggest adaptations or modifications that can help older 

adults with limited physical function or low vision prevent falls 

and live independently.

Tips for developing an effective home safety component

 Home safety assessments and modifications are most 

effective when they are done in the home by an 

occupational therapist and when they include education, 

recommendations, and a follow-up home visit to assess the 

need for additional modifications.

 Home assessments and modifications by an occupational 

therapist are especially effective in reducing falls among 

older adults who have already had a fall.

 Occupational therapists are specifically trained to help 

individuals adapt their living environments to their 

physical needs, so they can perform their daily activities as 

independently and safely as possible. Occupational therapists 

are also trained to provide education to older adults, their 

family members, and caregivers.

 Trained professionals such as a Certified Aging in Place 

Specialist (certified by the National Association of Home 

Builders), registered nurses, and physical therapists can also 

effectively carry out home assessments and modifications, in 

collaboration with occupational therapists. 

 In addition to home modifications, some older adults may 

need to use personal assistive safety and mobility devices. 

An occupational or physical therapist can provide the 

training needed to use these devices properly.
39

Chapter 5

Home safety web resources

American Occupational Therapy Association’s Fact Sheet on 

 Occupational Therapy and Prevention of Falls

www.aota.org/Consumers/WhatisOT/FactSheets/

Conditions/39478.aspx

CDC’s “Check for Safety: A Home Fall Prevention Checklist for 

 Older Adults” brochure 

www.cdc.gov/ncipc/duip/fallsmaterial.htm 

National Resource Center on Supportive Housing and 

 Home Modification

www.homemods.org

Home Safety Council: State of Home Safety’s Facts About 

 Safety in the Home 

homesafetycouncil.org/state_of_home_safety/sohs_2004_p017.pdf

Home Safety Checklist (in English, Spanish, Chinese, Italian, 

 Russian, Tagalog)

www.aging.ca.gov/resources/home_housing/home_safety_checklist.html

Ladder Safety Information Sheets

orthoinfo.aaos.org/fact/thr_report.cfm?Thread_

ID=92&topcategory=Injury%20Prevention
The 5 Building Blocks of Effective Community-Based Fall Prevention Programs

40

Notes:
Injury Prevention 41

CDC’s National Center for Injury Prevention and Control 

has developed recommended approaches for evaluating 

injury prevention programs, and these can be adapted 

for fall prevention programs. This chapter summarizes the key 

elements of these approaches. More complete and detailed 

information can be found in Demonstrating Your Program’s Worth: 

A Primer on Evaluation for Programs to Prevent Unintentional Injury

The full text of this publication can be found in pdf or html format 

at www.cdc.gov/ncipc/pub-res/demonstr.htm.

With objective evaluation, program managers and staff can:

•	 Show that their program is benefiting the community

•	 Show funding agencies that their program is successful

•	 Produce facts and figures to demonstrate positive outcomes

•	 Share the results in publications and presentations to be more 

likely to receive continued funding 

Evaluation should begin while the program is in the earliest

development stages, not after the program is complete. Evaluation

is an ongoing process that begins as soon as someone decides to

develop and implement a program; it continues throughout the life

of the program; and it ends with a final assessment of how well the

program met or is meeting its goals. Goal setting is crucial to the 

evaluation of your program whether you measure the number 

of participants who complete an exercise program or the percent 

change in participants’ knowledge about fall risk factors.

Chapter 6

 Evaluating Your 

Fall Prevention Program
42

The earlier evaluation begins, the fewer mistakes are made and the 

greater the likelihood of success. In fact, for an injury prevention 

program to show success, evaluation must be an integral part of its 

design and operation and evaluation activities must be part of the 

program activities.

If a program is well designed and well run, evaluating the final 

results will be a straightforward task of analyzing information that 

is gathered while the program is in operation. The results will be 

extremely useful, not only to your own program, but to other 

community partners, similar organizations, and injury prevention 

programs.

The following sections will help clarify:

•	 Why evaluation is worth the resources and effort involved

•	 How to conduct an evaluation, and

•	 How to incorporate evaluation into fall prevention programs.

These guidelines will help program managers conduct basic

evaluations. Refer to Appendix H for a complete program 

evaluation checklist.

Methods for conducting evaluation

There are two methods of program evaluation: 

•	 Qualitative methods (information or opinions collected in 

narrative form, such as through open-ended questions or 

interviews) 

•	 Quantitative methods (information collected objectively or 

in number form through tracking, counting, or measuring) 

The basic information in this chapter provides enough information 

for you to conduct simple evaluations. However, some organizations 

may choose to hire an evaluation consultant. The Demonstrating 

Your Program’s Worth: A Primer on Evaluation for Programs to Prevent 

Unintentional Injury publication also provides detailed information 

to enable you to communicate with, hire, and supervise evaluation 

consultants.
43

Chapter 6

Summary of qualitative evaluation methods—

personal interview 

Method: 

Personal interviews

Purpose:

1. To have individual, open-ended discussion on a range of issues.

2. To obtain in-depth information from individuals about their perceptions and concerns. 

Number of People to Interview or Events to Observe:

The larger and more diverse the target population, the more people must be interviewed. 

Resources Required:

• Trained interviewers

• Written guidelines for interviewer

• Recording equipment

• A transcriber

• A private location

Advantages:

• Can be used to discuss sensitive subjects that the interviewee may be reluctant to 

discuss in a group.

• Can probe individual experience in depth.

• Can be done by telephone.

Disadvantages:

• Time consuming to conduct interviews and analyze data.

• Transcription can be time-consuming and expensive.

• One-on-one interviews can lead participants to bias their answers toward 

“socially acceptable” responses. 
Evaluating Your Fall Prevention Programs

44

Summary of qualitative evaluation methods— 

focus group

Method: 

Focus Groups

Purpose:

1. To have an open-ended group discussion on a range of issues.

2. To obtain in-depth information about perceptions and concerns from a group. 

Number of People to Include:

4 to 8 participants per group.

Resources Required:

• Trained moderator(s)

• Appropriate meeting room

• Audio and/or visual recording equipment

Advantages:

• Can interview many people at once.

• Response from one group member can stimulate ideas of another.

Disadvantages:

• Individual responses can be influenced by group.

• Transcription can be expensive.

• Participants choose to attend and may not be representative of target population.

• Because of group pressure, participants may give “socially acceptable” responses.

• Focus groups are harder to coordinate than individual interviews.
45

Chapter 6

Summary of qualitative evaluation methods— 

participant-observation

Method: 

Participant-Observation

Purpose:

To see firsthand how an activity operates. 

Number of Events to Observe:

The number of events to observe depends on the purpose. To evaluate people’s behavior 

during a meeting may require observing only one event (meeting). However, to see if grab 

bars are installed correctly may require observing many events (installations). 

Resources Required:

• Trained observers

Advantages:

• Provides firsthand knowledge of a situation.

• Can discover problems the people involved are unaware of (e.g., that their own actions 

in particular situations cause others to react negatively).

• Can determine whether products are being used properly (e.g., whether a walking device 

is being adjusted and used correctly).

• Can produce information from people who have difficulty verbalizing their points of view. 

Disadvantages:

• Can affect the activity being observed.

• Can be time consuming.

• Can be labor intensive.
Evaluating Your Fall Prevention Programs

46

Summary of quantitative evaluation methods— 

counting system

Method: 

Counting systems

Purpose:

1. To record the number of contacts with program participants (e.g., number of people 

attending each exercise class).

2. To record the number of contacts with people outside the program (e.g., number of 

meetings with partners).

3. To record the number of items a program distributes or receives (e.g., brochures and 

fact sheets).

4. To measure changes in people’s knowledge, attitudes, beliefs, or behaviors by collecting 

the same information at the beginning and end of the program.

5. To estimate the amount spent on delivering your program.
47

Chapter 6

The stages of evaluation

There are four stages of program evaluation: 

•	 Formative 

•	 Process

•	 Impact

•	 Outcome

The appropriate time to conduct each stage and the most suitable methods to use 

are outlined below. 

Stage 1: Formative evaluation

What it shows:

• Whether proposed messages are likely to reach, to be understood by, and to be accepted 

by the people you are trying to serve (e.g., shows the strengths and weaknesses of 

proposed educational materials).

• How people in the target population get information (e.g., which newspapers they read or 

radio stations they listen to).

• Whom the target population respects as a spokesperson (e.g., a physician or local celebrity).

• Details that program developers may have overlooked about materials, strategies, or ways 

of distributing information (e.g., that seniors have difficulty reaching the location where 

classes are being held).

When to use:

• During the development of a new program. 

• When an existing program 1) is being modified, 2) has problems with no obvious 

solutions, or 3) is being used in a new setting, with a new population, or to target a new 

problem or behavior. 

Why it is useful:

• Allows programs to make revisions before the full effort begins. 

• Maximizes the likelihood that the program will succeed. 

Methods to use:

• Qualitative methods such as personal interviews with open-ended questions, focus 

groups, and participant observation.

(For details, see page 25 of Demonstrating Your Program’s Worth: A Primer on Evaluation for 

Programs to Prevent Unintentional Injury)
Evaluating Your Fall Prevention Programs

48

Stage 2: Process evaluation

What it shows:

• How well a program is working (e.g., how many people are participating in the program 

and how many people are not). 

• Identifies early any problems that occur in reaching the target population. 

• Allows programs to evaluate how well their plans, procedures, activities, and materials 

are working and to make adjustments before logistical or administrative weaknesses 

become entrenched.

When to use:

• As soon as the program begins operation.

Why it is useful:

• Allows programs to make revisions before the full effort begins. 

• Maximizes the likelihood that the program will succeed. 

Methods to use:

• Quantitative methods, such as: 

– Tracking direct contacts with all who are served by the program (older adults who 

have had direct contact with the program, the nature of the direct contacts, number 

of educational brochures distributed).

– Tracking indirect contacts (through health care providers, adult children of older 

adults, or other organizations who are sharing information with older adults).

(For details, see page 27 of Demonstrating Your Program’s Worth: A Primer on Evaluation 

for Programs to Prevent Unintentional Injury)
49

Chapter 6

Stage 3: Impact evaluation

What it shows:

• The degree to which a program is meeting its intermediate goals (e.g., how awareness 

about the value of exercise or home safety has changed among program participants). 

• Changes in the target population’s knowledge, attitudes, beliefs, or measurable 

fall risk factors. 

When to use:

• When the program is being implemented and has made contact with at least one person 

or one group of people in the target population. 

Why it is useful:

• Allows management to modify materials or move resources from a nonproductive to a 

productive area of the program. 

• Tells programs whether they are moving toward achieving their goals. 

Methods to use:

• Baseline measurement: measuring the target population’s knowledge, attitudes, 

beliefs, behaviors, or health risk factor (such as muscle strength or balance) before 

beginning the program or receiving services, using surveys and/or objective participant 

assessments. 

• Progress measurement: measuring the target population’s knowledge, attitudes, beliefs, 

behaviors or health risk factors (such as muscle strength or balance) at a predetermined 

amount of time such as at the end of a 3-month exercise class or at regular intervals 

in an ongoing program. Measurements can be made using surveys and/or objective 

participant assessments.

(For details, see page 29 of Demonstrating Your Program’s Worth: A Primer on Evaluation 

for Programs to Prevent Unintentional Injury)
Evaluating Your Fall Prevention Programs

50

Stage 4: Outcome evaluation

What it shows:

• The degree to which the program has met its ultimate goals (e.g., how much an exercise 

and education program has improved a person’s ability to carry out daily activities and 

reduce fall risks).

When to use:

• For ongoing programs (e.g., group exercise classes offered throughout the year) at 

appropriate intervals. 

• For one-time programs (e.g., a 6-month program to conduct home safety assessments 

and distribute home modification equipment or devices) when program is complete. 

Why it is useful:

• Allows programs to learn from their successes and failures and to incorporate what they 

have learned into the program or into their next project. 

• Provides evidence of success for use in future budget development and requests 

for funding. 

Methods to use:

• Generally the same methods used in impact evaluation are used in 

outcome evaluation.

(For details, see page 32 of Demonstrating Your Program’s Worth: A Primer on Evaluation 

for Programs to Prevent Unintentional Injury)
51

Chapter 6

Determining which stage to use

 To find out which stage of evaluation your program is ready for, 

answer the questions below. Then follow the directions provided 

after the answer.

Q. Does your program meet any of the following criteria?

•	 It is just being planned and you want to determine how best 

to operate. 

•	 It has some problems you do not know how to solve. 

•	 It has just been modified and you want to know whether the 

modifications work. 

•	 I t has just been adapted for a new setting, population, 

problem, or behavior. 

If yes to any of the four criteria, begin formative evaluation. 

If no to all criteria, read the next question.

Q. Your program is now in operation. Do you have information 

on who is being served, who is not being served, and how much 

service you are providing?

If yes, read the next question.

If no, begin process evaluation. You may also be ready for impact 

evaluation. Read the next question.

Q. Your program has completed at least one encounter with 

one member or one group in the target population 

(e.g., completed one exercise class). Have you measured 

the results of that encounter?

If yes, read the next question.

If no, you are ready for impact evaluation. If you believe you have 

had enough encounters to allow you to measure your success in 

meeting your overall program goals, read the next question.

Q. Is your program complete?

If yes, you are ready for outcome evaluation. 

If no, reread the above questions or refer to the publication 

in Demonstrating Your Program’s Worth: A Primer on Evaluation 

for Programs to Prevent Unintentional Injury. If you are still 

uncertain, consult a professional.
Evaluating Your Fall Prevention Programs

52

Evaluation web resources

Thompson NJ, McClintock HO. Demonstrating Your 

 Program’s Worth: A Primer on Evaluation for Programs 

To Prevent Unintentional Injury. Atlanta: Centers for 

Disease Control and Prevention, National Center for Injury 

Prevention and Control, 1998; revised March 2000.

www.cdc.gov/ncipc/pub-res/demonstr.htm

British Columbia Research Institute for Children’s & Women’s 

 Health, Injury Prevention Program Evaluation Manual

www.injuryresearch.bc.ca/Publications/Reports/ProgEvalMan%20

Report.pdf

National Council on Aging’s Evidence-based Healthy Aging 

 Programming: Tools and Checklists

healthyagingprograms.org/content.asp?sectionid=32&ElementID=439

CDC Evaluation Working Group: resources for project evaluation

www.cdc.gov/eval/resources.htm

RE-AIM Evaluation Framework 

www.re-aim.org/2003/commleader.html

Basic Guide to Outcomes Based Evaluation for Nonprofit 

 Organizations with Very Limited Resources

www.managementhelp.org/evaluatn/outcomes.htm
Injury Prevention 53

Publicizing your fall prevention program to older adults, the media, 

and others in the community will be critical to its success. This 

chapter provides tips and techniques that you can use to engage your 

community in fall prevention by:

•	 Conducting a successful community outreach campaign

•	 Working with the media

Conducting a successful campaign

The word “campaign” applies to a public health education effort of 

any size. Even if you are only developing a flyer to announce your 

new home-based exercise program for older adults, you still need 

to determine the who, what, when, where, how, and why of getting 

the flyer written, designed, printed, and distributed so that it will 

effectively reach your target audience. 

This section provides an overview of campaign development, from 

concept through evaluation. For more detailed information on the 

theory and application of health communication, visit the CDC 

National Center for Health Marketing website shown at the end of 

this section. 

The eight steps outlined below will help you make the best use 

of your limited time and resources in developing a successful 

community outreach campaign. 

Chapter 7

 Promoting Your 

Fall Prevention Program
54

Step 1: Assess your current situation. Take a realistic look at your 

community and ask pertinent questions. 

 Is your community concerned about fall prevention or will 

you need to lay some educational groundwork? 

 Do you believe your local media (radio, TV, newspaper, 

websites) would support your campaign? 

 What resources do you have that can help your efforts?

 Would a campaign be easier to mount if you partnered with 

other organizations in your community who serve older adults? 

Step 2: Set your campaign goal and objectives. Identify the goals 

and objectives for your outreach campaign. A goal is the overall 

health improvement you hope to achieve, such as reducing falls 

among older adults in your community. An objective is a specific 

outcome that you can use to measure progress toward your goal.

Set realistic and measurable objectives. For example:

 Double the enrollment of your exercise classes for seniors.

 Increase the percentage of older adults served by your 

organization who have installed grab bars or railings.

Step 3: Identify the target audiences your campaign should 

reach. Identify the groups of people you need to reach to meet 

the goal you set in Step 2. Learn as much as you can about them. 

Remember that the needs, beliefs, values, and expectations of target 

audiences vary. 

 Do the older adults you wish to reach see themselves as active 

and youthful? 

 Are they committed to living independently? 

 Should you reach out to adult children of older adults or 

healthcare providers in your campaign? 

The more you know about your target audience, the more effectively 

you can tailor your promotional efforts. For example, the Internet 

may not be an effective way to reach certain groups of older adults. 
55

Chapter 7

Step 4: Develop your messages for the campaign. Messages can 

be informative and convey new facts, or be persuasive and alter 

attitudes or change behavior. Sometimes they are both. 

 Many messages begin by raising awareness about an issue or 

program so people can agree with it, understand it, believe it, 

and then eventually act on it.

 Consider gender, culture, and age groups. Messages aimed 

at people aged 60 to 70 should be framed differently from 

those for individuals over 70. If the older adults you want 

to reach perceive themselves as youthful, they may ignore 

a message about the health problems of aging. A message 

focused on “staying healthy and independent” may generate 

more positive response than one focused on “preventing hip 

fractures and other injuries.”

 Pretest your messages with a sample of the audience and see 

if your message appeals to them. 

 Use audience feedback to make adjustments before launching 

your campaign.

Step 5: Identify message outlets. Decide how you can deliver your 

message most effectively. Answers to the following questions can 

help you identify the best outlets for your message.

 Where does your audience get information that they trust? Is 

it from the media, their peers, their physicians, or children? 

 Where does your audience spend time? Do they spend time 

at senior centers, libraries, or faith-based organizations such 

as churchs or synagogues? 

Partnerships offer unique opportunities to reach complementary 

target audiences. Healthcare providers can publicize your fall 

prevention program to older adults. Providers also can directly refer 

high-risk adults to your program. When asking a partner to help 

with promotional activities, emphasize the connection between their 

work and your program goal. See Appendix I for a sample letter to 

healthcare providers to solicit referrals. 
Promoting Your Fall Prevention Programs

56

Step 6: Develop an action plan for the campaign. Create an 

action plan that demonstrates good time and resource management. 

While it can be simple or complex, at a minimum your action plan 

should identify:

 Major activities and tasks

 Target date for completing each task

 The person responsible for ensuring that each task is 

completed

Step 7: Develop and pretest campaign materials. In developing 

materials, pay attention to reading level, print size, and languages. 

 Keep your wording simple and direct. 

 Consider design as well as content. For example, older adults 

may prefer larger type.

 Pretest any materials you develop as part of your campaign 

with members of your target audience group and make 

modifications based on their feedback. 

This crucial step can make the difference between success and failure 

in a community outreach campaign.

Step 8: Implement, evaluate, and modify your campaign. As 

you carry on your outreach campaign, determine if you are moving 

toward your goal. If not, investigate the reasons why. 

 See what barriers are preventing the message from reaching 

the target audience. 

 Determine what you can do to remove these obstacles. 

 Use what you learn to improve your campaign.
57

Chapter 7

Working with the media

You can use media such as local newspapers, radio, and television 

stations, to enhance your promotion activities. The media has 

a mandate to be of public service, so they should welcome the 

opportunity to make the community aware of your organization’s fall 

prevention program. See your relationship with the media as one 

of mutual advantage; you provide useful and timely information for 

their audiences, and they provide public access and outreach for you. 

 Start with your local telephone directory and create a list of 

media names and contact information for local reporters, 

especially the health reporter. 

 Check with your library or bookstore to find media 

directories that list daily and weekly newspapers, television 

stations, radio stations, newswire services, Internet 

news outlets, magazines, newsletters, and business trade 

publications in your community. Some examples of media 

directories include Bacon’s MediaSource and the News Media 

Yellow Book. (These web links can be found at the end of 

this section.)

 Don’t overlook community newspapers as potential news outlets.

 Local organizations such as faith-based, and senior citizen 

groups that publish their own newsletters may be eager to 

publicize your prevention program.

 Develop key points to include in the media materials.

Highlight the importance of your fall prevention program. 

If you’re hosting a community event, offer key points to 

guest speakers in advance so they can include them in their 

remarks. Appendix J has key points that include facts and 

national statistics about falls among older adults. For a 

greater effect, try to include statistics about falls among older 

adults in your state or community. These statistics may be 

available from state and county health departments and 

local hospitals. 
Promoting Your Fall Prevention Programs

58

Promotional web resources

CDC National Center for Health Marketing

www.cdc.gov/healthmarketing

CISION

us.cision.com

News Media Yellow Book

www.leadershipdirectories.com/products/nmyb.htm
Injury Prevention 59

Chapter 8

 Sustaining Your 

Fall Prevention Program

Create a written sustainability plan to provide a road map to guide 

you and your program’s community partners as you work on 

sustainability efforts.

The process of creating a written sustainability plan can strengthen 

community partners’ commitment and understanding of the efforts 

needed to keep your program operating and improving. A tangible 

document that describes your sustainability plan helps you and your 

community partners monitor progress on sustainability efforts. In 

developing your plan, consider the following:

Establish your vision

Determine the vision of your program. A common vision unifies 

all of your program’s sustainability efforts. Write it down and 

share it with all involved. Keeping your vision in sight will serve to 

strengthen your program’s sustainability.

Build collaboration

Continue to look for new community partners who possess unique 

skills and resources that will contribute to your program. Expanding 

your base of support is crucial to sustaining your program and 

providing its benefits to the older adults in your community.

Advocate for support 

Seek advocates for your program among business leaders, other 

CBOs, and government representatives who will speak up and take 

action on behalf of your program.
60

Integrate your program into community healthcare and senior 

services by linking with senior service providers, the health 

department, healthcare organizations, and the local Area Agency on 

Aging; they can provide ongoing community support and referrals.

Find funding 

Secure diversified funding streams from public and private sources 

to increase your program’s sustainability. Sources of funding include:

•	 Medicare 

•	 Health Maintenance Organizations

•	 Private or managed care insurers

•	 Private organizations

•	 Federal/state/local government or agency

•	 Local, state, or national (public or private) grant funders

•	 Program participant fees

Use your program evaluation results to promote sustainability. 

Study your program goals and evaluation results to identify areas 

for improvement or change that might make your program 

more sustainable.

Demonstrate the benefits of your program. Share your evaluation 

results with your target audience, the community, your partners, 

your current and potential funding sources, and stakeholders.

See Attachment K for a template to help you create a sustainability

plan for your fall prevention program.

Appendix A

 Sample Individual 

Falls Risk Assessment
My Falls-Free Plan

As we grow older, gradual health changes and some medications can cause falls, but many falls can be prevented. 

Use this to learn what to do to stay active, independent, and falls-free. 

The more “Yes” answers you have, the greater your chance of having a fall. Be aware of what can cause falls, and take 

care of yourself to stay independent and falls-free!

Name: ____________________________ Date: _________

Reviewed by: ___________________ This material is in the public domain and may be reproduced without permission. If you use or adapt this 

material, please credit the Washington State Department of Health, Injury & Violence Prevention Program.

Check “Yes” if you experience 

this (even if only sometimes)

No Yes What to do if you checked “Yes”

Talk with your doctor(s) about your falls and/or concerns.

Show this checklist to your doctor(s) to help understand and treat 

your risks, and protect yourself from falls. 

Review your medications with your doctor(s) and your pharmacist 

at each visit, and with each new prescription.

Ask which of your medications can cause drowsiness, dizziness, 

or weakness as a side effect.

Talk with your doctor about anything that could be a medication 

side effect or interaction.

Tell your doctor(s) if you have any pain, aching, soreness, stiffness, 

weakness, swelling, or numbness in your legs or feet—don’t 

ignore these types of health problems.

Tell your doctor(s) about any difficulty walking to discuss treatment.

Ask your doctor(s) if physical therapy or treatment by a medical 

specialist would be helpful to your problem.

Ask your doctor for training from a physical therapist to learn what 

type of device is best for you, and how to safely use it.

 Ask your doctor for a physical therapy referral to learn exercises 

to strengthen your leg muscles.

 Exercise at least two or three times a week for 30 min. 

Tell your doctor, and ask if treatment by a specialist or physical 

therapist would help improve your condition.

Review all of your medications with your doctor(s) or pharmacist 

if you notice any of these conditions. 

Schedule an eye exam every two years to protect your eyesight 

and your balance.

Schedule a hearing test every two years.

If hearing aids are recommended, learn how to use them to help 

protect and restore your hearing, which helps improve and protect 

your balance.

Ask your doctor(s) what types of exercise would be good for 

improving your strength and balance.

Find some activities that you enjoy and people to exercise with 

two or three days/week for 30 min. 

Limit your alcohol to one drink per day to avoid falls.

See your doctor(s) as often as recommended to keep your health 

in good condition.

 Ask your doctor(s) what you should do to stay healthy and active 

with your health conditions.

Report any health changes that cause weakness or illness as soon 

as possible.

Have you had any falls in the last 

six months?

Do you take four or more 

prescription or over-the-counter 

medications daily?

Do you have any difficulty walking 

or standing?

Do you use a cane, walker, or 

crutches, or have to hold onto 

things when you walk?

Do you have to use your arms to 

be able to stand up from a chair? 

Do you ever feel unsteady on your 

feet, weak, or dizzy? 

Has it been more than two years 

since you had an eye exam? 

Has your hearing gotten worse 

with age, or do your family or 

friends say you have a hearing 

problem?

Do you usually exercise less than 

two days a week? (for 30 minutes 

total each of the days you exercise) 

Do you drink any alcohol daily?

Do you have more than three 

chronic health conditions? (such 

as heart or lung problems, diabetes, 

high blood pressure, arthritis, etc. 

Ask your doctor(s) if you are unsure.)

Appendix A – Risk Assessment 63
Appendix B

 Identifying Partners 

Worksheet
Appendix B – Identifying Potential Partners 

Community 

Partners/ 

Resources 

Fall Prevention Intervention Components 

Education 

• Group 

• Individual 

Assessment 

• Gait 

• Balance; simple 

• Balance; in-depth 

• Strength 

Exercise

• 1:1 balance alone 

• 1:1 strength with 

 balance training 

• Group class 

• Individualized 

 exercise/PT 

• Tai Chi 

Medication

• Medication 

 review 

• Medication 

 management 

Vision

• Basic 

 assessment 

• Detailed 

 assessment 

• Vision 

 correction 

Home Safety

• Assessment 

• Basic 

 modification** 

• Skilled 

 modification** 

Other

• Assistive 

 device 

 training 

Area Agency on 

Aging 

Community 

health care 

providers 

Community 

hospital (s) 

outpatient 

programs and 

services 

EMS/Trauma 

Injury Prevention 

Coordinator 

Fire Depts. 

Gym/fitness 

center 

Health 

Department 

Home health 

agency 

Home 

modification 

resources 

Library system 

Local service 

organization(s) 

Other resources 

Parks and 

recreation 

Pharmacy 

Physical/occupat

ional therapy 

clinics 

University/ 

Community 

College 

YMCA 

65
Appendix C

 Sample Fall Prevention 

Brochure
67

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68

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Appendix C – Sample Fall Prevention Brochure
Appendix D

 Sample Fall Prevention 

Presentation
70

1

Preventing

Falls

What YOU Can Do

To Prevent Falls Many falls can be prevented.

By making some changes, YOU

can lower your chances of falling.

3

Four Things

YOU

Can Do To

Prevent

Falls

Begin a regular

exercise program.

Have your healthcare 

provider review

your medicines.

Have your

vision checked.

Make your

home safer...

1

2

3

4

3

FLOORS: Look at the floor in each room.

Q: When you walk

through a room,

do you have to

walk around

furniture?

 Ask someone to move

furniture so your path

is clear.

Q: Do you have throw

rugs on the floor?

 Remove rugs or use a

non-slip backing so

rugs won’t slip.

Q: Are there papers,

books, towels, 

magazines, shoes,

boxes, blankets or

other objects on

the floor?

 Pick up things on the

floor. Always keep

objects off the floor.

“Last Saturday our son helped us 

move our furniture. Now all the 

rooms have clear paths.”

3

3

3

STAIRS AND STEPS:

Look at the stairs you use both 

inside and outside your home.

Q: Are you missing

a light over the

stairway?

 Have an electrician

put in an overhead

light at the top and

bottom of the stairs.

3

Photo courtesy of Jake Pauls

Q: Is the carpet on

the steps loose

or torn?

 Make sure carpet is

firmly attached to

every step.

3

Q: Are the handrails loose or broken?

 Fix loose rails or put in new ones. Make sure

handrails are on both sides of the stairs.

3

3 3

BEDROOMS:

Look at all your bedrooms.

Q: Is the light near the

bed hard to reach?

 Place a lamp close to the

bed where it’s easy to reach.

3

Q: Is the path from your

bed to the bathroom

dark?

 Put in a night-light so you

can see where you’re

walking. Some night-lights

go on by themselves after

dark.

3

Appendix D – Fall Prevention PPT Thumbnails
71

2

BATHROOMS:

Look at all your bathrooms.

Q: Is the tub or shower floor

slippery?

 Put a non-slip rubber mat or

self-stick strips on the floor of the

tub or shower.

3

Q: Do you need some support

when you get in and out of

the tub or up from the toilet?

 Have a carpenter put grab bars

inside the tub and next to the toilet.

3

3 3

KITCHEN:

Look at your kitchen and eating area.

Q: Are the things you use

often on high shelves?

 Move items in your cabinets.

Keep things you use often on

the lower shelves (above 

waist level).

3

Q: Is your step stool

unsteady?

 If you must use a step stool, get

one with a bar to hold on to.

Never use chairs as step stools.

3

Other Things

YOU

Can Do To

Prevent

Falls

 Get up slowly after you

sit or lie down.

3

 Wear shoes both inside

and outside the house.

Avoid going barefoot or

wearing slippers.

3

 Improve the lighting in your

home. Put in brighter bulbs.

Fluorescent bulbs are bright

and cost less to use.

3

 It’s safest to have uniform

lighting in a room. Add

lighting to dark areas.

Hang lightweight curtains or

shades to reduce glare.

3

3

More Safety Tips

 Exercise regularly. Exercise

makes you stronger and

improves your balance and

coordination.

3

 Have your vision checked at

least once a year by an eye

doctor. Poor vision can

increase your risk of falling.

3

 Keep emergency numbers

in large print near each

phone.

3

3

You Can

Prevent

Falls

“Making changes in our home to prevent falls

is good for us and good for our granddaughter

3

when she comes to visit.”

For more information, contact:

Centers for Disease Control and Prevention

National Center for Injury Prevention and Control

1.800.CDC.INFO

www.cdc.gov/injury

Department of Health and Human Services

Centers for Disease Control and Prevention

Appendix D – Fall Prevention PPT Thumbnails
Appendix E

 Sample Exercises
Appendix E - Barnett Exercise Intervention 

Stay Safe Stay Active 

Daily Exercise Program 

1. Warm up t t 2. Shoulder rolls (Flexibility) 

3. March on spot (moblllty) 4. Ankle (strength) 

5. Knee bend (strength) 6. Sillo SIand (strength) 

7. Calf a Calf (streich) (stretch) 

\ \ 

Thank you Sally Castell for your diagrams 

73
 
Appendix E - Barnett Exercise Intervention 

Stay Safe Stay Active
 

Daily Exercise Program (Stage 2) 

1. Hip to 2. Foot Circles' the side' 

4. Shoulder blade exercises'" 3. Lift leg backwards' 

6. Knees in and out •• 

5. Arm cur'" 

7. Ankle Pumps .. 8. Hip extension .. 

Thank you to Stay on Your Feel* and Roybal- Boston University** for allowing 

us to use your diagrams 

74
 
Appendix F

 Sample Medication 

Review Form
Appendix F – Fall Prevention Medication Review Checklist 

Patient Name: ______________________Review Date: _______ 

Number of medications patient was taking: ________ 

Please indicate which of the following recommendations were made/actions taken when 

reviewing the above patient’s medication intake. 

□ Decrease number of medications, if possible (especially if taking more than four 

medications). 

Notes: 

□ Investigate lower dosages of medications, especially psychotropic drugs, diuretics and 

cardiovascular drugs. 

 Notes: 

□ Consider withdrawal of digoxin: 

 In patients with stable CHF 

 If CHF is due to valvular disease or hypertension 

 If there is no response to digoxin after one month with decreased heart size, or 

increased exercise capacity 

Notes: 

□ Stop or decrease number of psychotropic medications 

 Neuroleptics (i.e., Phenothiazines, Butyrophenones) 

 Sedative/hypnotics (i.e., Barbiturates, Hydroxyzine) 

- Antidepressants (i.e., Tricyclic Antidepressants, Selective Serotonin Uptake Inhibitors 

(SSRIs) 

- Benzodiazepines 

Notes: 

□ Avoid combination of certain drugs 

• Narcotics with psychotropics 

• More than one psychotropic 

Notes: 

Courtesy of the Michigan Fall Prevention Project 

Michigan Department of Community Health 

76
Appendix G

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Prevention Safety Checklist
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Appendix H

 Sample Program 

Evaluation Tool
Appendix H – Program Evaluation Checklist 

Program Evaluation Checklist 

This is a checklist of tasks that organizations developing fall prevention 

programs can follow to make sure no evaluation steps are omitted during 

program development, operation, and completion. 

 

1. Program Development

As soon as you or someone in your organization has the idea for a fall 

prevention program, begin evaluation. 

 Investigate to make sure an effective program similar to the one you 

envision does not already exist in your community. 

 If a similar program does exist and if it is fully meeting the needs of your 

proposed target population, modify your ideas for the program so that you 

can fill a need that is not being met. 

 Decide where you will seek financial support. 

 Find out which federal, state, or local government agencies give grants for 

the type of program you envision. 

 Find out which businesses and community groups are likely to support your 

goals and provide funds to achieve them. 

 Decide where you will seek non-financial support. 

 Find out which federal, state, or local government agencies provide 

technical assistance for the type of program you envision. 

 Find out which businesses and community groups support your goals and are 

likely to provide technical assistance, staff, or other non-financial support. 

 Develop an outline of a plan for your fall prevention program. Include in the 

outline the methods you will use to provide the program service to 

participants and the methods you will use to evaluate your program’s 

impact and outcome. 

 Evaluate the outline. For example, conduct personal interviews or focus 

groups with a small number of the people you will try to reach with your fall 

prevention program. Consult people who have experience with programs 

similar to the one you envision, and ask them to review your plan. Modify 

your plan on the basis of evaluation results. 

87
Appendix H – Program Evaluation Checklist 

 Develop a plan to enlist financial and non-financial support from all the 

agencies, businesses, and community organizations you have decided are 

likely sources of support. Use the outline of your plan for the injury 

prevention program to demonstrate your commitment, expertise, and 

research. 

 Evaluate the plan for obtaining support. For example, conduct personal 

interviews with business leaders in your community. Modify your plan on the 

basis of evaluation results. 

 Put your plan for obtaining support into action. 

 Keep track of all contacts you make with potential supporters. 

 If unexpected problems arise while you are seeking support, re-evaluate 

your plan or the aspect of your plan that seems to be the source of the 

problem. For example, if businesses are contributing much less than you 

had good reason to expect, then seek feedback from businesses that are 

contributing and those that are not. Or if you did not receive grant funds for 

which you believed you were qualified, contact the funding agency to find 

out why your proposal was rejected. Modify your plan according to your reevaluation results, and continue seeking support. 

 When you have enough support for your program, expand on the outline of 

your plan for the fall prevention program. Include in the design a 

mechanism for evaluating the program’s impact and outcome. 

 Evaluate your program’s procedures, materials, and activities. For example, 

conduct focus groups within your target population. Modify the plan on the 

basis of evaluation results. 

 Develop forms to keep track of program participants, program supporters, 

and all contacts with participants, supporters, or other people outside the 

program. 

 Measure the target population’s knowledge, attitudes, beliefs, and 

behaviors that relate to your program goals. The results are your baseline 

measurements. 

88
Appendix H – Program Evaluation Checklist 

2. Program Operation

Put your program into operation. 

 Track all program-related contacts (participants, supporters, or others). 

Track all items either distributed to or collected from participants. 

 As soon as the program has completed its first encounter with the target 

population, assess any changes in program participants’ knowledge, 

attitudes, beliefs, and (if appropriate) behaviors. 

 Continue tracking and assessing program-related changes in participants 

throughout the life of the program. Keep meticulous records. 

 If unexpected problems arise while the program is in operation, re-evaluate 

(using qualitative methods) to find the cause and solution. For example, 

your records might show that not as many people as expected are 

responding to your program’s message, or your assessment of program 

participants might show that their knowledge is not increasing. Modify the 

program on the basis of evaluation results. 

 Evaluate ongoing programs (e.g., exercise and education classes) at suitable 

intervals to see how well the program is meeting its goal of reducing fall 

related morbidity and mortality. 

3. Program Completion

 Use the data you have collected throughout the program to evaluate how 

well the program met its goals: to increase behaviors that prevent falls and, 

consequently, to reduce the rate of falls and fall injuries. 

 Use the results of this evaluation to justify continued funding and support 

for your program. 

 If appropriate, publish the results of your program in a scientific journal. 

This tool was based on guidelines from the Demonstrating Your Program's Worth, A Primer 

on Evaluation for Programs to Prevent Unintentional Injury (CDC NCIPC, 2000), a book 

designed to help program staff understand the processes involved in planning, designing, 

and implementing evaluation of programs to prevent unintentional injuries. 

www.cdc.gov/ncipc/pub-res/demonstr.htm

89
Appendix I

 Sample Pitch Letter
Appendix I – Sample Letter to Health Care Referral Source 

[Title] 

[Name of organization] 

[Address] 

Dear [Name]: 

Our organization needs your help in preventing falls among older adults—the leading 

cause of injury deaths and nonfatal injuries for persons aged 65 and older. We are 

offering a [free/low-cost] fall prevention [exercise class, counseling, home visits, etc.] 

to individuals whose current health status places them at increased risk of falling. 

Please recommend our service, described in more detail below, to your patients who 

would benefit from it. 

 

Our program is [name and description of program; program details. For example: 

“Stay Safe, Stay Active,” an evidence-based exercise program for older adults at risk 

of falling due to lower limb weakness, poor balance, slow reaction time, or a 

combination of these symptoms. We will hold 37 weekly classes of moderate exercise, 

led by a trained fitness instructor, beginning March 1, from 9 to 10 a.m., at the YMCA 

at 321 Main Street, Anytown. We will also provide participants with fall prevention 

strategies and exercises to do at home. Participants will improve their balance and 

coordination, muscle strength, reaction time, and aerobic capacity while reducing 

their likelihood of falling or being injured in a fall.] 

The Centers for Disease Control and Prevention has identified this intervention as 

effective in preventing falls. 

More than one-third of people aged 65 and older fall each year. Help your patients 

maintain their health and independence by learning how to avoid falls. Please call me 

at [telephone number] if you would like further information. [Recommended step: 

(Program) fliers to distribute to high-risk patients are available.] 

Sincerely, 

[Your name and title] 

91
Appendix J

 Key Points
Appendix J – Key Points Regarding Falls Among Older Adults 

Health Consequences of Falls (age 65+) 

• Falls are a major threat to the health and independence of older adults. 

• Each year in the United States, nearly one-third of older adults experience a 

fall. 

• Falls are the leading cause of injury deaths and the most common cause of 

nonfatal injuries and hospital admissions for persons aged 65 and older. 

• In 2004, more than 14,900 people aged 65 or older died of a fall-related injury. 

Another 1.85 million were treated in emergency departments for nonfatal 

injuries related to falls. 

• About one out of ten falls among older adults results in a serious injury (such as 

a hip fracture or head injury) that requires hospitalization. 

• In 2004, one adult died from a fall every 35 minutes. Every hour, 211 older 

adults were treated in emergency rooms for fall-related injuries. 

• In 2000, direct medical costs totaled $179 million for fatal falls and $19 billion 

for nonfatal fall injuries. 

• In [your state/community], falls account for [X percentage] of emergency room 

visits by people aged 65 or older. 

• In [your state/community], falls account for [X percentage] of hospital 

admissions for injuries among older adults. 

• In [your state/community], falls account for [X percentage] of deaths among 

older adults. 

(Contact your local hospital, agency on aging or county or state health 

department for statistics on fall-related injuries and deaths.) 

Biological risk factors 

9 Mobility problems due to muscle weakness or balance problems 

9 Chronic health conditions such as arthritis and stroke 

9 Vision changes and vision loss 

9 Loss of sensation in feet 

 

Behavioral risk factors 

9 Inactivity 

9 Medication side effects and/or interactions 

9 Alcohol use 

 

Environmental risk factors 

9 Home and environmental hazards (clutter, poor lighting, etc.) 

9 Incorrect size, type, or use of assistive devices (walkers, canes, crutches, etc.) 

9 Poorly designed public spaces 

93
Appendix K

 Sustainability Plan 

Template
Appendix K – Template for Developing a SUSTAINABILITY PLAN 

*********************************************************************** 

Sustainability Plan for {Your Program Name} 

Program Summary 

Describe what your program offers, who it serves, when it operates, how it is 

funded and who your community partners are. 

Vision 

What is the program’s vision? What results do you hope to achieve, and what 

are the activities that will lead to the desired results? Who will benefit? 

Collaborators 

Who are your partners? What are their roles, what resources do they 

contribute, and how do they figure in your sustainability plan? 

Advocates 

Who are your supporters? What are their goals and how are they providing help? 

Current Funding Sources 

Who is providing funding for your program? How long will they continue their 

contributions? 

New Potential Funding Sources

List possible funders who could provide additional support. Describe a plan to 

approach potential funders. Get additional referrals for both public and 

private funders through partners. 

Program Offerings 

State specifically how the program addresses the needs of the older adult 

participants, partners, and the community. Remember to include how your 

program incorporates effective intervention components to achieve its goals. 

Management 

Include how you are managing your program’s fiscal resources. Describe 

staffing and information management. 

Evaluation 

Describe how you will collect information to show results. What tools will you 

use to collect data? State how you will adapt the program to ensure you are 

maintaining the vision and meeting your objectives. 

95