As our population ages, fall injuries and deaths in North Carolina (NC) are an increasingly serious public health issue. Falls are the fourth leading cause of unintentional injury death for North Carolinians of all ages,and in every year from 1999 to 2010, the number one cause of injury death for individuals 65 and older.

From 2000-2011, the death rate from falls increased 65.9% in the 65 and older population. In 2011, 85% of the 883 deaths related to falls were among North Carolinians age 65 and older.That same year, NC experienced 25,141 hospitalizations and 193,805 Emergency Department (ED) visits due to falls. On an average injury day, there are 2 fall deaths, 69 hospitalizations, and 531 ED visits in NC. 

In 2011, the median hospital discharge fee for NC residents age 65 and older admitted for a fall was $25,404, a 35% increase from $18,800 in 2007.The total hospital discharge fees for North Carolinians 65 and older due to falls was over $806 million dollars. Of the 25,141 people hospitalized following fall-related injuries in 2011, 41% were discharged to a skilled nursing facility, 29% went home and 14% went home and required home health care. Hospital charges only account for a small portion of the total cost of a fall. Falls can also result in costs due to work loss and follow-up treatment.

NCCHW served as a subcontractor of the 2014 Prevention and Public Health Fund ﴾PPHF﴿ Falls Prevention ﴾FP﴿ grant to the NC Division of Aging and Adult Services ﴾DAAS) from 2015-2017. The 2014 grant established the Healthy Aging NC ﴾HANC﴿ Resource Center in January 2016 to serve as a statewide hub at NCCHW, with a goal of centralizing support for communication, data management, data reporting, and technical assistance for falls prevention activities ﴾www.healthyagingnc.com﴿. In 2017, NCCHW received a three-year award from the Administration for Community Living to: expand access to, and utilization of, two evidence‐based falls prevention programs ﴾EBFPP﴿; increase sustainability in 18 counties of Western North Carolina ﴾WNC﴿; and leverage the statewide integrated, sustainable evidence‐based falls prevention programs network.

BUILD CAPACITY

• NCCHW, through its Healthy Aging NC initiative, partners with the High Country Area Agency on Aging to maintain a statewide Tai Chi for Arthritis Training Academy. The training academy ensures the training of high-quality leaders in the evidence-based Tai Chi for Arthritis program, and adherence to fidelity to ensure falls prevention outcomes and benefits
• NCCHW, through its Healthy Aging NC initiative, brings together a network of five Area Agencies on Aging in Western NC and the Mission Health system to develop a referral and program feedback loop between clinical referrals and community falls prevention programming. The three-year grant-funded project will identify social determinants of health in the referral-to-program-implementation, and will lead to a value proposition on creating referrals through a centralized hub, or backbone organization.
• NCCHW staff, through the Healthy Aging NC initiative, supports statewide access to data and resources through software, website, and media options. This includes the website www.healthyagingnc.com; the on‐the‐cloud data management software Workshop Wizard; access to the National Council on Aging falls prevention database, and the ongoing partnership with the N.C. Division on Aging and Adult Services.

IMPACT POLICY

• NCCHW staff, through the Healthy Aging NC initiative, creates “systems changes” within agencies so they can maintain program leaders, collaborate through formal agreements, afford program materials, and provide workshops in an ongoing and sustained way. This occurs through NCCHW staff capacity, the Tai Chi Training Academy, access to the website, regular programmatic data results, and resource development.
• NCCHW staff, through the Healthy Aging NC initiative, works on strategies for health care providers and insurance providers to include CDSME in the provision and reimbursement of services. This occurs by raising awareness of the benefits of CDSME, establishing clinical and community partnerships, supporting Medicare reimbursement processes, and developing business acumen tools like value propositions. NCCHW staff conduct research on these topics and offer trainings to support our partners in achieving long-term sustainability.

IGNITE COMMUNITY INITIATIVES

• NCCHW staff, through the Healthy Aging NC initiative, supports the scaling of falls prevention programs in communities needing the programs. This is done through state and regional falls prevention coalitions, regional network convening, creating referral systems, offering marketing and registration online via healthyagingnc.com, conducting research on program best practices and developing requested toolkits.
• NCCHW serves as a convener of those with interests in preventing falls, reducing healthcare costs, and improving healthcare outcomes. Through Healthy Aging NC, NCCHW is the centralized, coordinated evidence‐based falls prevention program network hub for NC.

The University of North Carolina at Asheville, NC Center for Health and Wellness maintains a full time Falls Prevention (started January 2016) and data administrator (started December 2015) to manage the deliverables of a 2014 ACL grant. Since December 1, 2015, the data administrator has received data packets for the AMOB and Tai Chi for Arthritis programs.The Falls Prevention Coordinator has been involved in: the branding of the entry portal for healthy aging programs (via a website); developing a continuum of care tool kit; presenting on the resource center to state and regional falls prevention coalitions and other partners;assisting with falls prevention advisory team meetings; seeking referral processes from diverse partners; integrating the various evidence-based falls prevention programs into a connected network;and engaging in sustainability strategy discussions. Deliverables expected include: the development of a statewide business plan and sustainability plan; distribution and evaluation of a clinician falls prevention awareness survey;and completion of the continuum of care toolkit.

NCCHW is also involved with the North Carolina Medical Society Foundation (NCMS), an organization that is helping rural Accountable Care Organizations (ACOs) develop across North Carolina.There have been discussions about including falls prevention programs into ACO funding mechanisms, building off the infrastructure that already exists with YMCAs for Diabetes reimbursement. NCCHW has also met with partners such as Carolina Medical Systems, Genesis Rehab Company,Wake Forest Baptist Health,and others to investigate community/clinical partnerships and long term sustainable funding for evidenced-based falls prevention programs.To continue and advance the work of the Resource Center, the Division of Public Health’s Injury and Violence Prevention Branch included the Resource Center in their CDC CORE Injury funding request. This funding was awarded and $10,000 will be given to the NCCHW Falls Prevention Resource Center per year for 5 years.The NCCHW has also begun engaging in fundraising efforts for the Resource Center work. Meetings with clinical partners have been held resulting in Mission hospital system implementing NC Fall Prevention Coalition’s Information Packet into their patient portal system. We continue to work with them to embed strategies that will improve quality measures, raise awareness among clinicians and the public, and result in fewer fall related injuries and deaths among North Carolinian elders.

CHALLENGES

By 2025 it is projected that 90 of NC’s 100 counties will have more population age 60 and older than ages 0-17.This substantial increase of older adults in NC will likely result in a drastic rise in deaths, hospitalizations,and ED visits due to unitentional falls. Additional challenges are that community health improvement processes often lump fall related concerns in with “physical activity” or that awareness of the burden of falls in one’s area is unknown and the issue is not represented well in community or hospital assessments processes. We also have the challenge of changing public perception that falls are a preventable demise and not a normal part of aging.

Map of the Counties Impacted by Falls Prevention Trainings (Updated July 2018)

Increasing awareness of evidence-based falls prevention screening and programs to reach older adults and adults with disabilities who are at risk for falls through a centralized resource center is a primary function of this work. UNC Asheville through the NC Center for Health and Wellness will support the expansion of evidence-based Falls Prevention screening (Building Better Balance) and programs (A Matter of Balance, and Tai Chi Moving for Better Balance,and Tai Chi for Arthritis) to reach older adults and adults with disabilities who are at risk for falls.We will maintain a centralized online hub/resource center that will facilitate in the coordination of evidence-based Falls Prevention activities and programs.We will work to strengthen the collaboration of Evidence-based Falls Prevention activities and programs at the state and local level to improve access of older adults and adults with disabilities who a great risk for falls to community programs that decrease fall risk by incorporating new community programs into the Hub.We will elevate the visibility and knowledge of the falls prevention hub as a single point of entry for falls prevention information for providers, clinicians,and the public in North Carolina by promoting the Hub through various communication channels.

Additionally, we will embed data collection and reporting systems for the various programs into the Statewide Falls Prevention Resource Center.We will conduct data collection and dissemination for Centers for Disease Control and Prevention grant reports as requested. Programs will be promoted and delivered through establishment or reinforcement of Regional integration committees and leveraging the successes of various Fall Prevention Coalition activities in the state,as well as through The Fall Prevention grant advisory team and a variety of partners.

YMCA Alliance of NC/ YMCA of WNC

The YMCA of WNC and Alliance of YMCAs have been one of our largest partnerships. They are the disseminators of the YMCA: Moving for Better Balance Tai Chi program and work very closely with us on program expansion. NCCHW brought together the YMCA of WNC and the Land of Sky Area Agency on Aging to explore strategies for linking program participants on a continuum of care and have begun embedding the A Matter of Balance program as a complement to other programming offered.

UNC Chapel Hill

UNC Chapel Hill houses the Carolina Geriatric Education Workforce Enhancement Program which is an integral leader in expanding education around the Otago Exercise Program to physical therapists throughout the nation.

NC Department of Human Services

NC Division of Aging and Adult services

These state partners are integral part of the efforts to create more access and visibility of fall prevention strategies and evidence based programs in North Carolina. We work with them to disseminate information and updates about Resource Center activities among the aging network partners. We also collaborate with them to make strategic choices and create guidance for the state on how to disseminate and operate evidence based programs.

Injury Free NC and the Injury and Violence Prevention Branch of DPH

These two groups provide up to date data on the state of fall death and injury in the state and provide access to partners with whom we share our resources.

Statewide Area Agency on Aging Network

16 Area Agencies on Aging are responsible for a variety of health promotion and aging services in North Carolina and primary implementers of the A Matter of Balance and Tai Chi for Arthritis programs. We serve as technical assistance and expansion support alleviating many of their administrative burdens.

Home Health Agencies

Various home health agencies partner with state and local fall prevention coalitions and historically are interested in championing programs and being the eyes and ears of their communities to implement fall prevention strategies.

Mission Hospital Systems

Mission Hospital is committed to the health and wellness of the 18 western most counties in North Carolina. NCCHW staff work together with Mission staff to embed evidence-based programs as part of the standard of care for the aging population in Western North Carolina.

Regional and State Fall Prevention Coalitions

NCCHW serves on and works in conjunction with the state and several regional coalitions where fall prevention information and best practices are shared among various community stakeholders.

Alliant Quality

Alliant Quality is the Quality improvement organization for North Carolina. They engage in some degree of data sharing with NCCHW and provide access to practice care managers and other across the state.

Community Care Organizations across NC

Community Care organizations work with NCCHW to increase awareness of programs and strategies for fall prevention among their staff and find ways to embed referral systems.

Wake Forest Baptist Health

Wake Forest Baptist Health’s Senior Advisor for Transitional Care and Outcomes (Pam Duncan) is an advisor to the Fall Prevention activities of NCCHW and has assisted us in embedding Healthy Aging NC information into their Compass study to connect stroke survivors to community resources.

Genesis Rehab

Genesis Rehab has operationalized procedures and continues to educate its physical therapists on implementing Healthy Aging NC to connect discharging patients to community based fall prevention programs.

Office on Disability

NCCHW maintains a partnership with the NC Office on Disability and both work together to find ways to connect programs in the disability community.

Office of Minority Health

NCCHW maintains a partnership with the Office of Minority Health and relies on their insights and expertise to inform our strategies for connecting fall prevention programming in minority communities.

NC ACT

NCACT’s yearly conference serves as a platform for us to share best practices and to learn about other work in this area.

Multiple agencies that support Older Adults (senior centers,geriatric case managers,care transition teams, independent living facilities,etc)

All of these partners are further potential for increasing the visibility of our services and resources.