Research and Investment: Two Pillars of Fall Prevention

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 Robyn Stone

We all know that falls play a serious and significant role in increasing the rates of hospitalizations, nursing home placements, and even death among older people.

Researchers like myself have no trouble rattling off the all-too-familiar statistics: falls cause 95% of broken hips, 16% of emergency department visits, and 7% of hospitalizations. They cost the nation $34 billion each year. And most of them are preventable.

So if we know so much, why do one in three older Americans over age 65 still fall every year?

It’s not that we lack ideas for tackling this huge challenge. We simply lack the willingness to invest in those ideas.

After all, a number of impressive evidence-based programs have already been proven to reduce falls among older adults.

There’s the Matter of Balance program developed at Roybal Center at Boston University. This eight-week structured group intervention helps participants reduce their fear of falling and increase their activity levels. Basically, it puts older adults back in control of their lives by helping them build their strength and balance while taking practical steps to make their living environment safer. Many area agencies on aging, senior centers, and affordable senior housing providers are offering this program to older adults across the country with tremendous success.

I’m also a big fan of the CAPABLE (Community Aging in Place, Advancing Better Living for Elders) program developed at the Johns Hopkins University School of Nursing. Three things impress me about CAPABLE:

• It takes a holistic, team approach to fall prevention. An occupational therapist, registered nurse, and handyman visit an older person’s home and work together to identify and address mobility and self-care issues.
• It doesn’t focus just on preventing falls. Instead, it builds a person’s capacity to live independently. Modifying the home environment is part of that. But the occupational therapist plays a critical role in helping participants understand what they can do to safely negotiate that environment.
• It works. Of the 100 low-income older adults who participated in the program over a five-month period, 79% improved their self-care, and the disability level of the average participant was cut in half.

Policymakers around the country should watch carefully as Michigan explores how to build CAPABLE into its Medicaid home and community-based waiver program. My guess is that many states could reduce health care costs significantly if they invested Medicaid funds in home modification activities and evidence-based programs to prevent falls.

Federal policymakers have a similar opportunity to incorporate evidence-based fall prevention programs into Medicare Advantage Plans. These programs have the flexibility to pay for services, like home modification and fall-prevention education, which could help beneficiaries avoid expensive health care interventions and nursing home placement.

Investing in fall-prevention interventions at the state and federal level could offer an additional benefit: encouraging primary care physicians (PCP) to pay attention to where and how their patients live.

Older adults spend most of their lives in their homes and communities—not in the doctor’s office. A payment system that allows PCPs to actually care what happens to patients when they go home would truly transform health care.

Robyn Stone is a Senior Vice President at Leading Age.

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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.