Multifactorial Fall Prevention Interventions

Multifactorial interventions for fall prevention often involve a fall risk assessment followed by strategies to address individual risk factors. The U.S. Preventive Services Task Force (USPSTF) determined that multifactorial interventions can offer some benefits on a case-by-case basis for individuals over the age of 65.

A fall risk assessment can be done by a healthcare provider to determine how likely it is that a patient could fall. Providers can use several tests to assess a patient's balance, strength, and gait, such as Timed Up-and-Go (Tug), 30-Second Chair Stand Test, and 4-Stage Balance Test. Some programs may also include an in-home visit or home safety assessment as part of the initial fall risk assessment.

Once risk factors are identified, several interventions may be used to address those fall risks. Programs can work with individuals to determine which interventions are most feasible for them. Multifactorial interventions often include at least two or more of the following:

Fall prevention education
Exercise-based program
Home modification
Assistive devices, such as a cane or walker
Medication management
Addressing health issues that increase the risk of falling, such as vision issues or foot problems
Proper footwear
Fall detection alert systems

Examples of Programs Using Multifactorial Interventions

The Center for Disease Control and Prevention's (CDC) Stopping Elderly Accidents, Deaths, and Injuries (STEADI) initiative is designed to help healthcare providers prevent falls among at-risk patients. The initiative provides resources related to screening for and assessing fall risk factors, information about medications that can increase the likelihood of falls, and trainings related to fall prevention.
The Ponca Tribe of Indians of Oklahoma Injury Prevention program addresses falls through four priority areas: home safety modifications, exercise programs, annual vision checks, and medication reviews. The program implements several strategies within each focus area to reduce falls among adults over the age of 55.
In Arkansas, ARcare’s family medical centers offer fall prevention programs as part of their longevity programming. These programs are designed to help people over the age of 50 make changes to their environment and lifestyle to prevent falls.
CAPABLE (Community Aging in Place—Advancing Better Living for Elders) is a multi-pronged program that combines nursing, occupational therapy, and home repair services to help mitigate injury risks for older adults. Through this five-month program, clients work with providers to assess their needs and set goals. The program was originally developed by the Johns Hopkins School of Nursing but has expanded to several rural sites in Hawaii, Maine, Minnesota, Pennsylvania, and Texas. For more information see the Rural Health Models and Innovations section.

Implementation Considerations

Programs considering implementing multifactorial interventions may need to assess the availability and variety of fall prevention programs and resources in their community. To stay up to date on available community resources, programs interested in multifactorial interventions may consider partnering with organizations that focus on providing a range of older adult services or support fall prevention networks, such as Area Agencies on Aging and fall prevention coalitions. Programs may consider whether to provide several types of fall prevention services directly, or to develop referral channels with other existing fall prevention programs.

For additional considerations, please see implementation considerations for exercise-based fall prevention programs and home modification programs.

Program Clearinghouse Examples

Resources to Learn More

A CDC Compendium of Effective Fall Interventions: What Works for Community-Dwelling Older Adults, 4^th Edition
Document
An annotated list of evidence-based fall prevention programs to help service providers in public health, healthcare, and other facilities implement programs to reduce falls among older adults. Includes a section on multifaceted interventions.
Author(s): Stevens, J., & Burns, E.
Organization(s): Centers for Disease Control and Prevention, National Center for Injury Prevention and Control
Date: 1/2023

The Falling LinKS Toolkit
Document
Covers the risk factors for falling and strategies to prevent falls, including exercise-based interventions, vision checks, medication management, and home modifications.
Organization(s): Wichita State University, Regional Institute on Aging
Date: 2013

Older Adult Knowledge and Behavior Change in the Stepping On Fall Prevention Program in a Community Setting
Document
Presents findings from an evaluation of Stepping On, an evidence-based fall prevention program, conducted with 182 older individuals and implemented in rural and urban North Dakota.
Author(s): Strommen, J., Brotherson, S.E., & Yang, Z.
Citation: Journal of Human Sciences and Extension, 5(3), 99-121
Date: 2017