Category: Social and Community Context

23 - National Dissemination of Evidence-Based Programs for Older Adults in Low-Income Areas: Social Context for Fall Prevention and Disease Self-Management


Economic insecurity impacts more than 25 million Americans aged 60 years and older, making free and low-cost health and wellness resources critical. Rural and inner-city locations experience persistently higher poverty rates. This warrants detailed examinations of communities that support disadvantaged older adults.


Over 90% of older Americans have at least one chronic condition; nearly 75% have two or more.  These conditions have stark public health consequences due to issues including polypharmacy, medication side-effects, and disease progression.  Falls represent one consequence of chronic conditions and impact 1-in-4 older adults each year.


Consequently, this study aimed to identify the national reach of chronic disease self-management education (CDSME) and fall prevention programs in rural and disadvantaged communities.



Data were collected from two sets of Administration for Community Living (ACL) grantees from 2010 to 2017.  One set was funded to offer one or more of 11 CDSME programs (83 grantees spanning 47 states).  The other set was funded for one or more of 8 fall prevention programs (40 grantees spanning 22 states).  All programs were deemed highest-tier evidence-based programs for older adults, with effectiveness demonstrated through experimental or quasi-experimental studies.  Data from each national initiative were compiled separately. Descriptive statistics, cross-tabulations, and independent-sample t-tests helped assess program reach by delivery site rurality and county-level poverty rates.  Geographic information system (GIS) geospatially represented reach based on economic indicators.


Of the 300,860 CDSME participants, 76% were female, 54% were non-Hispanic white, 16% were Hispanic, and 18% were African American.  Eighteen percent attended workshops in rural areas.  On average, participants attended workshops in counties where 5% of families were below the 125% poverty line, 11% were below the 150% poverty line, and 20% were below the 200% poverty line. 


Of the 45,812 fall prevention participants, 80% were female, 73% were non-Hispanic white, 6% were Hispanic, and 7% were African American.  Nineteen percent attended workshops in rural areas.  On average, participants attended workshops in counties where 4% of families were below the 125% poverty line, 9% were below the 150% poverty line, and 18% were below the 200% poverty line. 


For both initiatives, a significantly larger proportion of participants attending workshops in rural areas were in more impoverished areas (P<0.001).



Findings suggest these interventions can reach/serve vulnerable older adults. Additional efforts are needed to address social determinants associated with chronic disease and falls and promote systems change for scalable and sustainable intervention delivery.


Matthew LEE.. Smith

Associate Professor
Texas A&M School of Public Health
College Station, Texas

Recognizing health status is influenced by a vast and interconnected set of determinants, Dr. Matthew Lee Smith has devoted his career to create synergistic partnerships and initiatives to encourage positive lifestyles and reduce rates of preventable morbidity and mortality. He has earned a national reputation as a falls expert and evaluator of evidence-based programs for older adults. His involvement in local, state, and national evaluation initiatives have been integral to foster understanding about the reach, adoption, implementation, effectiveness, and maintenance of different evidence-based programs. Dr. Smith’s ability to form interdisciplinary collaborations affords him opportunities to apply his translational research and evaluation experience to bridge research and practice issues among the healthcare sector, aging services network, and public health system.