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This guide has been prepared in recognition of the special role of state and local communities in reducing falls and fall-related injuries within the older adult population. It provides a compendium of practical tools, resources, and strategies to assist coalition building efforts by states working collaboratively to address this growing public health issue. This guide also provides the framework, infrastructure, and guidance that states can share with local communities who are collaborating to implement fall prevention interventions. The guide is grounded in real world experiences – its primary source is the State Coalition Workgroup (a component of the National Falls Free™ Coalition) which consists of leaders in ten states that have established state or large regional coalitions. Coordinators for each of these state efforts have agreed to share their historical development, tools, resources, and lessons learned for inclusion in this guide.

Much has been written about effective group dynamics and engagement processes for creating and managing coalitions which will serve the reader well and should be reviewed as part of the preparation. A list of those resources is provided. This guide is more narrowly focused on fall prevention and how states have organized effective, sustainable fall prevention coalitions that are making a difference at the community level.

In order to remain relevant to emerging coalitions and in acknowledgment of the vibrant and dynamic nature of coalitions, this resource will need to undergo frequent revisions and is therefore offered as an online tool. Such a communication mode will facilitate routine updates. It has been developed as an html document to facilitate direct linking of the user to a myriad of resources and references.

Why Falls? Why Now?

Falls and fall related injuries among older adults account for 37% of unintentional injury-related deaths. Fully 30% of people over the age of 65 who live in the community fall each year. The risk of being seriously injured in a fall increases with age. In 2001, the rates of fall injuries for adults 85 and older were four to five times that of adults 65 to 74 (Stevens, 2005). Two-thirds of those who fall do so again within six months (Parra & Stevens, 2000).

In 2005, over 15,000 people 65 and older died from injuries related to unintentional falls; about 1.85 million people 65 and older were treated in emergency departments for nonfatal injuries from falls, and more than 483,000 of these patients were hospitalized (J. Stevens, personal communication, August, 2007). Twenty to 30% of falls cause moderate or serious injuries such as fractures (most frequently hip, wrist or shoulder) or head traumas which are associated with significant morbidity, reduced mobility, decreased functioning, and loss of independence (Alexander et al., 1992; Sterling et al., 2001; Seeley, et. al., 1991).  

Falls and fall-related injuries are attributed to a complicated constellation of individual and environmental risk factors. We know the risk of falling increases with age, especially after age 85, and this risk is loosely associated with our trend toward more sedentary lives. Aging related declines in reaction time, vision, and other sensory capabilities are additional risk factors. Growing functional losses and increasing medication usage associated with chronic conditions and geriatric syndromes are also recognized risk factors for falling.

The older adult population is expected to soar as baby boomers reach retirement age. In 2000, the U.S. Census Bureau reported over 34.8 million adults over the age of sixty-five, with this number expected to grow to almost 54 million in 2020 and 77 million by 2040. Given the association of falls and fall-related injuries with increasing age, we can anticipate that these rates will also grow rapidly. Such unprecedented growth in the older adult population and in the rates of falls and fall-related injuries could easily overwhelm the resources available to address these issues. Thus, this growth alone presents the imperative to address falls and fall related injuries now.