Improving Local Service Delivery to Prevent Falls in Community-Dwelling Older Americans: A Conceptual Model

Background/Purpose:  Unintentional falls are the leading cause of both fatal and nonfatal injuries among Americans aged 65+, resulting in approximately 2.4 million emergency department visits and over 20,000 deaths annually. Local health departments and area agencies on aging can play an important role in fall prevention. Little is known about the degree of collaboration among these agencies. This model presents a systematic way to examine such collaborative efforts and the types of fall-prevention services delivered at the community level.

Methods:  The conceptual model was developed from two theoretical frameworks. The first is the Donabedian (1980) structure-process-outcome model, as applied by Handler et al. (2001) to examine public health system performance. The second is the precaution adoption process model (PAPM), a behavior change model applied here to local agency directors.

Results/Outcomes: According to the model, outcomes are a cumulative result of the interaction between the macro context (federal- and state-level factors), structural capacity (including local agency director factors), and processes (fall-prevention programs and services). Expected outcomes of successful local implementation of evidence-based fall-prevention services include 1) reduction in fall rates, 2) decrease in fractures and other injury due to falls, 3) decrease in admission to hospitals and long-term care facilities, and 4) decreased medical costs associated with falls.

Conclusions: This model highlights elements of local public health systems that should be considered in efforts to increase provision of evidence-based fall-prevention services to community-dwelling older adults. The model provides a systematic approach to both planning and evaluation of local fall prevention services.