Examining Factors Influencing Older Adult Engagement in Fall Prevention: A Comparative Analysis Among Stakeholders

ABSTRACT

Background

Falls are a leading cause of fatal and non‐fatal injuries for older adults in the United States with significant consequences for health, mobility, and independence. Understanding what barriers influence older adult engagement is essential to facilitating uptake of evidence‐based interventions to prevent falls and fall‐related injuries.

Methods

Semi‐structured focus groups were held with 59 participants in three stakeholder groups: (1) community‐dwelling older adults, (2) caregivers of older adults, and (3) healthcare providers who engage with older adults. Themes that emerged were categorized by the stakeholder group that identified them and evaluated using the social‐ecological model and assigned to a level within that framework (individual, interpersonal, community, or societal).

Results

Barriers identified to older adult participation in fall prevention activities had the most themes emerge at the individual‐level, which included denial; discomfort avoidance; fear of being a burden; pride; and self‐perception. Interpersonal‐level themes were the normalization of falls; healthcare provider attitude, behavior, and practices; social support; and well‐intentioned family. Finally, the themes observed at the community level included cost; lack of education and awareness; limited healthcare resources; lack of transportation; and healthcare system timing and weaknesses. Some themes were identified across all stakeholder types, while others were recognized by only one or two. The only theme at the societal level was age‐related stigma.

Conclusions

These findings demonstrate a variety of barriers across stakeholder types and provide valuable insights for developing strategies to effectively promote older adult participation in fall prevention activities to reduce falls and enhance healthy aging.

Summary.

• Key Points

  • ○
    Falls are not a normal part of aging, yet they are a significant public health issue for older adults.
  • ○
    Numerous evidence‐based interventions to prevent falls in this population are available, yet uptake appears to be limited.
  • ○
    The multidimensional perspectives of stakeholders yielded unique barriers in addition to barriers that had consensus among the groups.
• Why Does This Paper Matter?

  • ○
    We certify that this work is novel.
  • ○
    This research advances the understanding of older adult engagement with fall prevention through a cross‐stakeholder analysis that reveals shared and divergent perspectives on barriers to participation.
  • ○
    The results may inform future efforts to develop effective and targeted fall prevention strategies for older adults.

1. Introduction

Falls are a leading cause of fatal and non‐fatal injuries for American older adults with significant consequences for health, mobility, and independence [1, 2]. Over 35 million falls occur annually among U.S. adults aged 65 and older, resulting in 8.4 million injuries, over 950,000 hospitalizations, 32,000 deaths, and healthcare costs exceeding $50 billion [3, 4]. Even non‐injurious falls can have detrimental effects on older adults' quality of life, leading to decreased activity and social interactions due to fear of falling, which can accelerate physical and psychological decline [5].

Despite the availability of evidence‐based interventions, fall rates have not improved, and falls persist as a leading cause of injury for older adults [6, 7, 8, 9, 10]. The predicament of falls is particularly unfortunate as falls are not an intrinsic part of aging, and most falls are considered preventable [11, 12]. A special report by the Centers for Disease Control and Prevention (CDC) reviewed fall‐related research and programming between 1985 and 2005 and found that many evidence‐based interventions were underutilized by the intended older adult population, despite the potential for reducing falls, fall injuries, and healthcare costs [13]. In 2011 two of the authors of the CDC's special report published a theory paper outlining a research agenda for accelerating adoption of fall prevention interventions, emphasizing the importance of adoption and implementation in public health efforts [14]. More recently, an international multistakeholder group published global guidelines for fall prevention, focusing on a person‐centered approach to be deployed through the healthcare providers and other professionals working with older adults [9].

The limited adoption of fall prevention activities by older adults has not been directly studied. However, recent research has begun to investigate barriers and facilitators to implementing interventions, and this study is unique in its exploration of barriers among older adults, caregivers, and healthcare provider stakeholders [15, 16, 17, 18]. Understanding these multi‐stakeholder perspectives could provide a more comprehensive understanding for the design and deployment of fall prevention interventions to promote uptake of evidence‐based activities by older adults to reduce falls and fall‐related injuries.

The goal of this study was to evaluate the perceptions and beliefs of older adults, caregivers, and healthcare providers on fall prevention interventions relative to the nested levels of the socio‐ecological model. Specifically, we sought to identify the barriers to older adult participation in fall prevention activities as perceived by each group and to evaluate similarities and unique observations across these stakeholder groups. Finally, we chose to categorize identified barriers using the social‐ecological model framework to enable understanding of how to organize and conceptualize barriers and provide insights into new approaches that could be used to overcome them.

2. Methods

2.1. Study Design and Participants

This thematic analysis received approval of an Institutional Review Board (IRB# 2018H0219). Thematic analysis is a qualitative research method that evaluates patterns of shared meaning, or themes, within a given data [19]. The data set reviewed was obtained through focus groups. Participants were recruited with representatives from three stakeholder types: (1) community‐dwelling adults aged 60 and older (“older adults”), (2) individuals who provided regular care for an adult aged 60 or older (“caregivers”), and (3) healthcare professionals who provided care and treatment to adults aged 60 and older (“healthcare providers”). Adults aged 18 and older were eligible to participate in the study (≥ 60 for older adult group), and all participants self‐disclosed capacity to provide informed consent. Recruitment was completed by electronic advertisement at a medical center, posted advertisements at community locations, healthcare provider referrals, personal referrals, and announcement during public speaking events.

2.2. Procedures

Recruitment materials connected interested persons to researchers, who confirmed eligibility and coordinated focus group placement. Focus group composition was designed for three to 10 individuals per session to optimize quality of output and with a planned minimum of three sessions per stakeholder type. However, one caregiver group had only two participants due to an unexpected no‐show resulting in two participants. This session was held at the discretion of the senior researcher who confirmed participants' comfort with sharing in that context. Focus groups were held between 30 July 2018 and 28 February 2019. Participants provided consent and completed a demographics questionnaire at the research encounter specific to their stakeholder group. Focus groups were led by researchers trained in qualitative methods and guided by a series of pro‐forma questions. The researchers were mindfully active in the discussions, providing clarifications to the open‐ended questions and gentle steering if needed to keep the group on track. Sessions lasted up to 90 minutes and were recorded using two digital recorders to ensure adequate capturing of sound from all focus group participants.

2.3. Data Analysis

Digital recordings were transcribed verbatim. The transcripts were first read to provide the context of the conversation and a general perspective of participant interactions and discussion tone, then analyzed for themes. Code books were maintained for each stakeholder type and evolved until theme saturation was achieved. No additional focus groups (beyond the planned three) were deemed necessary as coders agreed theme saturation had been achieved. Theme saturation was finalized when no new themes emerged from coding a transcript for a stakeholder group. The researchers documented which stakeholder types identified specific barriers, and themes were assessed for repetitions and variations of observed barriers across stakeholder groups. Theme assignment was verified by two independent researchers. Themes were then organized by the hierarchical levels of the social‐ecological model (individual, interpersonal, community, or societal) with agreement among the research team. The social‐ecological model is a framework for evaluating and understanding multilevel and interdependent factors affecting health and well‐being and has been applied to qualitative studies to understand barriers to various health‐promoting behaviors [20, 21, 22, 23]. The same dataset was used to conduct a separate analysis evaluating community paramedicine to deliver fall prevention to older adults [24].

3. Results

A total of 10 focus groups were held, three with older adults (n = 15), three with caregivers (n = 16), and four with healthcare providers (n = 28). Participant demographics are presented in Tables 1 and 2. The themes observed in the study are marked with which stakeholder types identified them. Themes stratified in the social‐ecological hierarchy are outlined in Table 3. Related quotes are available in the supplemental materials.

TABLE 1.

Participant demographics.

Older adults	Caregivers	Healthcare providers
The older adult participants were from rural (47%), suburban (40%), and urban (13%) areas and 67% had a bachelor's degree or higher. Less than half (40%) had a friend or family member with a significant life disruption due to a fall and the majority of older adults (93%) reported no calls to emergency medical services (EMS) for themselves in the past 12 months. Only a third had ever had a fall risk assessment and most (73%) had never participated in a fall prevention class.	The caregiver group was compromised of 38% rural, 44% suburban, and 19% urban setting residents, and 56% had a bachelor's degree or higher. Most caregivers (81%) stated their older adult had never participated in fall prevention activities and only 38% believed their older adult had ever undergone a fall risk assessment. Less than half of caregivers (44%) were aware of at least one fall by their older adult in the past 12 months, and of those who reported older adult falls (n = 7), 71% estimated a frequency of 2–5 falls over the year with most older adults experiencing a hospitalization (n = 5). Of the reported older adult falls, over half (57%) received physical therapy as a result but only one older adult participated in a fall prevention class as a result.	Among healthcare provider participants, 93% regularly assessed six or more older adults per week and over two‐thirds (68%) stated that they regularly perform fall risk assessments on older adults who have fallen, but only half have done so for older adults without a history of falls. Most healthcare providers (54%) have recommended fall prevention classes to older adults who have fallen, but less than a third (29%) have recommended these to older adults who have not reported a fall. According to the healthcare providers surveyed, only 27% believed that their older adult patients typically follow through on fall prevention class recommendations.

TABLE 2.

Participant demographics by stakeholder type.

Stakeholder type	Average age (range)	Female sex (%)
Older adults	73 (61–88)	10 (67)
Caregivers	56 (29–76)	14 (88)
Healthcare providers	43 (32–48)	11 (39)

TABLE 3.

Summary of results: Presentation of barriers to fall prevention by stakeholder type.

	Stakeholder type	Themes
Individual	All groups	Denial Discomfort avoidance Fear of being a burden Fear of embarrassment Lack of impetus Pride Self‐perception
	Caregivers	Aesthetics Fear of discrimination Resistance to change
	Older adults and caregivers	Disinterest Fear of falling Sensitive masculinity
	Caregivers and healthcare providers	Justification of falls Physical ability Preserving autonomy Resistance to help Sentiment
Interpersonal	Caregivers	Normalization of falls
	Caregivers and healthcare providers	Healthcare provider attitude, behavior, and practices Social support Well‐intentioned family
Community	All groups	Cost Lack of education and awareness Limited healthcare resources Lack of transportation
	Healthcare providers	Healthcare system timing Healthcare system weaknesses Values
	Older adults and healthcare providers	Difficult to access Poor design and accommodations
Societal	Older adults and caregivers	Stigma

3.1. Individual

The individual‐level of the social‐ecological model refers to factors that describe an individual person, including perceptions, beliefs, and attitudes. The themes that appeared across all stakeholder groups as barriers to older adult participation in fall prevention included denial, self‐perception, pride, fear of being a burden, fear of embarrassment, discomfort avoidance, and lack of impetus. Denial and self‐perception manifested in older adults as a denial of physical limitations and a persisting self‐image of being capable of accomplishing tasks that were unsafe. One caregiver succinctly put it, “Denial. It's just denial. [Older adults] just don't want to admit that they can't do the things they used to do.” All stakeholder types voiced a belief that older adults do not see themselves as likely to benefit from fall prevention interactions, even if the older adults felt that such activities could benefit other older adults.

Pride was also viewed as a significant obstacle by all stakeholder groups, and it was thought that participation in fall prevention activities may be perceived as a concession to frailty, which may threaten an older adult's identity and societal values of strength and autonomy. Closely related to this psychological barrier were the fears of being a burden and of embarrassment, which highlight social dimensions of aging. A healthcare provider shared, “… [older adults] don't want to ask for the resources because then they'll be a burden,” while an older adult disclosed how the fear of embarrassment directly interfered with participation in fall prevention: “[I don't want to participate] because I don't want to be laughed at.” Stakeholders felt that these fears can lead older adults to avoid making overt requests for help and to avoid activities that might expose their vulnerabilities to others, suggesting a level of awareness of alterations of ability, despite an unwillingness to modify behaviors.

Discomfort avoidance was described as encompassing physical pain and mental discomfort, with stakeholders noting that fall prevention activities were perceived as painful, embarrassing, and inconvenient by older adults, particularly when contrasted with alternatives like medications, indicating a preference for easier, less intrusive options. An older adult participant felt that even procedural inconvenience was a deterrent: “I've heard of people that don't want to [do] water exercise programs [for fall prevention] because they think it's so much trouble to get in a bathing suit, shower, do your hair …”

Even when the benefits of participation in fall prevention activities are understood, stakeholders noted that a lack of motivation can lead to noncompliance, exacerbated by a lack of immediate consequences that lead older adults to take a reactive rather than preventative approach to falls. Illustrating this, an older adult described an event from their personal life: “… I got sick and just got up to use the restroom and afterwards fainted in my bathroom, and I hit my head … after that scare, I really had realized … I could've been unconscious for hours and nobody would've known, and yet I didn't do anything about it … sometimes [older adults] have a scare, but we still don't do anything about it.”

Caregivers were the only stakeholders whose perspectives contributed unique themes at the individual‐level of the social‐ecological model. These themes included aesthetics, fear of discrimination, and resistance to change, which are related to perceived social consequences of aging and the stigma associated with it. Caregivers noted the emotional and practical impact that these concerns had on older adults, causing them to avoid measures such as grab bars with the thought that this signaled aging or disability, particularly in public or professional settings. A caregiver described how her mother experienced an ankle fracture but anticipated negative repercussions at work if she used the recommended mobility aids: “… She really had this fear that people in her job were going to see her as old, and they were either going to lose respect for her or push her out, and so she even fought against it more, and she wouldn't even use a walker.”

Older adults and caregivers had consensus on some individual‐level themes that were rooted in emotions and social dynamics, including disinterest, fear of falling, and sensitive masculinity. Participants felt that disinterest in fall prevention activities stemmed from a lack of perceived relevance, competition with other activities, or simply a preference for maintaining their current lifestyle. When asked why they do not want to participate in fall prevention programs, one older adult simply stated they did not want to. Another older adult shared that while they used to be active in group exercise classes, they no longer feel that they can participate: “I'm afraid to step away from my walker, if it's any more than two steps. I don't want to fall.” An older (male) adult shared that he perceived classes as being “geared towards women,” and that was a major deterrent.

Caregivers and healthcare providers shared several observed barriers at the individual‐level: justification of falls, physical ability, preservation of autonomy, resistance to help, and sentiment. Older adults often appeared to rationalize falls as isolated incidents, attributable to external and uncontrollable factors, rather than internal and modifiable ones that could be addressed through fall prevention activities. Similarly, their perception of their physical ability may be distorted by psychological barriers that older adults themselves identified in this study, including pride and denial. There was also a strong feeling that older adults resist fall prevention activities out of fear that participation would result in their loss of independence. One healthcare provider summarized this as, “Anything they are suggested to change is seen as a threat. They think that their independence is going to get taken away. They think they're going to a nursing home.” A community paramedic participant said that despite offering a no‐cost, at‐home program designed to help older adults who had been transported by ambulance to the hospital, “… they get discharged, we [reach out], and they just don't want any help.”

3.2. Interpersonal

This level of the social‐ecological model expands beyond the individual to encompass the influence of social networks (e.g., family, healthcare providers, etc.) on uptake of fall prevention activities. As with the individual‐level themes, caregivers were the only group that noted an interpersonal‐level barrier that other stakeholders did not mention, which centered around the normalization of falls. Falls are not a normal part of aging [25, 26], yet stakeholders in the caregiver groups noted both a personal belief that falls cannot be prevented (“there is nothing you can do to prevent falls”), and an observation that older adults likely share this belief: “Sometimes I think people think falling is normal … they sort of brush it off as something maybe that doesn't warrant any attention or intervention because their friends trip and fall…”

Caregivers and healthcare providers identified interpersonal themes related to patient care and well‐being: healthcare provider attitude, behavior and practices, social support, and well‐intentioned family. Healthcare providers noted that their profession was susceptible to harmful behaviors in the care interaction, including inauthentic delivery, hurtful and alienating practices such as speaking to people other than the older adult patient, and even self‐deception as to the true health status of their patient. Caregivers felt that healthcare providers had been inattentive in the care of their loved ones: “I don't think the doctor ever did anything for him.”

A lack of social support was also noted as a significant barrier to implementing fall prevention and wide‐ranging effects were brought up, from an inability to implement safety measures in the home due to physical limitations to social isolation stymying adoption of fall prevention activities. Participants suggested that cultural changes, including increased probability of older adults living separately from their kids—and sometimes quite far away—have contributed to the issue. Such changes make it more difficult for family members to provide direct support and maintain regular social interaction. Finally, caregivers and healthcare providers shared a belief that family members, with a positive intent of protecting their loved one, create barriers through restriction of older adult activity. A healthcare provider stated, “Overbearing caregivers that have their best interest at heart, but really don't realize that there are ways to keep [older adults] safe and mobile and active,” and a caregiver shared that this directly contributed to a parent's passing: “All [my mom] did was sit there and [my dad] would say, “Don't get up: I'll get it! I don't want you to fall”… They never went out, and he did every single thing for her, so we always say he kind of killed her with kindness…”

3.3. Community

The community level of the social‐ecological framework describes the various contexts in which older adults operate that may influence their willingness or ability to participate in fall prevention activities. All stakeholder types commented on cost, lack of education and awareness, limited healthcare resources, and lack of transportation as barriers to uptake of fall prevention interventions among older adults. These barriers relate to challenges in accessing prevention activities. Cost was designated a major barrier, with a caregiver stating, “It's all about the money.” Older adults confirmed this was an important factor in decision‐making, and they felt that low or no‐cost options could increase interest in fall prevention. Healthcare provider input ranged from the belief that older adults have an understandable concern about finances to the opinion that, “Even [older adults] who have unlimited resources with money – they don't want to pay.” Other providers felt that education was an important component to counter concerns about cost, especially since there are many services available free of charge to older adults and others that are covered by insurance.

Education and awareness were also highlighted topics by all groups. Stakeholders felt that fall prevention resources were not well known by anyone, including healthcare providers. Older adults felt like their networks did not spread information about available options, and that even if they are interested in the idea of fall prevention, they are unsure how to go about learning more. An older adult participant stated, “I don't know of any [fall prevention resources in my community]. I'm in healthcare. And I'm kind of surprised I'm not aware of any.”

Stakeholders from each group shared various aspects of limited healthcare resources, including healthcare provider capacity to address patient needs or effectively provide resources to patients. Accessible specialized resources (e.g., heated indoor pool) to promote recovery and well‐being were viewed as scarce. All stakeholder groups noted that transportation to fall intervention strategies was a major barrier. Concerns centered around older adults who could not drive themselves and the availability of alternative transportation options. This topic was considered especially difficult to address due to high costs associated with privatized driving options, severely limited public transportation, and scheduling conflicts for working friends and family with social and/or healthcare appointments.

Healthcare providers were the only stakeholder group to identify unique community‐level barriers. These revolved around the healthcare system in the form of the timing of direction to resources, weaknesses in healthcare delivery, and older adult values related to the healthcare system. Overall, healthcare providers felt that the current way that the healthcare system addresses education and access to resources fails to consider the capacity of older adults and their families to absorb information during high‐stress incidents. As one healthcare provider emphasized, “… all they're thinking about is, ‘How am I getting home, and how fast can I get home?’”

Healthcare providers pointed out many system weaknesses that can prevent older adult engagement in fall prevention, primary of which was a lack of focus on prevention. Providers noted that the healthcare system has strong financial incentives for reactive treatment: “[I]t's not going to be the neuro money maker or the cancer money maker, but you're improving lives. And [hospital leadership] have to understand that prevention really is where we need to be for a lot of things, and it's a matter of educating the educated on why fall prevention is so important.” Additionally, healthcare providers felt that older adults should be treated as a special population, like pediatrics, and that current practices harmfully shape older adult behavior. They also believed that the healthcare system would benefit from creating new pathways for older adults with limited resources. A single but notable observation by a healthcare provider suggested that values of selflessness and sacrifice may function as a barrier to older adults using fall prevention tools, sharing, “The really older folks are like, ‘I wouldn't want to waste resources on me because we've got to save it for the younger people.’”

Emphasizing the accessibility and usability of fall prevention, older adults and healthcare providers noted the community‐level factors of difficult to access and poor design and accommodation. Stakeholders mentioned both physical and technological accessibility barriers related to participation in fall prevention programming. They also felt that built environments and educational content were not well designed, discouraging older adults from going places and preventing them from being able to process and absorb information.

3.4. Societal

Factors at the societal‐level of the social‐ecological model reflect policies and cultural norms that have the ability to influence older adult participation in fall prevention. This level contained only one factor—stigma—and was mentioned by older adults and caregivers. Comments supported the idea that older adults believe that certain behaviors are associated with old age and intertwined with their self‐worth. A caregiver wondered, “Maybe [older adults] don't see [using resources] as preventative. Maybe they see it more as, ‘If you need it, therefore you are frail and old.’”

4. Discussion

This study fills a critical gap in the literature by assessing shared and unique multistakeholder perspectives on barriers to fall prevention among older adults through application of the social‐ecological framework. This approach provides a helpful lens for understanding and meaningfully addressing barriers across multiple levels of influence. Our findings have the potential to inform better‐tailored initiatives to successfully engage older adults in fall prevention interventions. This is particularly timely given that fall rates among older adults have not declined and fall death rates have increased despite decades of research and fall programming. Additionally, with the projected rapid growth of the older adult segment of the U.S. population and the increased risk of falling with age, understanding barriers to uptake of fall prevention interventions is of growing relevance and urgency.

The inclusion of multiple stakeholder perspectives in this study—older adults, caregivers, and healthcare providers—proved useful in developing a comprehensive understanding of barriers to fall prevention. Each group offered unique insights that, when combined, provide a more nuanced and complete picture of the challenges faced in implementing fall prevention strategies. Older adults provided firsthand accounts of their experiences, fears, and motivations, offering important insight into the personal and emotional aspects of fall prevention that may not be apparent to outside observers. Caregivers, with their intimate interactions with older adults, were uniquely positioned to identify subtle barriers such as the normalization of falls and resistance to change, which might be overlooked in clinical settings. They also provided key perspectives on how family dynamics and home environments influence fall prevention efforts. Healthcare providers, drawing from their professional expertise and familiarity with healthcare systems, identified crucial barriers within the healthcare system itself, such as timing of interventions and systemic weaknesses in prevention‐focused care. Their insights into the challenges of implementing fall prevention strategies within the constraints of the current healthcare system are vital for developing practical and effective interventions. By triangulating these perspectives, we gain a more holistic understanding of the complex interplay of factors influencing fall prevention, enabling the development of more comprehensive and effective strategies to address this critical public health issue.

4.1. Individual‐Level Barriers

The findings of this study highlight that many barriers to older adult participation in fall prevention activities are at the individual‐level, consistent with previous research [15, 27, 28]. All stakeholder types identified denial, discomfort avoidance, fear of being a burden, fear of embarrassment, lack of impetus, pride, and self‐perception as potent factors. These themes align with other studies in the field. For instance, embarrassment is a recognized barrier to fall prevention participation by older adults, thought to function because of a contradiction between the experience (e.g., a fall) and their own expectations for themself, resulting in a threat to self‐identity [27].

Interestingly, our study revealed some discrepancies in perceptions among stakeholder groups. Several stakeholders expressed disbelief that older adults are honest with themselves and others about their fear of falling and perception of their risk for falls. However, research by Hanlin et al. suggests that most older adults appear to be transparent when questioned individually, with one‐on‐one interviews with older adults finding that in a group where 52% were at high risk for falling, 75% reported fear of falling [29]. This incongruence highlights the importance of using appropriate assessment methods when evaluating fall risk perceptions among older adults.

Caregivers uniquely identified aesthetics, fear of discrimination, and resistance to change as barriers, while older adults and caregivers both noted disinterest, fear of falling, and sensitive masculinity. These findings suggest that interventions strongly emphasizing behavior changes may be unappealing to older adults and could impede the very progress they seek to facilitate, unless they are framed and marketed differently [30]. This aligns with a Cochrane review which stated that despite the benefits of evidence‐based programming, it is necessary to individualize approaches to fall prevention, specifically identifying where the older adult is willing and able to make changes to ensure participation and resulting benefits [31].

4.2. Interpersonal‐Level Barriers

At the interpersonal‐level, our study identified the normalization of falls (noted only by caregivers) and healthcare provider attitude, behavior, and practices, social support, and well‐intentioned family (noted by both caregivers and healthcare providers) as significant barriers. These findings are consistent with a 2018 study that surveyed community service providers' perceptions of barriers to fall prevention among older adults and identified normalization of falls as an existing belief that can discourage fall prevention efforts [16]. The results of this study suggest that healthcare providers at all levels, including EMS, are considered trusted sources of information by older adults [15]. This trust presents a strategic opportunity for educating older adults on fall risk and prevention and inciting interest in uptake of fall prevention activities. However, it also highlights the need for healthcare providers to be well‐informed and proactive in addressing fall prevention with their older adult patients.

4.3. Community and Societal Level Barriers

Community‐level factors were the second most prolific tier of barriers identified in this study, with all groups noting cost, lack of education and awareness, limited healthcare resources, and lack of transportation as obstacles. These findings highlight the systemic challenges older adults face in accessing fall prevention interventions. Healthcare providers uniquely identified barriers related to healthcare system timing and weaknesses, as well as older adult values. This aligns with a study by Jones et al., which surveyed physicians and reported insufficient time, focus, and materials for screening older adults for fall risk [32]. Their study concluded that physicians needed targeted training, screening and educational materials, and referral resources to improve fall prevention practices.

The findings also support evidence that healthcare providers are particularly effective at directing older adults to interventions, with a majority of older adults reporting that healthcare providers are their preferred method of learning about falls and effective fall prevention [29, 33]. This trust and benefit extend to a variety of healthcare providers external to the conventional physician/doctor/hospital delivery models, including community paramedics, which are EMS providers that are focused on prevention [24].

Finally, stigma was a critical theme for societal barriers to fall prevention. This aligns with other studies which found that stigma associated with aging and participation in fall prevention is a barrier to participation in fall prevention activities among older adults [34]. A perception of falls as an inevitable part of aging may compound this stigma, discouraging proactive prevention measures.

5. Limitations and Future Directions

Thematic analysis can be affected by interpretive subjectivity, though this is minimized by the involvement of multiple researchers. This study focused on community‐dwelling older adults and does not include the experiences or perspectives of those in assisted living or skilled nursing facilities. Future studies are needed to explore the unique barriers to fall prevention in those settings.

Author Contributions

Catherine C. Quatman‐Yates, Carmen E. Quatman, and Jessica M. Wiseman planned the study. Catherine C. Quatman‐Yates and Jessica M. Wiseman performed data collection. Jessica M. Wiseman completed analysis and wrote the paper. All authors contributed revisions to the manuscript.

Disclosure

The content is solely the responsibility of the authors and does not necessarily represent the official views of the university, the College of Medicine, or the Center for Clinical & Translational Science.

Conflicts of Interest

The authors declare no conflicts of interest.

Supporting information

Table S1: Quotes from focus group participants.