Falls are not a normal part of aging, and most falls can be prevented. As the leading cause of both fatal and nonfatal injuries for older adults, falls are one of the most common and significant health issues facing persons aged 65 years and older.1 Approximately 17.1% of North Carolinians are aged 65 or older, and one in four people in this age group falls annually.2 Older adults who fall once are two to three times more likely to fall again.2
The North Carolina Division of Public Health Injury and Violence Prevention Branch estimates that unintentional falls among older adults in the state caused a daily average of almost four deaths, 54 hospitalizations, and 230 emergency department visits in 2020, with an average hospitalization cost of $59,367.2 Since older adults are the fastest growing population group in North Carolina,3 addressing fall risk is an urgent public health crisis.
Fall-related injuries also cause quality-of-life issues, such as the potential loss of independence, decreased mobility, and, in some cases, early admission to a nursing home. The fear of falling can cause people to limit their activities, leading to reduced mobility and increased risk of falling.4
Modifiable fall risk factors include muscle weakness, gait and balance problems, poor vision, hearing loss, unsafe footwear, use of four or more medications (including those that cause drowsiness, dizziness, or confusion), some chronic conditions, and home and environmental hazards.5 The Centers for Disease Control and Prevention (CDC) Stopping Elderly Accidents, Deaths, & Injuries (STEADI) initiative promotes screening, assessing, and intervening for fall risk. Effective interventions can include referring patients to a physical therapist for gait, balance, or strength training or to a community-based falls prevention program; addressing chronic conditions; reviewing medications; checking for home hazards; and having an annual vision and hearing exam.6
Healthy Aging NC, a statewide resource center for evidence-based health promotion programs, was established in 2014. Since then, over 13,500 older adults and adults with disabilities have participated in evidence-based falls prevention programs through the state aging network. Information for health care providers and the public about community-based, evidence-based falls prevention programs and other strategies to reduce falls can be found at healthyagingnc.com and ncfallsprevention.org.
Since 2008, the North Carolina Falls Prevention Coalition (NCFPC) has brought together over 90 cross-sector organizations to reduce the number of injuries and deaths from falls among adults. Coalition activities include providing falls prevention education; working with health care providers to ensure that older adults are routinely screened for falls and referred to clinical or community-based, evidence-based falls prevention programs; promoting the availability of and access to these programs throughout the state; and advocating for increased awareness of and action on this public health issue. Annually since 2009, the NCFPC has secured a Governor’s Proclamation to designate the observance of Falls Prevention Awareness Week in September, with communities holding numerous events to call attention to falls and falls prevention strategies. The NCFPC meets quarterly, works closely with seven regional falls prevention coalitions across the state, and is actively implementing a five-year action plan to reduce the number of fall-related injuries and deaths in the state.
Several North Carolina state agencies and organizations have incorporated falls prevention policies, objectives, and recommendations into their strategic plans and activities.
The 2022 North Carolina State Health Improvement Plan includes two proposed policy indicators to address falls prevention. Statewide work groups are creating action plans to foster partnerships to reduce falls and related injuries, increase awareness of risk factors, and advance access to interventions.7
The 2019–2023 North Carolina State Plan on Aging has an objective that “older adults will have access to evidence-based health promotion, wellness, and disease prevention programs,” with a strategy to reach the objective through the NCFPC’s activities.8
The North Carolina Division of Aging and Adult Services is currently writing the 2023–2027 aging plan, and per the Older Americans Act (OAA) requirements, must address “screening for fall-related traumatic brain injuries”.9 The plan is scheduled to be released on July 1, 2023.
The North Carolina Division of Aging and Adult Services, pursuant to requirements in OAA Section 361, requires all Title III-D funding to be spent for evidence-based health promotion and disease/injury prevention programs, including falls prevention.10
The North Carolina Division of Public Health Injury and Violence Prevention Branch’s strategic plan (scheduled to be updated in 2023) includes several falls prevention strategies, such as building an integrated falls prevention network and enhancing capacity for falls prevention coalitions and health care systems to implement evidence-based/-informed programs.11 As examples, two of the most widely disseminated evidence-based falls-risk reduction and prevention programs offered in North Carolina include “A Matter of Balance” and “Tai Chi for Arthritis and Falls Prevention”.12
In November 2021, the North Carolina Institute of Medicine initiated a Task Force on Healthy Aging to focus on four primary topics related to aging in community settings: falls prevention; nutrition and food security; mobility; and social connections. The final report with recommended policy changes will be published by mid-2023.13
Ellen Caylor Schneider, MBA cofounder, NC Falls Prevention Coalition; associate director, Policy and Strategic Alliances, UNC Center for Aging and Health, Carolina Geriatrics Workforce Enhancement Program, University of North Carolina at Chapel Hill, School of Medicine, Chapel Hill, North Carolina.
Ellen Bailey, MA, MPH chair, NC Falls Prevention Coalition; senior project manager, Falls Prevention, North Carolina Center for Health Wellness (NCCHW) at UNC-Asheville, Asheville, North Carolina.
Ingrid Bou-Saada, MA, MPH co-chair, NC Falls Prevention Coalition; injury prevention consultant, Division of Public Health, Injury and Violence Prevention Branch, NC Department of Health and Human Services, Raleigh, North Carolina.
Disclosure of interests
E.S. and I.B-S. serve on the NCIOM Task Force on Healthy Aging. No further interests were disclosed.