Prioritizing Community-Clinical Linkages to Prevent Falls in Older Adults

July 01, 2026 | Amy Ciarlo

Falls among adults age 65 years and older are the leading cause of fatal and nonfatal injury, decreased independence, and health care costs across the United States. As the U.S. older adult population grows, falls are projected to increase. Moreover, older adults living in rural areas report 25% more falls than their urban counterparts, compounded by barriers including increased distance to care, fewer public transportation options, and limited health promotion services.

Despite the statistics, falls are preventable — through the mobilization of health agencies, providers, communities, and older adults themselves.

Evidence-Based Approaches

Health care providers play a critical role in supporting the health and independence of older adults. CDC’s Stopping Elderly Accidents, Deaths, and Injuries (STEADI) initiative provides a coordinated approach to screen patients for fall risk, assess modifiable risk factors, and implement effective intervention strategies to reduce falls. STEADI translates complex guidance into actionable clinical workflows, including tools for gait and balance assessment, medication review, and patient education.

Community-level evidence-based programs complement clinical care. Exercise programs such as Tai Chi, Matter of Balance, and Staying Active and Independent for Life improve balance, strength, and confidence among older adults. Additionally, programs offering home safety assessments help identify hazards and modifications to prevent falls. Research consistently shows that collaborative efforts linking clinical and community-based programs support sustainable falls prevention at scale. Efforts to establish these linkages are especially impactful in rural and underserved communities where program offerings are limited.

ASTHO's guide to Expanding Falls Prevention Through Surveillance, Community-Clinical Linkages, and Strategic Planning and Evaluation helps health departments align and expand these efforts. It outlines three strategic steps:

1. Assess the current falls prevention landscape.
2. Identify opportunities to strengthen community-clinical linkages.
3. Develop a plan to implement and sustain those linkages over time.

State Health Agency Highlights

Since 2023, ASTHO has partnered with CDC to build capacity among states to establish and strengthen community-clinical linkages for older adult falls prevention and expand the adoption of STEADI into clinical practices. The Iowa Department of Health and Human Services and Oklahoma State Department of Health participated in a multi-year pilot learning community. Through technical assistance, structured learning sessions, and action/evaluation planning, both states captured measurable progress in implementing STEADI and connecting clinical providers to community resources.

Iowa: Building a Connected Ecosystem

Iowa's strategy centered around the Iowa Community HUB (HUB), a community care hub that links networks of community-based organizations to the health care continuum through centralized infrastructure. Iowa has used the HUB to expand reach of evidence-based falls prevention programming.

Key achievements from the Iowa pilot include:

• Embedding STEADI workflows into multiple partner clinics, including electronic referral orders within EHR systems linking patients directly to the HUB.
• Training numerous clinicians on STEADI principles.
• Expanding the Iowa Falls Prevention Coalition membership and building a broader statewide network of regional coalitions.
• Partnering with the University of Iowa Injury Prevention Research Center for evaluation support, using key informant interviews and the Consolidated Framework for Implementation Research.
• Establishing a Best Practice Advisory system to automate fall risk reminders for clinicians within EHR workflows.

"STEADI is the tool that helped it all come together… Since partnering with the HUB, [our clinic] gained a trusted intervention option that addresses clinical and non-clinical needs."

Iowa also identified and filled gaps for state-specific falls prevention data and resources, procured multilingual materials to support diverse patient populations, and expanded marketing within clinical settings to raise awareness of available programs.

Oklahoma: Scaling Through Practice Facilitation

Oklahoma partnered with their state Medicaid agency, Oklahoma Health Care Authority, and contracted practice facilitators to integrate STEADI into primary care settings statewide. This reached more than 288 providers, with the following outcomes:

• 146 providers received education specifically on STEADI.
• 126 were actively screening patients for fall risk.
• 124 indicated they were intervening to reduce identified fall risk factors.
• 82 confirmed following up with patients who have identified fall risk factors.
• 69 had fully integrated STEADI into their practice workflow.

Oklahoma expanded access to evidence-based programs across the state through instructor trainings of evidence-based programs, with Tai Chi and Matter of Balance being especially popular among participants. It also collaborated with county health departments to host programs in community settings such as libraries, faith communities, and senior centers. Participants in Oklahoma's community programs reported meaningful impact on their lives and independence.

"Tai Chi has significantly improved my balance and flexibility... I feel Tai Chi has improved my ability to live independently for a longer time."

Considerations for Implementation and Sustainability

The ASTHO pilot learning community identified several high-value strategies for health agencies working to scale falls prevention efforts:

• Build localized and sustainable coalitions with support from statewide frameworks that are flexible and reflect community priorities.
• Leverage community care hubs and referral infrastructure to create durable pathways between clinical screening and community-based programs.
• Educate providers on falls prevention billing codes to incentivize screening and reduce time burden.
• Invest in Community Health Worker programs to expand capacity for environmental screenings in home and community settings, offer educational resources, and bridge the gap between clinical care and social needs.
• Use storytelling and qualitative data alongside numbers to demonstrate impact, appeal to policymakers, and source sustainable funding.
• Integrate falls prevention within broader efforts for promoting healthy aging and older adult health, brain health and caregiving, and physical activity to align priorities and reduce siloed programming.
• Expand culturally appropriate, evidence-based fall prevention programs in high-risk and rural communities through flexible telehealth and home-based delivery.
• Address potential workforce and partnership barriers through flexible scheduling, accommodating limited agency staffing, volunteer burnout, and rural resource gaps.

Falls prevention is a strategic public health investment with a demonstrable return including reduced injury rates, lowered health care costs and burden, decrease in family caregiver strain, and improved quality of life. Considering flexible funding approaches for this work, such as braiding and layering federal, state, and local funds can help sustain falls prevention capacity. Health agencies are uniquely positioned to lead this work by convening cross-sector champions (e.g., health care, aging services, community organizations), supporting the implementation of STEADI, and tracking community-clinical referral pathways. ASTHO remains committed to supporting state health agencies in preventing older adult falls and will share details about future opportunities to continue this work.

Reviewed by Christi Mackie, MPH, Vice President, Community Health & Prevention; Erin Bayer, MPH, Senior Director, Chronic Disease Prevention & Health Improvement; and Clint Grant, MS, Director, Healthy Community Design.