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It takes a village to prevent falls: reconceptualizing fall prevention and management for older adults

¹ Veterans Affairs, Greater Los Angeles Healthcare System, Los Angeles, CA, USA
² David Geffen School of Medicine at University of California, Los Angeles, CA, USA
³ Fall Prevention Center of Excellence, Andrus Gerontology Center, University of Southern California, Los Angeles, CA, USA
⁴ Daniel J Epstein Department of Industrial and Systems Engineering, University of Southern California, Los Angeles, CA, USA
⁵ RAND Corporation, Santa Monica, CA, USA

Dr D A Ganz, Veterans Affairs, Greater Los Angeles Healthcare System, 11301 Wilshire Boulevard (11G), Building 220, Room 308, Los Angeles, CA 90073, USA; dganz{at}mednet.ucla.edu

Systematic evidence reviews support the efficacy of physical activity programs and multifactorial strategies for fall prevention. However, community settings in which fall prevention programs occur often differ substantially from the research settings in which efficacy was first demonstrated. Because of these differences, alternative approaches are needed to judge the adequacy of fall prevention activities occurring as part of standard medical care or community efforts. This paper uses the World Health Organization Innovative Care for Chronic Conditions (ICCC) framework to rethink how fall prevention programs might be implemented routinely in both medical and community settings. Examples of innovative programs and policies that provide fall prevention strategies consistent with the ICCC framework are highlighted, and evidence where available is provided on the effects of these strategies on processes and outcomes of care. Finally, a "no wrong door" approach to fall prevention and management is proposed, in which older adults who are found to be at risk of falls in either a medical or community setting are linked to a standard fall risk evaluation across three domains (physical activity, medical risks, and home safety).