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What home and/or community strategies or modifications are most important to reduce the risk of falling and how can policymakers encourage their widespread adoption? View the full forum.

By Erika Poethig and Emily Blumenthal

Two and a half million older adults end up in the emergency room each year with injuries from a fall, often suffering serious hip and head injuries or even death. In 2013, falls resulted in $34 billion dollars in direct medical costs, the majority of which are paid through public sources. Behind these daunting numbers are individual stories. Many of us have a loved one who has experienced a fall; we have had the sudden realization of their vulnerability and instability, and have seen how a fall reduces their quality of life due to pain, impaired mobility or fear of another fall.

Falls, the leading cause of injury for older adults, primarily occur in the home, a reminder of the important relationship between health and housing.

Research supported through the MacArthur Foundation’s How Housing Matters program illustrates the important role housing plays in the prevention of this serious health issue. By making housing safe and suitable for older adults through home modifications and age-friendly design, we can help reduce the prevalence of falls.

There is a wealth of knowledge and resources around home modifications. From small, no-cost adjustments like removing rugs and rerouting cords, to low-cost modifications replacing door knobs and installing handrails, and more expensive modifications like building ramps, we know a great deal about how to make homes safer for seniors to prevent falls. These relatively small investments can have big returns.

We are seeing a range of public and nonprofit stakeholders stepping up to enable seniors to safely remain in their home and community. There are creative implementation programs, including local efforts as well as statewide initiatives like Ohio’s Steady U campaign. This initiative through the Ohio Department of Aging recognizes that one’s entire social and physical environment can play a role in preventing falls. There are also financing mechanisms, including federal assistance delivered through local Area Agencies on Aging.

Despite the myriad programs and initiatives, falls continue to be a pervasive issue for older adults. How do we build upon what we know and the myriad of policies/programs around this issue to facilitate a real reduction in falls?

We have evidence on effective strategies, but we need to learn more about effective mechanisms to get older adults, their families and service providers to adopt these practices. Part of this will mean reducing the stigma associated with aging, handrails and canes. Wider adoption of age-friendly design practices may be a longer-term solution and contribute to changing the conversation around falls and senior housing.

Fall prevention is not a niche issue, and older adults are not a marginal group. This is a pervasive health issue facing a growing demographic that touches every segment of the U.S. population. We need policies that reflect the simple truth that housing has serious implications for health and our ability to age with good quality of life hinges in part on having housing that can meet our needs as we age.

Erik Poethig is the director of urban policy initiatives at the Urban Institute. Emily Blumenthal is a research analyst at the Urban Institute.


Welcome to the BPC Health and Housing Expert Forum. Each month contributors from different parts of the health and housing sectors will be invited to respond to a discussion topic. Have a question you’d like us to consider? Please leave it in the comments.

Any views expressed on this forum do not necessarily represent the views of the Senior Health and Housing Task Force, its co-chairs, or the Bipartisan Policy Center.