Abstract:
Since the early 2000s, the Aging Network has made great strides in building capacity for and delivering evidence-based programs that promote the health and well-being of older adults. With an eye toward a more dynamic approach to understanding, developing, and using evidence, ACL recently funded its first ever Research, Demonstration, and Evaluation Center (ACL Innovation Lab). Drawing on research and the experience of the Aging Network, the Lab will focus on addressing gaps in the reach and relevance of interventions that prevent falls among older adults.
Key Words:
Administration for Community Living, disease-prevention, health-promotion, evidence-based programs
As is commonly known, the U.S. population is aging. By 2050, the U.S. Government projects that more than 100 million people will be ages 60 or older (U.S. Census Bureau, 2023). Roughly half of people ages 65 and older have at least one disability (Okoro et al., 2018), 81% have multiple chronic conditions (Buttorff et al., 2017), and one in four reports falling each year (Kakara, 2023).
The Administration for Community Living (ACL) funds services and supports to older adults and people with disabilities to help them live well, in the communities of their choice, for as long as possible. A cornerstone for living independently is preventing and managing chronic conditions and preventing falls. In that regard, ACL strives to learn and improve upon the evidence for interventions to manage chronic conditions and prevent falls.
ACL, like many organizations, has been continuously educating our staff to understand how evidence informs and drives efforts to achieve our mission. For nearly 4 decades, ACL’s Administration on Aging (AoA) has funded the delivery of programs that support healthy lifestyles and promote healthy behaviors (ACL, 2023c).
Since the early 2000s, the nationwide Aging Network, consisting of State Units on Aging, Area Agencies on Aging, community-based service providers, and tribal organizations, has been steadily moving toward wider implementation of disease-prevention and health-promotion programs that that have been proven to improve the health and well-being of older adults. In 2012, a formal requirement was added to the Older Americans Act (OAA) that all programs delivered using OAA health-promotion funding be evidence-based.
In response to this requirement, ACL engaged a variety of constituents to help develop formal criteria for evidence-based programs (EBP) for health promotion. This definition and its associated criteria were informed by a review of the research, existing EBP registries, and information about health-promotion programs being successfully delivered via the Aging Network. As a resource for ACL health-promotion grantees and the public, ACL also funded the development of an Evidence-Based Program Review Process and listing of EBPs that meet ACL EBP criteria. Since 2017, EBPs delivered by ACL grantees and their partners have reached more than 4 million older adults and adults with disabilities (National Council on Aging & ACL, 2024).
‘ACL engaged a variety of constituents to help develop formal criteria for evidence-based programs (EBP) for health promotion.’
Evidence is dynamic and changes over time, and the Aging Network has applied many lessons since the existing ACL EBP criteria for health promotion were developed. As our population ages, ACL wants to be responsive to people aging into OAA services, including evidence-based programs.
ACL routinely connects with grantees, service providers, and partners in the Aging Network to understand how the network, service provision, and needs change over time. ACL recently commissioned four reports to capture and analyze successes, challenges, and opportunities with EBP delivery in the Aging Network (ACL, 2022, 2023b; NCOA, 2021, 2024). A brief summary of key findings from these reports is included below:
- The implementation of an ACL definition and criterion for, and continued investment in, EBP delivery and technical assistance has increased these programs’ reach within across the Aging Network.
- Many EBPs have expanded to include remote delivery options, which has enhanced program reach but comes with challenges.
- Older adults’ EBP interests and preferences are diverse, with an increasing number of older adults gravitating toward non–classroom-based EBPs.
- Existing ACL-designated EBPs can be resource-intensive and difficult to sustain, and present challenges in maintaining fidelity, particularly for organizations with limited capacity and fewer resources.
- There has been a decrease in the number of EBPs approved through the ACL-supported EBP review process, and the process may not fully appreciate Indigenous knowledge or other types of evidence.
- Gaps remain in the availability of EPBs that are relevant and responsive to specific populations, such as Indigenous communities, non-English-speaking communities, and individuals living with behavioral health conditions.
- There is significant variability in the way evidence is defined and used across agencies, organizations, and programs.
Collectively, these reports demonstrated that, while the Aging Network continues to make strides in building capacity for and delivering evidence-based programs with fidelity, gaps in EBP capacity and program reach persist, particularly for populations the OAA prioritizes.
With an eye toward a more dynamic approach to understanding, developing, and using evidence for aging programs, ACL recently funded its first ever Research, Demonstration, and Evaluation Center, called the ACL Innovation Lab (the Lab), to conduct research, demonstrations, and evaluations pertaining to falls prevention among older adults.
The Lab is not duplicating the depth of research on falls prevention; rather, the aim of the Lab is to take what the Aging Network has learned about implementing EBPs and fill a gap for communities that may never choose to implement an EBP.
One responsibility of the Lab is to develop a taxonomy for falls-prevention research based on falls-prevention literature.
The Lab has focused its efforts on testing a method to identify the most successful components from evidence-based programs and use those components to design more flexible, evidence-informed approaches to prevent falls among older adults. While the Lab is just embarking on this work, there is a deep knowledge from which to draw so that communities that want to implement and sustain falls prevention programs in the most evidence-informed ways may be able to do so. The Lab is building upon what the Aging Network has learned and using it to inform research and test methods to allow for a more sustainable approach for communities that may never be able to implement an EBP.
The responsibilities of the Lab are to develop a taxonomy for falls-prevention research based on falls-prevention literature; develop a community-driven and community-based participatory-research process to test evidence-informed falls prevention interventions through sub-awards to community-based aging entities to understand and measure these interventions; provide in-depth technical assistance to potential and awarded organizations; and disseminate findings to the Aging Network (ACL, 2023b).
EBP are a critical part of understanding what works, for whom, and under which circumstances (Bamberger et al., 2006). The decades of research and implementation experience in the Aging Network has uncovered the need, and opportunity, to explore flexible approaches to falls prevention in communities that cannot or may not choose to implement an EBP.
Evidence and knowledge are gained incrementally, and the literature on falls-prevention interventions has taken decades to reach a point where the Lab can deconstruct EBPs to analyze the most successful components and test the Lab’s approaches. In essence, the Lab is building upon what the Aging Network and ACL have learned and attempting to fill a gap for communities that have differing needs and capacity for sustaining EBPs.
As ACL and the research community learn more about the Lab’s approach, ACL will continuously monitor any impacts from the results of the Lab’s research that can inform a more inclusive approach to generating new evidence and learning to prevent falls in the Aging Network.
Amanda Cash, DrPH, MPH, directs the Office of Performance and Evaluation at the Administration for Community Living, in the U.S. Department of Health and Human Services, and acts as ACL’s chief data officer. Shannon Skowronski, MPH, MSW, is an Aging Services program specialist in the same office.
Photo credit: Shutterstock/PeopleImages.com - Yuri A
References
Administration for Community Living. (2022, December 27). Fidelity evaluation of ACL’s evidence-based programs. United States Department of Health and Human Services. https://acl.gov/news-and-events/announcements/fidelity-evaluation-acls-evidence-based-programs
Administration for Community Living. (2023a, May 10). 2023 notice of funding opportunity for ACL Innovation Lab now available. United States Department of Health and Human Services. https://acl.gov/news-and-events/announcements/2023-notice-funding-opportunity-acl-innovation-lab-now-available
Administration for Community Living. (2023b, September 6). Analysis of evidence-based health promotion and disease prevention program review processes. United States Department of Health and Human Services. https://acl.gov/sites/default/files/programs/2023-10/ACLEBPFinalReport.pdf
Administration for Community Living. (2023c, November 6). Health promotion. United States Department of Health and Human Services. https://acl.gov/programs/health-wellness/disease-prevention
Bamberger, M., Rugh, J., & Mabry, L. (2006). RealWorld evaluation: Working under budget, time, data, and political constraints. Sage Publications.
Buttorff, C., Teague, R., & Bauman, M. (2017.) Multiple chronic conditions in the United States. RAND Corporation. https://www.rand.org/pubs/tools/TL221.html
Census Bureau. (2023.) Projected population by five-year age group and sex for the united states, main series: 2022–2100 [Data set]. United States Department of Commerce. https://www.census.gov/newsroom/press-kits/2023/population-projections.html
Kakara, R., Bergen, G., Burns, E., & Stevens, M. (2023). Nonfatal and Fatal Falls Among Adults Aged ≥65 Years—United States, 2020–2021. MMWR Morbidity and Mortality Weekly Report, 72:938–943. DOI: 10.15585/mmwr.mm7235a1
National Council on Aging (NCOA) and ACL. (2024). NCOA Healthy Aging Programs Integrated Database and ACL Older Americans Act Program Performance System, number of participants between October 1, 2017–September 30, 2023.
National Council on Aging. (2021). Evidence-based health promotion programs among American Indian, Alaska Native, and Native Hawaiian communities: A call to action to improve cultural relevance and accessibility. https:/www.nicoa.org/wp-content/uploads/2021/03/1-FINAL-REPORT-Evidence-Based-Health-Promotion-Among-AIANNH-Communities.pdf
National Council on Aging. (2024). State units on aging survey of Title III-D evidence-based program delivery and review process. https://www.ncoa.org/article/evidence-based-programming-results-of-a-state-units-on-aging-title-iii-d-survey
Okoro, C. A., Hollis, N. D., Cyrus, A. C., & Griffin-Blake, S. (2018, August 17). Prevalence of Disabilities and Health Care Access by Disability Status and Type Among Adults—United States, 2016. Morbidity and Mortality Weekly Report, 67(32), 882–887. https://www.cdc.gov/mmwr/volumes/67/wr/mm6732a3.htm?s_cid=mm6732a3_w
