Identifying Barriers to Fall Prevention for Community-Dwelling Older Adults in Delaware:: A Qualitative Study

Falls are a major public health concern among older adults in the United States, and Delaware reflects this growing burden. Fall-related mortality increased steadily from 2012 to 2021, coinciding with a rapidly aging population. Despite the availability of effective evidence-based fall-prevention programs, adoption remains limited among high-risk populations. Grounded in implementation science, this study aimed to identify barriers and facilitators influencing the uptake of fall-prevention interventions among community-dwelling older adults and healthcare providers in Delaware. This project began November 2024 with data collection and analysis concluding March 2026.

A qualitative descriptive, multi-method design was employed including semi-structured interviews with nineteen older adults and focus groups of nine healthcare providers in southcentral Delaware. Interviews and focus groups were audio recorded, transcribed, and analyzed using inductive and deductive coding. Themes were analyzed using Theoretical Domains Framework and Behavior Change Wheel to categorize barriers and facilitators affecting fall prevention participation.

Barriers to fall prevention spanned multiple domains, including limited awareness of programs, financial and transportation challenges, provider gatekeeping, time constraints, and inconsistent referral practices. Older adults frequently underestimated their fall risk, underreported falls, and demonstrated low adherence to preventive behaviors, often compounded by social isolation. Facilitators included willingness to adopt prevention strategies, individualized fall action plans, family and social support, use of emergency alert technologies, and strong provider motivation to address fall risk.

Gaps in fall prevention reflect implementation challenges rather than a lack of available evidence-based programs. Interconnected behavioral, structural, and system-level barriers influence both older adults and healthcare providers. Coordinated, evidence-informed implementation strategies are needed to expand program reach and improve outcomes for Delaware's growing older adult population.

Standardized fall risk screening, interprofessional referral pathways, and population-specific implementation strategies for Delaware communities may help reduce fall-related morbidity and mortality among the state's rapidly aging population.