Older Adults and Adults with Disabilities: Federal Programs Provide Support for Preventing Falls, but Program Reach is Limited

Fast Facts

The CDC reported falls were the leading cause of death from unintentional injury among older adults in 2020.

Nine federal programs specifically aim to help prevent falls or improve accessibility for older adults or adults with disabilities. They do so by providing home safety assessments, ramps, exercise programs, and more. But the programs need to share more information with one another.

We also found that adults with disabilities ages 45-59 reported fall injuries at higher rates than those 60 and up. However, CDC analysis of data on falls focuses on older adults.

We recommended looking at broader data on falls and sharing information better.

Some federal programs help prevent falls for older adults or adults with disabilities.

Elderly person on ground

Highlights

What GAO Found

Nine federal programs are designed to help prevent falls or improve accessibility for older adults or adults with disabilities by providing evidence-based falls prevention (e.g., exercise classes), home assessments (e.g., home safety checklists), or home modifications (e.g., railings or ramps). Four agencies oversee these programs: Administration on Community Living (ACL), Centers for Disease Control and Prevention (CDC), the Department of Housing and Urban Development, and the Department of Veterans Affairs. These programs serve limited numbers of individuals, based on agency survey responses. Officials from national stakeholder organizations GAO spoke with said that not all populations at risk of falls may be served, including adults with disabilities under age 60. GAO's analysis of national data on self-reported falls from 2020 found that adults with disabilities aged 45 to 59 reported rates of falls and fall-related injuries that were higher than those reported by individuals 60 and over. However, because CDC's analysis of these data has focused solely on older adults, federal agencies may be limited in their understanding of the range of groups at risk.

Estimated Percentage of Reported Falls and Fall-Related Injuries by Age and Disability Status, 2020

Federal agencies have conducted various health-related studies of three of the nine federal programs. These studies suggest positive health outcomes for older participants. For example, a study of older adults participating in one of ACL's programs, which included exercise and other evidence-based falls prevention interventions, found some experienced fewer falls and fall-related injuries.

Federal agencies administering the nine programs have coordinated to some degree and disseminated falls prevention resources to consumers. But they lack a way to sustain information sharing and reach all groups at risk of falls with relevant resources. ACL was created, in part, to help manage fragmentation among federal programs that help people who are aging or have disabilities live independently. However, it has not identified a mechanism to sustain efforts to share falls prevention and home modification information among agencies. Further, most federally sponsored consumer resources on these topics target older adults. ACL has not used its existing network of disability organizations and providers to share information on the risk of falls or falls prevention for adults with disabilities under age 60. Yet GAO's analysis found they are also at high risk of falls. By facilitating information sharing across federal programs and among its own disability network, ACL could better help all groups at risk of falls to safely age and live in their homes and communities.

Why GAO Did This Study

Studies report that each year, about one in four older adults—many of whom may also have a disability—suffers a fall. According to CDC, falls were the leading cause of death from unintentional injury among older adults in 2020. They cost billions of dollars in medical expenses. However, studies also show that assessing and modifying the home environment or using other interventions can help prevent falls.

This report examines (1) what federal programs are designed to provide evidence-based falls prevention, home assessments, or home modifications for older adults and adults with disabilities and what do national data indicate about those at greatest risk of falls, (2) what do federal agencies know about how these programs affect participants' health, and (3) to what extent do federal agencies coordinate their efforts and provide consumer information to those at risk of falls. GAO analyzed CDC falls data from 2020, the most recent data available, and surveyed relevant federal programs. GAO interviewed officials from national aging and disability organizations; and reviewed studies of federal programs, falls prevention resources, and relevant federal laws and regulations.

Recommendations

GAO is making three recommendations, including that CDC examine falls data for adults of various ages and that ACL facilitate additional information sharing across federal programs and among its disability network. The agencies concurred with the recommendations.

Recommendations for Executive Action

Agency Affected Recommendation Status

Centers for Disease Control and Prevention

Agency Affected	Recommendation	Status
Centers for Disease Control and Prevention	The Director of the CDC should expand the scope of its analysis of Behavioral Risk Factor Surveillance System (BRFSS) data to include the prevalence of falls and fall-related injuries among adults under age 65 who may be at higher risk of falls, including adults with disabilities, and, as appropriate, share findings with ACL and other agencies overseeing relevant programmatic efforts. For example: CDC could analyze existing BRFSS data on adults aged 45 to 64 and share findings, as appropriate. CDC could propose asking adults aged 18 to 44 the two BRFSS fall-related questions, as part of the survey update process. (Recommendation 1)	Open CDC agreed with this recommendation. As of January 2023, CDC officials said they have begun exploring options to expand the scope of the BRFSS data analysis for adults under age 65. Specifically, CDC is analyzing BRFSS data on falls among adults with disabilities aged 45 to 64. CDC will also consider how best to disseminate these findings, such as through targeted outreach to key partners, publications, and email outreach to those who subscribe to CDC updates on older adult falls prevention.
Administration for Community Living	Priority Rec. The Administrator of ACL should identify a collaborative mechanism to facilitate sustained information sharing on all populations at risk of falls and in need of evidence-based falls prevention, home modifications, or home assessments. For example, this could be accomplished by establishing an interagency working group or by building upon the existing efforts to expand the reach of the Housing and Services Resource Center. (Recommendation 2)	Closed – Implemented ACL identified two collaborative mechanisms to sustain information sharing in this area. In July 2023, ACL launched the Inter-Agency Coordinating Committee on Healthy Aging and Age-Friendly Communities. The committee is intended to provide a regular forum for information sharing to address falls across the lifespan, including among people with disabilities, veterans, and older adults. The Committee membership includes agencies within the Department of Health and Human Services, including the Centers for Disease Control and Prevention, as well as the Departments of Agriculture, Housing and Urban Development, Transportation, and Veterans Affairs. Members of the committee meet monthly and are creating a strategic framework on healthy aging and age-friendly communities which includes a focus on existing federal efforts, best practices, and recommendations related to falls prevention, according to ACL officials. In addition, ACL has taken steps to expand the reach of its Housing and Services Resource Center, which provides ongoing training about evidence-based falls prevention, home modifications, or home assessments. As part of this effort, ACL is promoting accessible housing to reduce the risk of falls within the home and has been holding monthly meetings with key federal agencies to share information and explore additional opportunities for collaboration.
Administration for Community Living	The Administrator of ACL should share and highlight information on falls risk and related resources for adults with disabilities who are younger than 60 more prominently among its disability network to inform state and local planning efforts. For example, to the extent possible and appropriate, ACL could work with CDC to highlight relevant falls data and leverage existing resources on falls prevention. (Recommendation 3)	Open ACL agreed with this recommendation. As of December 2023, ACL officials said ACL's Administration on Disabilities has compiled promising practices related to falls prevention and are in the process of developing a dissemination plan for the information. Further, ACL's disability programs are beginning to participate in the Housing and Services Resource Center's training and technical assistance activities related to falls prevention. ACL officials have also met with CDC staff who work on falls prevention to discuss activities they could do jointly. ACL officials said they identified evidence-based falls prevention materials to share with CDC and with ACL's disability networks. ACL plans to continue meeting with CDC to discuss data-related actions. We encourage ACL to work with CDC to highlight relevant falls data for adults with disabilities who are younger than 60.

The Director of the CDC should expand the scope of its analysis of Behavioral Risk Factor Surveillance System (BRFSS) data to include the prevalence of falls and fall-related injuries among adults under age 65 who may be at higher risk of falls, including adults with disabilities, and, as appropriate, share findings with ACL and other agencies overseeing relevant programmatic efforts. For example:

CDC could analyze existing BRFSS data on adults aged 45 to 64 and share findings, as appropriate.
CDC could propose asking adults aged 18 to 44 the two BRFSS fall-related questions, as part of the survey update process.

(Recommendation 1)

CDC agreed with this recommendation. As of January 2023, CDC officials said they have begun exploring options to expand the scope of the BRFSS data analysis for adults under age 65. Specifically, CDC is analyzing BRFSS data on falls among adults with disabilities aged 45 to 64. CDC will also consider how best to disseminate these findings, such as through targeted outreach to key partners, publications, and email outreach to those who subscribe to CDC updates on older adult falls prevention.

Administration for Community Living

Priority Rec.

The Administrator of ACL should identify a collaborative mechanism to facilitate sustained information sharing on all populations at risk of falls and in need of evidence-based falls prevention, home modifications, or home assessments. For example, this could be accomplished by establishing an interagency working group or by building upon the existing efforts to expand the reach of the Housing and Services Resource Center. (Recommendation 2)

ACL identified two collaborative mechanisms to sustain information sharing in this area. In July 2023, ACL launched the Inter-Agency Coordinating Committee on Healthy Aging and Age-Friendly Communities. The committee is intended to provide a regular forum for information sharing to address falls across the lifespan, including among people with disabilities, veterans, and older adults. The Committee membership includes agencies within the Department of Health and Human Services, including the Centers for Disease Control and Prevention, as well as the Departments of Agriculture, Housing and Urban Development, Transportation, and Veterans Affairs. Members of the committee meet monthly and are creating a strategic framework on healthy aging and age-friendly communities which includes a focus on existing federal efforts, best practices, and recommendations related to falls prevention, according to ACL officials. In addition, ACL has taken steps to expand the reach of its Housing and Services Resource Center, which provides ongoing training about evidence-based falls prevention, home modifications, or home assessments. As part of this effort, ACL is promoting accessible housing to reduce the risk of falls within the home and has been holding monthly meetings with key federal agencies to share information and explore additional opportunities for collaboration.

Administration for Community Living

The Administrator of ACL should share and highlight information on falls risk and related resources for adults with disabilities who are younger than 60 more prominently among its disability network to inform state and local planning efforts. For example, to the extent possible and appropriate, ACL could work with CDC to highlight relevant falls data and leverage existing resources on falls prevention. (Recommendation 3)

ACL agreed with this recommendation. As of December 2023, ACL officials said ACL's Administration on Disabilities has compiled promising practices related to falls prevention and are in the process of developing a dissemination plan for the information. Further, ACL's disability programs are beginning to participate in the Housing and Services Resource Center's training and technical assistance activities related to falls prevention. ACL officials have also met with CDC staff who work on falls prevention to discuss activities they could do jointly. ACL officials said they identified evidence-based falls prevention materials to share with CDC and with ACL's disability networks. ACL plans to continue meeting with CDC to discuss data-related actions. We encourage ACL to work with CDC to highlight relevant falls data for adults with disabilities who are younger than 60.