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Message from the Co-Directors “The 2007 Fall Prevention Summit was the crowning event of Year 3 for the Fall Prevention Center of Excellence (FPCE). We are proud to say that – with the sponsorship of the Archstone Foundation, and The California Wellness Foundation - the FPCE was able to organize and host an event that, by all accounts, was highly successful in terms of sharing information, networking, and developing recommendations for next steps and new strategies in fall prevention. We thank all Summit participants for their time, support, and their enthusiasm. It was a pleasure being in the company of a group of experts who are as committed to fall prevention as we are. It was all participations’ active and passionate engagement that led to the success we now celebrate. At the Fall Prevention Summit everyone joined forces. Discussions centered around the question, “How can California better address the serious problem of falls in its growing elderly population?” Summit activities focused on developing recommendations that would lead to expanding multi-factorial fall prevention programs across the state, improving data collection, infusing fall prevention into the planning of aging, public health, transportation, housing, and health care programs. The Summit picked up where the 2003 California Blueprint for

Fall Prevention conference left off, and brought together over 140 stakeholders

Contents:

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From left to right: Fall prevention walk leaders Sherri Sussman, Debbie Rose, Ph.D., and Laurence Rubenstein, M.D.

w w w . s t o p f a l l s . o r g

Fall Prevention Projects 2

Model Projects 8

Resources 10

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from various fields that are – or should be – involved in fall prevention, among them California’s Area Agencies on Aging, universities, community-based organizations, health plans, service providers, local and state governments, foundations, and consumer advocacy organizations, as well as senior housing, low income housing, and assisted

living facilities. Thank you for helping us raise the awareness about fall prevention as a public health problem! The Summit provided the opportunity for stakeholders to build consensus policy changes that will strengthen California’s fall prevention infrastructure and thereby, benefit all older adults in California. The day after the Summit, 22 high priority policy recommendations were presented to the California Commission on Aging. The Commissioners agreed to support fall prevention as a public health issue of 2008. A “Fall Prevention Awareness Week” resolution, introduced by Senator Al Lowenthal, passed the Senate on February 29, 2008, and is now on its way to the Assembly. The 2007 Fall Prevention Summit will be remembered and revisited as significant fall prevention event of 2007.”

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At the Fall Prevention Summit (from left to right): FPCE Co-Director, Jon Pynoos, PhD, Archstone Vice President, Mary Ellen Kullman, MPH, and FPCE Co-Director, Debbie Rose, PhD.

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Canadian Healthcare System – Embracing Fall Prevention As a visiting keynote speaker at a recent Canadian conference on senior health and safety, Center Co-Director Dr. Laurence Rubenstein became re-acquainted with the Canadian healthcare system and its approach to senior health issues. The February 2008 conference in Edmonton was sponsored by the Provincial Health Authorities of Alberta and featured participants from all over Canada, presenting ideas and programs devoted to senior health and safety. Several things about the Canadian system were made very clear. First, Canada features an organized system of universally covered healthcare for all Canadians. Each province is divided into a number of regional health authorities, each of which is responsible for funding and organizing healthcare services for the region. The specifics of care provided vary somewhat from province to province, but all provide a high level of health services to essentially the entire population covered by government funding. In Canada, quality healthcare is considered a right. While there is a fee-for-service “alternative” system on the side for those who can afford to pay for it, most Canadians primarily rely on the government funded system and are generally quite happy with it. While the queues for elective surgery and procedures may be longer than in the USA, most services are available on demand. Second, Canada is widely aware of fall prevention as a major public health concern facing older adults. For several years, Canada has promoted programs of fall prevention, mostly at the local level but often coordinated provincially. A 2001 report describes local and regional Canadian fall prevention programs in some detail: http://hc-sc.gc.ca/seniors-aines/pubs/inventory/pdf/Inventory_e.pdf Some provinces have regional fall prevention plans, although most do not, relying instead on local programs. But fall prevention is clearly a priority health concern in Canada, as is exemplified by government-sponsored conferences to promote it. While the Canadian conference did not contain any breakthroughs or information on effective new fall prevention methodology, its very occurrence should set a glowing example to its neighbors to the south and get us to realize that it is indeed possible to make senior fall prevention a national priority.

Jon Pynoos, PhD Debra Rose, PhD Laurence Rubenstein, MD, MPH

The Fall Prevention Center of Excellence Instrumental in Creating the Napa Valley Fall Prevention Coalition Napa Valley is a special fall prevention success story. Thanks to seed funding from the Archstone Foundation and assistance from the FPCE, the AAA serving Napa and Solano counties established the “Napa Valley Fall Prevention Coalition”, an active member of California’s growing fall prevention community. In its first year, the AAA submitted two important proposals supporting fall prevention. The Napa County Master Tobacco Agreement received the first proposal and approved funding for $65,000. The second proposal was submitted to Queen of the Valley Medical Center Community Benefits Committee. This effort resulted in a grant award of $100,000. One of the most effective advocacy tools used by the AAA had been created by an FPCE researcher, Christy Nishita, PhD. During an FPCE teleconference call, Terri Restelli-Deits, Planner for the AAA, mentioned that data on the cost of falls would grab the attention of policymakers, funders, and other leaders in the community. Using California patient discharge data from 2004, Dr. Nishita analyzed the cost of hospitalized falls in Napa and Solano counties. Her analysis discovered that the average cost of an older adult who was hospitalized for a fall in 2004 was nearly $40,000 per patient. Ms. Restelli-Deits submitted these figures to Queen of the Valley Medical Center for consideration. Only a week later she received the good news: the AAA was awarded $100,000 of the $400,000 available to establish Napa Valley’s first Fall Prevention Program called StopFalls Napa Valley. Based on the data provided by the FPCE, the Solano Coalition for Better Health (a coalition composed of all the hospitals in Solano) added a goal targeted to the older adult population. This was an encouraging “first” in the Solano coalition’s history. Despite ongoing advocacy over the years, the older adult population had not been a high priority goal or objective.

New FPCE Fact Sheet Examines Fall Injuries among Older Californians Researchers Dr. Christy Nishita and Ms. InHee Choi prepared a 4-page pamphlet titled “Profile of California Falls.” Using the 2000-2004 California Patient Discharge data, it summarizes the rate of hospitalized fall injuries by age, gender, and race/ethnicity. It also examines the length of stay and the mean costs of hospitalized fall injuries. The data show that persons of advanced age, women, and whites were at highest risk of falling. Most falls occurred at home, and 80 percent of older Californians with a hospitalized fall injury stayed in the hospital for 7 days or less, with the cost of fall hospitalizations averaging more than $40,000. Moreover, the likelihood of returning home after a hospitalization declined with age. The data were supplied by the California Office of Statewide Health Planning and Development in partnership with the California Department of Health Services, EPIC Branch. For more information and to download the fact sheet, please visit the Fall Prevention Center of Excellence website www.stopfalls.org

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Terri Restelli-Deits, Planner for the AAA serving Napa and Solano counties, posing questions at the 2007 California Fall Prevention Summit.

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Coalitions As of October 2007, five existing (Phase I) and five new (Phase II) coalitions are participating in the current grant cycle. A welcome letter, resource matrix, and the FPCE contact list were sent to all grantees. An initial teleconference of all Phase II coalition grantees took place on December 18, 2007, with 16 grantee representatives and 7 FPCE staff members participating. A follow-up teleconference was held on January 29, 2008. The call addressed TA, mentoring, reporting, evaluation, and “lessons learned”. Phase I grantees generously shared their experiences with coalition start-up, recruitment, and developing assessment tools. The mentoring guidelines had been developed by the FPCE evaluation team, with the input of Phase I grantees and the TA leads. The Summit in December provided an excellent opportunity for FPCE staff to talk with the grantees who attended about their start-up activities, including a meeting of all grantees in March 2008.

Program Expansion Representatives from three Program Expansion projects that received Phase II funding convened with Archstone Foundation staff and FPCE senior leadership in Long Beach at the beginning of 2008. Heather Dale, MSW and Elizabeth Shatzel, MPA from the Alzheimer’s Family Services Center involved in the Adult Day Health Care - Partners in Preventing Falls project, Mike Stifel, BA and Kathy Warner, OTR from Jewish Family Services of Los Angeles’ STRIDE program, and Anna Fenner, LCSW and Dolly Tataje from ONEgeneration’s Fall Prevention Project presented successes and “lessons learned” during the first 18-months in Phase I. Their presentations highlighted the variability of sites and participants involved in fall prevention. The fall prevention experts discussed issues of implementing multifactorial fall prevention programs, evaluating and sustaining their efforts, and further development of a community-based fall prevention network.

Archstone Senior Fall Prevention Initiative

Damaged Sidewalks: More Than a Financial Stumbling Block in Los Angeles

Hip fractures in adults over 65 years of age, 95 percent of which are caused by falls, cost Medicare and MediCal billions of dollars each year. Many of these falls are preventable, according to Caroline Cicero, a research assistant at the Fall Prevention Center of Excellence. “Some city staff think that, ‘People who slip, trip, or fall aren’t paying attention,’ but that’s not necessarily true,” said Ms. Cicero. While “intrinsic” factors, such as vision and gait problems, can contribute to falls, there are many fixable “extrinsic” or environmental factors that also cause falls. Uplifted and cracked sidewalks are one of the most prevalent extrinsic factors in Los Angeles. These damaged sidewalks are “especially a problem for people who are older, who are more likely to sustain injuries because of diminished physical abilities or osteoporosis,” Ms. Cicero said. Of the 10,800 miles of sidewalks in the city of Los Angeles, over 4,000 miles are known to be in need of repair by the City, according to Dennis Weber, Division Manager of the Special Projects Division of the Bureau of Street Services, which is responsible for repairing sidewalks that are damaged by trees. According to the Los Angeles Municipal Code, the City is only responsible for repairing sidewalks damaged by trees. The Special Projects Division estimates that root growth from trees causes approximately 80 percent of sidewalk damage in Los Angeles. Los Angeles does have a system for people to report sidewalks in need of repair via telephone, mail, or online. However, many older people may not be aware of this system. In a survey of 150 people over 65, Ms. Cicero found that less than one-third of respondents knew

how to report a hazardous sidewalk. Even if one does report a damaged sidewalk in Los Angeles, there is no guarantee the sidewalk will be fixed promptly. “We’re on a backlog which is in the neighborhood right now of 80 years,” Weber said. Of the more than 4,000 miles of damaged sidewalk, the Special Projects Division was only able to repair 54.19 miles in the last fiscal year, 2006-2007, according to documents obtained from the Division. The number of sidewalks the Special Projects Division is able to repair is dictated entirely by how much money the Los Angeles City Council budgets for the sidewalk repair program. The City Council has decreased spending on the sidewalk repair program every year since 2002-2003. “It has decreased the last couple of years because of the budget crunch,” explained Council Member Bernard Parks, who represents the 8th Council District, encompassing USC and surrounding areas. The Special Projects Division receives funding from two sources to perform sidewalk repairs. The first is the “general fund,” which refers to the money allocated by the City Council in the budget. The dollar amount is translated into miles, based on the assumption that it costs $260,000 to repair one mile of sidewalk, according to Weber. “We take that total mileage and we divide it by 15 Council Districts and that would be their

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Damaged Sidewalks in Los Angeles

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Falls are a public health problemHave you reported uneven sidewalks, poor lighting, or broken curbs in your neighborhood? If you have had positive feedback from your city when you reported a hazard in your community, please let us know.

Write to Caroline Cicero at cicero@usc.edu

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allocation,” Weber explained. In other words, each City Council District is allocated the same amount of miles from the general fund.

The second source of funding are the Community Development Block Grants (CDBGs), which are allocated by the U.S. Department of Housing and Urban Development. This money can only be used in “low to moderate income areas,” so council districts with more areas with this economic profile (including the 8th District), receive more CDBG funds. As the amount of funding for sidewalk repairs from the general fund has decreased, so too has the amount from the CDBG. Right now, HUD grants CDBG funds to cities primarily to make economic improvements in low to mid-income neighborhoods.“I would like to see fall prevention become a known public health problem on the federal, state, and local level,” Ms. Cicero said, “where it’s rubberstamped by HUD that you can use your CDBG money for fall prevention in your community.” Ms. Cicero said that city governments, like that of Los Angeles, need to rethink how they allocate the CDBG funds they receive from the federal government. “They might say they’re going to use it to eliminate blight areas in their community,” Ms. Cicero said, “but they’re not using it, in their minds, to do fall prevention.” Ms. Cicero also said that more money would be available to cities like Los Angeles for repairing sidewalks if the California Department of Housing and Community Development amended its criteria for awarding redevelopment grants. “Fixing sidewalks for fall prevention is not an approved redevelopment use of funds,” Ms. Cicero said, “but it could be.” The only option the City offers to expedite sidewalk repairs is the “50/50 Voluntary Partnership Program.” Under this program, started three years ago, homeowners pay exactly half of the costs of fixing the sidewalks in front of their properties; the City pays the other half from the general fund. First, a homeowner must inform the Bureau of Street Services that he or she is interested in participating in the “50/50” program. Then, the

Bureau sends estimators to the home to determine the projected costs of repairing the sidewalk. If the homeowner agrees to the estimate, the Special Projects Division schedules the work to be completed within one year. The average cost for homeowners in the “50/50” program is $1,300, according to Weber. Council Member Parks is supporting another type of program for expediting sidewalk repairs, called a “point of sale” program. In such a program, “when a person sells their house, there is money set aside in the escrow funds to make those sidewalk repairs before the new owner actually takes over ownership,” Weber said. “Just as we require you to put earthquake straps on your water heater,” Parks said, “we should require your sidewalk to be in order before you sell the property.” “If we had [a point of sale program] in place over the last five years,” Parks said, “we would have repaired a significant amount of our sidewalks because of the amount of property sales.” Right now, the Special Projects Division does not have enough manpower to make the number of repairs that would be required in a point of sale program. If the City were to implement a point of sale program to increase the amount of sidewalk repairs, private contractors would have to do at least some of the work. Unless the point of sale or another cost-sharing program is passed by the City Council, there is no sign that the number of sidewalks being repaired in Los Angeles will increase. Still, Parks says repairing some sidewalks, no matter how few, is better than repairing none. “If you have a downturn in the budget, as we’ve had in the last year or so and expect to have over the next two years,” Parks said, “you’re constantly trying to meet a bare minimum of sidewalk repairs without eliminating sidewalk care altogether because of lack of funds.”

-- By Lee Epstein and Danya Burakoff

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Falls are a public health problemIf you or someone you know has had an experience with an outdoor fall worth sharing, please let us know.

Write to Caroline Cicero at cicero@usc.edu

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“I would like to see fall prevention become a known public health problem

on the federal, state, and local level”

Effective Exercise for Older Adults: Tai Chi Researchers have shown that tai chi, the ancient form of Chinese self-defense, is an effective exercise program for older adults. It improves physical strength and stability, key factors in preventing falls. Tai chi is rapidly gaining popularity around the world. Most recently, a group of interested older adults met at the Los Angeles public library in Chinatown (photo). They wanted to learn more about this gentle, low-impact exercise that everyone talks about. FPCE’s Bernard Steinman was one of the curious

exercisers. He said he had never participated in anything like it and found that the tai chi movements were “… more strenuous than it looks.” Mr. Steinman attended the class because he wanted to learn how tai chi could benefit older adults at risk for falling. “Most people in the class attended for the physical, and potentially spiritual benefits that tai chi is thought to provide”, Mr. Steinman told us. Tai chi focuses on multidirectional weight shifting, awareness of body alignment, and multi-segmental movement coordination, while integrating synchronized breathing. Good evidence now exists for the use of alternative forms of exercise such as tai chi as a medium for lowering fall risk and/or fall incidence rates among more sedentary community-residing older adults who are relatively healthy. Programs incorporating more simplified forms of tai chi and a smaller number of movement sequences that emphasize the types of movements most affected by the aging process appear to be particularly effective in reducing falls. Regularly practicing older adults report less anxiety and depression, but improved balance and coordination, better sleep quality and cardiovascular fitness. Tai chi exercisers frequently express less fear of falling, an identified risk factor for falling.

-- By Danya Burakoff

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Pathways to Sustaining Fall Prevention Activities This TA brief (written by Emily Basner, BA, Gretchen Alkema, PhD, and Phoebe Liebig, PhD) was created to provide effective methods for program sustainability. Sustainability is an organization’s capacity to continue engaging fall prevention program participants and community stakeholders through activities and services over time. Often, when a grant is awarded to an organization to initiate or support its activities, funding is provided for a limited period of time. Fall prevention organizations need to have strategies in place to ensure the sustainability of their activities after initial funding ends. This brief offers a variety of strategies and ideas to promote sustainability beyond securing additional funds, such as redefining the scope of activities, creating partnerships with other organizations, seeking volunteers and in-kind support, and educating providers, policy makers, and the public on the risk of falls and fall prevention activities. It is essential to start the sustainability process early and continue sustainability practices throughout the life of fall prevention efforts to ensure that activities have a lasting impact on the community and the people who are served. The brief has been distributed to the 13 existing Archstone Foundation coalition grantees to strengthen the sustainability of their fall prevention activities.

FPCE researcher Bernard Steinman, MS, (left) practicing tai chi at a public library in LA’s Chinatown. Ph

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Putting All the Pieces Together:Multifactorial Fall Prevention through the InSTEP Model Projects

The evidence for effective fall prevention programs has grown tremendously in the past 15 years. Yet, important questions surrounding the optimal program components, intensities, and target populations remain unanswered. Clear evidence showing efficacy for three program elements - multifactorial medical fall risk assessment, targeted exercise, and environmental inspection and amelioration – is needed.

The InSTEP program (Improving Stability through Evaluation & Practice) responds to this evidence. To date three program sites at Southern California senior centers implement this program to help researchers compare the relative benefits and costs of “high” and “medium” intensity as well as “participant preference” fall prevention programs. Preliminary InSTEP data are promising and may answer initial questions on program intensity, the incremental value of behavior modification, and relative cost-effectiveness. St. Barnabas Senior Center, as well as the Lakeview Senior Center in Irvine and Walnut Senior Center are implementing InSTEP programs with all three key program elements. Other senior centers in Los Angeles and Orange County are expected to follow their lead.

St. Barnabas The St. Barnabas Senior Center of Los Angeles has reason to celebrate. The Center opened its doors to older adults in Los Angeles 100 years ago and has provided a continuum of care ever since. That continuum includes case management, transportation and escort, congregate meals, home delivered meals, grocery shopping and delivery, in-home supportive services and a cyber café. St. Barnabas Senior Services is also proud to offer a model InSTEP program. To date, 20 older adults have completed the St. Barnabas program. Cy Baumann of Rebuilding Together SoCal was part of the effort from the very beginning. “The program had made each of the clients quite aware of conditions that pose a risk for falling in their homes, and they were delighted to have the modifications put in place”, he tells us at a visit at the senior center. He remembers, “… one of the modifications included a handrail that extended nearly 70 feet along an inclined walkway with several flights of stairs extending from the street to the entry door.” At the end of April InSTEP participants, past and

current, will gather at St. Barnabas to celebrate for an InSTEP graduation and alumni meeting. Kathy Warner, a licensed occupational therapist and the InSTEP exercise instructor will present current participants with a certificate stating that they have successfully completed a 12 weeks program. “The InSTEP program is a great program to achieve overall fitness including stretching, aerobics, strengthening and balance. It has been well-received by participants, and they are feeling progress at all levels. It is a fun program for the participants and the instructor too!!” The group camaraderie is high, which will hopefully lead to life-long fall prevention efforts after their time with InSTEP comes to an end. “The InSTEP program has given many seniors the opportunity to divert from their usual daily routines by joining an exercise class, meeting others seniors and socializing on a regular basis throughout the week. More importantly, the program has helped boost their self confidence and realize that they are capable of living independently in the comforts of their own homes. As a social worker for the program, it has been a pleasure to watch their physical progress and overall enthusiasm for the program from beginning to end”, said Bridgette Lazarraras, who completes the medical risk screens and home risk assessments for the St. Barnabas InSTEP program. Tina Hummel, InSTEP Model Program Coordinator at St. Barnabas, is currently recruiting participants for the third rotation of the program. “InSTEP has made extraordinary strides with seniors, helping them with strength and balance, but equally important, helping them with confidence that they can still be independent and safe”, confirms Martha Spinks, Executive Director at St. Barnabas.

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Walnut Senior Center is currently recruiting for a class starting June 16, 2008. St. Barnabas is recruiting for a class starting July 9, 2008. Interested older adults who would like to participate or who know individuals who would benefit from a fall prevention program such as InSTEP, can reach InSTEP Model Coordinators Tina Hummel and Carrie Greer at 213.740.1364.

Upcoming Programs

Fear of Falling One in three people 65 and older fall each year. Identified risks for falls include muscle weakness, dizziness, poor medication management, diabetes and depression, but also osteoporosis, arthritis, and problems with sensory perception and memory. Possibly underestimated is another risk factor: the “fear of falling”. Psychologists define the fear of falling as a concern about falling that can lead an individual to avoid activities he or she is capable of doing. This persistent, abnormal, and unwarranted fear causes thousands of people distress. Studies indicate 30-50% of older adults fear falling and restricts their movement, inside and outside the home. Fear of falling is an involuntary psychological process that, like most anxieties, creates a sense of uncertainty and vulnerability that disturbs feelings and behaviors. Symptoms can include shortness of breath, irregular heartbeat, sweating and nausea. Like many fears, the fear of falling is created by an unconscious mind as a protective mechanism. In many cases, the anxiety-syndrome is a negative consequence of falling. A publication from a panel of medical experts on fall prevention states that “the loss of self-confidence can result in self-imposed functional limitations.” Fear of falling in older populations is associated with avoidance

of activity, which negatively impacts health by decreasing strength and endurance, and increasing the risk of breaking a bone when falling. Inactivity frequently leads to a loss of independence and depression, which escalates the problem further by requiring medication or leading to increased alcohol

consumption. One can cope with the fear of falling by increasing activity levels through exercise such as tai chi featured on page 7. Quite possibly, balance

training, group exercises, and strength training may reduce the risk of falling by reducing the fear of falling. However, becoming physically active may not be sufficient to reduce the fear of falling. Older adults identified as fearful of falling need to develop both physical and better mental skills to overcome their fear. This is not a trivial matter. Some programs such as Matter of Balance, for example, use cognitive restructuring techniques aimed at helping clients turn negative into positive thoughts, and replace their concerns about falling with constructive, confidence-building strategies (Tennstedt et al., 1998). Other fall risk reduction programs such as FallProof TM (Rose, 2003), combine targeted balance and mobility training with mastery experiences, verbal persuasion, and social support strategies aimed at fostering improved fall self-efficacy as well as improved balance and mobility. (To view references please visit www.stopfalls.org)

-- By Danya Burakoff

New Program Review is Here! Great news! The Fall Prevention Center of Excellence announces the new release of a long-awaited fall prevention program review describing 9 fall risk reduction/prevention programs currently in dissemination in the United States, including California. These fall prevention programs were selected according to the following criteria: a) a clear focus on fall risk reduction, b) the availability of replication materials, and c) published evidence of program efficacy and/or extensive field testing. This brief will be accessible in print format and via www.stopfalls.org, the website created and maintained by the Fall Prevention Center of Excellence. We invite feedback! Developers of the programs included in this brief are welcome to respond, comment, or even clarify. We also encourage those who would like to have their fall prevention programs included in future versions of this brief to contact Anna Quyen Do Nguyen, OTD, OTR/L at the Fall Prevention Center of Excellence - anna.q.nguyen@gmail.com

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“The fear of falling is defined as a concern about falling that can lead an individual to avoid

activities he or she is capable of doing.”

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Continuing Education Database The “continuing education” database is offered as a service of the StopFalls Network California in conjunction with the Fall Prevention Center of Excellence (FPCE) to assist professionals in finding continuing education opportunities in the area of fall prevention. Although efforts are made to review each course, inclusion in the database should not be viewed as an endorsement by the FPCE or StopFalls Network. Neither the StopFalls Network nor the FPCE make any guarantees regarding these courses or the information presented in this database. Questions regarding individual courses should be directed to the respective organization offering that course. As with any continuing education course, for questions regarding applicability and acceptance of continuing education units, individuals should contact their professional licensing board prior to registration. For comments regarding this database or to suggest a course for possible inclusion, please contactShaun Rushforth at srushfor@usc.edu

New Advocacy Toolkit The StopFalls Network is putting together an advocacy toolkit. It will include as a centerpiece three versions of a PowerPoint presentation to raise awareness among local experts and leaders (e.g. Boards of Supervisors) on the problem of falls in their community, what is currently being done, and how the leaders can help. It will be possible to “customize” the slides by location, with drop in spots for local data and activities. Currently, Network members are reviewing a prototype of the toolkit that will also include fall prevention fact sheets, sample proclamations, sample letters to policymakers, case studies, instructions on obtaining local falls data, and a menu of advocacy options. StopFalls members hope to make this toolkit available shortly. Please look for further information on the FPCE website at www.stopfalls.org

ICADI 2008 – Reframing Universal Design St. Petersburg, Florida hosted the 5th Annual International Conference on Aging, Disability, and Independence. This year the conference focused on advancing technology and services to promote quality of life and support people as they age, while maintaining independence in daily living at home, at work, and in the community. FPCE staff Anna Q. Nguyen, OTD, OTR/L and Rachel Caraviello (photo on page 11) attended the conference, including a one-day pre-conference workshop titled “The 21st Century Community”. It explored universal design (UD), how it can be marketed, and how to infuse principles of evidence-based practice. Universal design refers to a socially inclusive design approach that considers the needs of a diverse population. Having emerged from the disability and de-institutionalization movements of the late 1970s, many professionals serving older adults currently associate UD with accessibility, disability, and aging. From a marketing perspective, consumers do not connect with such terms as they are seen as stigmatizing. For years, these negative associations have hindered the proliferation of UD in remodeling and the development of new homes.

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StopFalls Network News

“We’d Like to Hear From You“Life is filled with stories! You may know a person whose life changed after a serious fall. Or you may care for a person who fell and suffered serious injuries. These are important stories we want to know and tell others. We’dlike to hear from you! How has a fall impacted your life? Please send your story to:

The Fall Prevention Center of ExcellenceAttn.: Regina Gongoll, MSGUniversity of Southern California3715 McClintock Ave.Los Angeles, CA 90089-0191213.821.6703or email a copy to: gongoll@usc.edu

continued on page 11

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Common universally designed features include lever door handles, open loop drawer pulls, raised electrical outlets (18”), brightly illuminated paths, and wider hallways and doors, as well as zero step entry at not one, but all entrances. If executed well, universally designed features are virtually invisible; they are seamlessly integrated into the overall design. At this point, however, many consumers do not recognize the term “universal design” or know of its underlying concepts. It is still possible to redefine and reframe UD to make it more marketable and consumer-friendly – either by transforming it into an appealing, designer lifestyle or by linking it to a thriving movement, such as “green housing”. Similarly, the concept of “fall prevention” has marketability issues. In order to utilize fall prevention concepts, individuals must acknowledge that everyone can fall and suffer fall-related injuries or even die after a serious fall. Unfortunately, advertisers say little about such vulnerability. Baby Boomers are told to consider the age of 60 as “the new 40”; advertisers promise independence, vitality and good health well into Boomers’ older age. Fall prevention advocates may have to come up with fundamentally different marketing strategies in order to encourage better acceptance of interventions and programs. The challenge is to link fall prevention with a desired movement towards better health, improved lifestyle and continued independence.

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From left to right: Rachel A. Caraviello (FPCE), ICADI Conference Chair William C. Mann, OTR, PhD (UF), Anna Quyen Do Nguyen, OTD, OTR/L (FPCE), ICADI Sponsor and Partner Organization Coordinator Gwen-dolyn Mann, MSW (UF), and Shigeki Inoue (MIT)

Since 2003, the year of the first statewide Blueprint for Fall Prevention conference in Sacramento, substantial progress has been made toward increasing visibility of fall prevention as a major public health issue. More sustainable fall prevention programs have been developed; policy makers are more aware of fall prevention efforts in their communitites and are taking fall prevention initiatives seriously; practitioners, researchers and consumers are joining forces to create a strong fall prevention infrastructure in California that will benefit all older adults at risk of falling. This chart and other helpful graphics illustrating California’s efforts since 2003 are available on www.stopfalls.org

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Fall Prevention Center of Excellence(multi-factorial approach via physical activity , medical management , & home modification )

CALIFORNIA FALL PREVENTION EFFORTS - 2008

“Safe California” PlanCalifornia Senior Fall

Prevention Projects

● 10 Coalition Development● 6 Program Expansion

Evidence-Based Disease Prevention

Project Implementation :

“Matter of Balance”

Examples of Independent Fall Prevention Programs

● CHIPPS – SF DPH ● Senior Safety Task Force – Sonoma AAA● SIPP – Alameda Co. ● Senior Health Improvement Program – Butte Co.● Farewell to Falls – Stanford ● Shasta Co. Fall Prevention Coalition● Staying Mobile – Ctr. Healthy Aging ● Mature & Secure from Falls – Sequoia HospitalHome Modification

Programs

InSTEP Model Projects

Administration on Aging Archstone Foundation Centers for Disease Control & Prevention California Wellness FoundationLocal/County

Funding

Veterans Health Administration GRECC / UCLA

USC Andrus Gerontology Center

CSU Fullerton Center for Successful Aging

CA Department of Public Health

Fall Surveillance Data Analysis

StopFalls Network

Program Analysis & Technical Assistance

CA Department of Aging & AAA Network

MSSP & Linkages FP Programs

Partners in Care Foundation

AAA Title III-D Health Promotion

Projects

Legend : Green = Funding Sources ● Yellow = Coordinating Agencies ● Blue = FPCE Collaborators ● Orange = Fall Prevention Activities & Programs

Developed by Fall Prevention Center of Excellence , March 2008

FallProof ™

www.stopfalls.org

California Fall Prevention EffortsResources

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12Credits:Editor: Regina Gongoll

Contributors: Gretchen Alkema, Emily Basner, Athan Bezaitis, Danya Burakoff, Rachel Caraviello, In Hee Choi, Caroline Cicero, Lee Epstein, Carrie Greer, Tina Hummel, Anna Quyen Do Nguyen, Christy M. Nishita, Kali Peterson, Laurence Z. Rubenstein, Bernard Steinman and Rachel Zerbo Graphic Design: TalentPool Design www.talentpool.design

Acknowledgments:Special thanks go to: The Archstone Foundation for funding FPCE News as part of its “Fall Prevention Initiative”

Phoebe Liebig, PhD, and Gretchen Alkema, PhD, who helped inform the development of this newsletter

Trevor Nelson, who serves as webmaster for FPCE’s website, www.stopfalls.org and for FPCE News (electronic edition)

The Fall Prevention Center of Excellence is supported by the Archstone Foundation

Who We AreCo-Directors:

Laurence Rubenstein, MD, MPHDirector, Geriatric Research Education & Clinical Center (GRECC), VA Greater Los Angeles Healthcare SystemProfessor of Medicine David Geffen School of Medicine at UCLA

Debra Rose, PhDProfessor and Co-DirectorCenter for Successful AgingCalifornia State University Fullerton

Staff:Maria Henke, MAProgram Director

Regina Gongoll, MSGProgram Manager

Miguel VasquezProgram Coordinator

Kali Peterson, MSG, MPAInSTEP Project Manager, Geriatric Research, Education, and Clinical Center (GRECC), VA Greater Los Angeles Healthcare System

Carrie GreerInSTEP Model Program Coordinator

Tina HummelInSTEP Model Program Coordinator

Gretchen Alkema, PhDResearch Scientist

Anna Quyen Do Nguyen, OTD, OTR/LResearch Scientist

Josea Kramer, PhDResearch Associate

Phoebe Liebig, PhDResearch Associate

Julie Overton, MSG/MHATraining and Development Resource Specialist

Barb Alberson, MPHHealth Educator, State and Local Injury Control Section (SLIC), California Department of Public Health

Rachel Zerbo, MPHDPH Fall Prevention Project Manager,Epidemiology and Prevention for Injury Control (EPIC), California Department of Public Health

Bernard Steinman, MSResearch Associate

Emily BasnerResearch Assistant

Rachel CaravielloResearch Assistant

In Hee Choi, MIPAResearch Assistant

Caroline Cicero, MSW, MPLResearch Assistant

Trevor NelsonWebmaster www.stopfalls.org

Fall Prevention Center of ExcellenceProgram OfficeUniversity of Southern CaliforniaAndrus Gerontology Center, Room 228Los Angeles, CA 90089-0191

Tel: 213. 740.1364Fax: 213.740.7069Email: info@stopfalls.orgwww.stopfalls.org

FPCE In the NewsA Very Special LectureIn USC NEWS On March 3rd, the USC Davis School’s Jon Pynoos, PhD, traveled to the University of Illinois College of Law as an honored guest to deliver the 2008 Anne F. Baum Memorial Elder Law Lecture at http://www.stopfalls.org/news/2008/0306.shtml

Summit takes Stand on Fall PreventionIn Agenda, Aging Services of California, February 2008 Aging Services Director of Communications, Stuart Greenbaum, attended the 2007 California Fall Prevention Summit in Long Beach, CA and reports at http://www.aging.org/i4a/pages/index.cfm?pageid=1144#agenda

Successful Strategies for Fall PreventionIn Aging Well, Vol. 1,1; P. 28 Older adults can fall anywhere, but they most often fall inside, outside, or near the home. USC staff writer Athan G. Bezaitis introduces successful strategies for fall prevention at http://www.agingwellmag.com/winter08p28.shtml

Jon Pynoos, PhDUPS Foundation Professor of GerontologyAndrus Gerontology CenterUniversity of Southern California