Amy Ciarlo, senior analyst for Chronic Disease Risk Factors at ASTHO, highlights how fall prevention goes beyond clinical care, and shares about programs like the CDC's STEADI program that aim to minimize fall risk.
As America's population ages, preventing falls is becoming one of public health's most urgent challenges. In this episode, Amy Ciarlo, senior analyst for Chronic Disease Risk Factors at ASTHO, talks about why fall prevention requires more than clinical care alone. She discusses how the CDC's STEADI framework helps healthcare providers identify and reduce fall risk, why tai chi and evidence-based community programs A Matter of Balance are essential partners in prevention, and how stronger connections between healthcare systems and community organizations can create lasting improvements. Ciarlo also shares lessons from Iowa and Oklahoma, where sustainable partnerships, referral networks, and coordinated planning are helping older adults stay healthy, independent, and safe.
Prioritizing Community-Clinical Linkages to Prevent Falls in Older Adults | ASTHO
Voices From the Field: Public Health Success Stories | ASTHO
Leveraging Partnerships to Shape Funding and Policy Across Public Health Issues | ASTHO
JOHN SHEEHAN:
This is Public Health Review Morning Edition for Wednesday, August 5, 2026. I'm John Sheehan with news from the Association of State and Territorial Health Officials.
As America's population ages, preventing falls is becoming one of public health's most urgent challenges. Today, Amy Ciarlo, senior analyst for chronic disease risk factors at ASTHO, talks about why fall prevention requires more than critical care alone. She discusses how the CDC's steady framework helps healthcare providers identify and reduce fall risk, why tai chi and evidence-based community programs like A Matter of Balance are essential partners in prevention, and how stronger connections between health care systems and community organizations can create lasting improvements.
AMY CIARLO:
We anticipate a significant increase in falls among older adults in the coming years as this population is projected to grow. More than 10,000 Americans are turning 65 every day, and over the past decade, we've already seen fall incidents and fall-related death rates rise, and current trends suggest that increase will continue. And with that, we expect more serious injuries among older adults, particularly head injuries and hip fractures, which can have life-changing consequences, if not fatal, and these injuries create additional strain through increased health care costs from emergency department visits, hospitalizations, rehabilitation needs, and additionally, this can impact independent living and mobility and add to caregiving demands.
SHEEHAN:
Yeah, absolutely. If anyone has a has a family member that's gone through it, it's devastating.
CIARLO:
Absolutely.
SHEEHAN:
There's also a disparity among rural and urban seniors. Can you talk about that?
CIARLO:
Yeah, and you know, there's a number of factors that lead to older adults living in rural communities having greater risk factors for unintentional falls, often facing worse outcomes than their urban counterparts. In rural communities, there are typically delays in emergency response times, greater travel distance to receiving care, as well as fewer public transportation options and limited access to preventative care and rehabilitation services. And older adults in rural areas more often live alone, and we see that social isolation is a big concern and risk factor. And lastly, the physical environment can lead to increased trip hazards.
SHEEHAN:
Sure, you've written about the CDC's STEADI Initiative, S-T-E-A-D-I, as a clinical tool, and something that has actually moved from helping providers not just identify but reduce falls. Can you explain that?
CIARLO:
Yeah, study provides a standardized three-step clinical framework, which is to screen for fall risk, assess the patient's fall risk, and intervene through referrals. And this can be directly integrated into clinical practice workflows through specific tools and resources that are available to healthcare providers through the study initiative. Examples include utilization of EHR systems for this integration with flow sheets, outlining distinct roles across care teams, such as having, like, a pharmacist conducting medication reviews or medical assistants performing initial screenings and physical assessments.
SHEEHAN:
And another point you make in the blog is that clinical care isn't cutting it. That it really takes community programs to complement clinical care.
CIARLO:
Yeah, some of the more common risk factors among aging adults involve leg muscle weakness and poor balance. However, a referral to physical therapy alone often isn't enough, and it requires long-term self-management by patients after this care has ended. Older adults that participate in recurring exercise with a balance component see the greatest impact on reducing fall risk. Older adults are also more likely to engage in group exercise programs led by a trained facilitator, and they may also be more likely to engage in other fall prevention strategies, such as like a home safety assessment to identify any potential trip hazards and home modifications to prevent fall risk. So, these programs like Tai Chi, Matter of Balance, and SAIL are evidence based and offered at the community level to help older adults engage in daily exercise and fall-reduction strategies
SHEEHAN:
and ASTHO's fall-prevention guide outlines three steps for strengthening fall-prevention efforts. What are they? What is most challenging?
CIARLO:
Yeah, the three strategic steps are the first one being assessing the current state of falls prevention in a health agency's state or territory, including what falls prevention work is is currently being done, and then the second step is how health agencies can leverage roles and responsibilities to further community clinical linkages in their jurisdictions, with many strategies and considerations listed in that step, and the third one is having states plan next steps in their falls prevention initiatives using the current state assessment and information provided about falls prevention strategies. One of the biggest challenges tends to be sustainability planning, which kind of spans step two and step three of this guide, and that's largely because it depends on funding structures and just organizational buy-in that health agencies are not fully in control of. So it requires a lot more strategic thinking and planning, and perhaps some creativity to plan for sustainability and falls prevention initiatives,
SHEEHAN:
Two states, Iowa and Oklahoma, have have shown different approaches to their fall prevention efforts. Are there lessons from these states that other states could apply?
CIARLO:
A success that was strongly noted by both state teams was having high engagement with key partners to really drive engagement and increase momentum in falls prevention and healthy aging more broadly. In Oklahoma, we see much of that happening through all the local health departments expanding falls prevention efforts, especially with community programs and outreach to the community at large, at the direction and leadership of Oklahoma's injury prevention service team, and Iowa's utilization of their community care hub as a robust referral system, and the network of local coalitions which follow the framework and action plans from their statewide coalition. So investing in these relationships across many sectors, finding key champions, and then building sustainable coalitions seems to be the biggest takeaways.
SHEEHAN:
Yeah, for sure. That sounds like the community/clinical connection is really where it's at. Is that the biggest takeaway from the blog, and what should people explore further?
CIARLO:
Yeah, I would say the this the one take home message is that study and community clinical linkages aren't just part of a screening tool. Together, they lead to sustainability. Both states have shown real, measurable results, but those wins only last if there is investment in the infrastructure underneath them, durable referral pathways between clinics and community programs, some funding models that braid together federal, state, and local dollars instead of relying on a single grant cycle, and then building workforce capacity can keep clinical and community care connected over time. And this is really well detailed in the considerations for implementation and sustainability section of the blog.
SHEEHAN:
Amy Ciarlo, thanks so much.
CIARLO:
Thank you. Thanks for having me.
SHEEHAN:
Amy Ciarlo is senior analyst for chronic disease risk factors at ASTHO.
ASTO has curated a collection of stories that highlight how public health agencies are addressing and preventing adverse childhood experiences, or ACEs, suicide, overdose, mental health-related concerns, and more. It's part of a new, larger suite of products. Find jurisdictional examples, relevant resources, and considerations to take back to your teams at the link in the show notes.
A new infographic titled "Bridging Systems: Healthcare and Public Health Collaboration for Preparedness" highlights key themes from a three-part interview series on how public health and healthcare partners are strengthening emergency preparedness through collaboration. Although each jurisdiction took a unique approach, common lessons emerged on building trusted partnerships, integrating systems, tailoring solutions to local needs, and investing in sustainable preparedness. Find it all at the link in the show notes.
This has been Public Health Review Morning Edition. I'm John Sheehan for the Association of State and Territorial Health Officials.
