New York University Falls Prevention Program

Implementing innovative, cost-effective community-based delivery modalities that reliably and effectively deliver evidence-based, culturally-sensitive programs, proven to prevent injury, preserve function, improve quality of life, and reduce morbidity and mortality among an older and more diverse population, will significantly impact health costs and help address the anticipated surge in demand for health services and long-term care. Such efforts need to appeal to diverse populations and have outcomes achievable with a community delivery.

This application is proposing to expand the reach of an evidence-based program, "PROFET", developed for older adults who experienced a fall-related injury, to an at risk community-dwelling population who have not sustained a fall-related injury requiring medical intervention. The investigators hypothesize that oral health care programs and services can be a portal for identifying underserved community dwelling elders at risk for falls who can benefit from a fall prevention program. As more adults see their dentist than visit a physician in a given year, dental clinics, a safety net site for the delivery of oral health care to the elderly, are ideally situated to take an active role in injury prevention efforts. Dental clinics attached to community health centers and academic institutions have established linkages and referral patterns across systems of care and disciplines that can facilitate delivery of preventive services prior to an injury-sustaining event, delaying or preventing unintentional injuries. To date, fall prevention efforts have predominately targeted those who have already experienced an injury-sustaining fall. All older adults may profit from fall prevention interventions (regardless of whether they have experienced a fall-related serious injury). Expanding delivery to reach an at-risk population living in the community, will enable earlier intervention efforts to prevent/reduce falls, serious injury and hospital stays including a first serious fall which in and of itself increases risk for subsequent serious falls.

The aims of this initiative are to: (1) adapt and deliver "C-PROFET", an evidence-based, multifactor fall prevention program, to at-risk, community-dwelling older (65+), multi-ethnic, economically constrained, community residents (n=30) identified in non-traditional community settings (general dental clinic and community dental outreach program delivering oral health care to the elderly in community-based facilities, including senior centers); and (2) to assess the reach, uptake, feasibility and acceptability of the program. NYU College of Dentistry (NYUCD) dental clinic is a low cost community clinic providing quality dental care to the uninsured and those living on a restricted income. The clinic maintains over 300,000 patient visits annually and 17% of the patient population are 65 and older. Examination of the utility of the dental clinic and dental outreach program as a portal for fall prevention programs will be guided by the "RE-AIM" framework which consists of five core elements: (1) Reach ("How do investigators reach the targeted population?"); (2) Effectiveness ("How do investigators know the program is effective?); (3) Adoption ("How effective is this program in different settings?"); (4) Implementation ("How do investigators ensure that the program is delivered consistently?"); (5) Maintenance ("How do investigators incorporate the program so that it is delivered over the long term?").