The Role of Social Care in Falls Prevention: Addressing Social Barriers and Supporting Community Solutions

Attendee of a RUSH generations falls prevention program.

Older Adult Falls are an Important and Multifactorial Issue

Falls remain one of the most pressing health concerns for older adults in the United States. Every year, 14 million older adults experience a fall, and the consequences extend well beyond the physical injuries themselves. Falls have long-reaching consequences, both physical and psychological, including broken bones, hospitalizations, and long-term disability, they also often cause fear, anxiety, and a loss of confidence that can diminish independence. Falls are also the leading cause of fatal and non-fatal injuries among older adults, causing 38,000 deaths annually.

Despite their prevalence, fewer than half of older adults who fall report the incident to their health care providers. This silence is often tied to internalized ageism (often confused as stigma), fear of losing autonomy, or lack of trust that resources are available to help them.

Falls among older adults are multifactorial in nature, meaning they rarely occur because of a single cause. Instead, they result from an interplay of medical, physical, behavioral, and social factors. An older adult might fall due to a combination of muscle weakness, medication side effects, vision impairment, and an unsafe home environment. Depression, fear of falling, or social isolation can further compound the risk. Because the causes are so diverse, prevention must be equally comprehensive, requiring contributions from many professions working together. For decades, falls prevention has been approached primarily from a biomedical perspective. Clinicians focus on polypharmacy, balance impairments, chronic conditions, or sensory decline. These medical risk factors are essential to understand, but they are not the whole story.

Increasingly, it is becoming clear that falls are shaped not only by the body but also by the environment, by social conditions, and by the structural inequities that shape daily life. Housing stability, neighborhood safety, access to transportation, economic security, and social connectedness all play powerful roles in determining whether an older adult is likely to fall, and whether they will recover fully afterward. A fear of falling, which can be caused by a number of issues, creates a vicious cycle for many older adults—leading them to restrict their social and physical activity, which in turn drastically increases their fall risk.

Rush Generations staff facilitate a falls prevention program.

This is where social care perspectives, especially those of social workers, add important value. Social workers contribute to falls prevention not only by addressing the social and structural context—like housing, transportation, and insurance barriers—but also by attending to mental health and behavioral health needs. Social work practice draws from the person-in-environment perspective, recognizing how individual risks interact with systems, communities, and larger structures.

In care management roles, social workers are often the ones helping older adults navigate complex, fragmented systems of care, ensuring they can access both clinical services and social supports. Social workers are also trained to address psychosocial concerns like depression, fear of falling, and stigma, which are often overlooked but highly relevant to fall risk and recovery.

Importantly, the literature and practice show that social workers are highly skilled at leveraging the strengths of others on care teams. Rather than working in isolation, social workers excel at connecting disciplines together, ensuring that the expertise of physicians, therapists, nurses, pharmacists, and community health workers is brought to bear in ways that center the older adult’s needs and goals. Social workers are trained to recognize and address the broader context of people’s lives, including the social determinants of health.

Social Drivers of Health and Fall Risk

Consider an older adult who lives in a neighborhood with cracked sidewalks, limited lighting, and no nearby safe spaces for physical activity. Even if this person has the physical strength to remain active, fear of unsafe surroundings may keep them indoors, leading to decreased mobility and higher risk of falls. Or think about a patient who receives a referral to physical therapy but cannot afford the copayments, or who has no way to get to the clinic because of limited transportation options. The clinical recommendation is sound, but without addressing these social barriers, the plan cannot be fully implemented.

Income security, housing stability, food access, and social support all intersect with fall risk. Older adults living with financial strain may not be able to install grab bars or purchase assistive devices. Those experiencing isolation may not have someone to call after a fall, delaying care and increasing complications. Depression and fear of falling are known to elevate fall risk, and both are closely linked to social disconnectedness.

These examples demonstrate that falls are not just an individual medical issue but a community and systemic one. If prevention strategies fail to account for social and structural realities, they will fall short for those most at risk.

The Role of Social Workers in Care Management

Social workers in health care and community settings are often at the frontlines of addressing these barriers. In falls prevention, their role is multifaceted. First, they act as navigators, helping patients and families connect to resources such as transportation programs, home modification assistance, and community exercise classes. Second, they act as advocates, ensuring that health care providers and systems recognize and respond to the barriers patients face. Third, they address psychosocial needs, including fear, depression, and stigma, which often prevent older adults from reporting falls or engaging in prevention strategies.

Social care management is particularly important here. For an older adult who has already fallen, a social worker can coordinate follow-up care that includes both medical and social supports. They can help ensure that discharge planning accounts not only for medical recovery but also for the home environment, access to food, and availability of caregivers. For those at risk of falling, social workers can help anticipate barriers and build individualized plans that integrate health care, social care, and behavioral health.

This person-centered approach recognizes that prevention cannot be standardized across all older adults. Instead, prevention must be tailored to the realities of each person’s life, which means engaging with the social and structural drivers of risk.

Rush Generations staff facilitate a A Matter of Balance, a falls prevention program.

Peer-Led Evidence-Based Programs

Another powerful avenue for falls prevention lies in evidence-based, peer-led programs. Interventions like A Matter of Balance or Tai Chi for Arthritis and Falls Prevention have been shown to reduce fall risk, improve balance, and build confidence. What makes these programs especially valuable is that they are delivered in community settings and often facilitated by trained peers rather than health professionals. These programs are also integrated into communities around the nation, many times through Area Agencies on Aging, aging network organizations, and other nonprofits and health systems like AgeOptions, AgeGuide, and Rush Generations (and many more!) in Illinois.

These programs achieve several things at once. They provide older adults with practical strategies to improve mobility and reduce fear of falling. They also foster social connection, which is itself a protective factor against falls. By meeting in groups, participants build networks of support, which can reduce isolation and encourage accountability.

Social workers have a crucial role to play in both the dissemination and oversight of these programs. They can help ensure that evidence-based interventions are implemented in ways that are culturally responsive and accessible to diverse communities, as well as can address participants’ social needs that present barriers to program participation. The Rush Generations team is currently championing important work to align these evidence-based programs with social care, so these programs can effectively reach participants with complex health and social needs. By addressing participants’ barriers to participation and aligning programming with their patient-centered goals, we are able to ensure our programs align with health equity approaches. Importantly, social workers can also use their trusted relationships to encourage participation, especially among older adults who might be hesitant or who have not traditionally engaged with health services.

Addressing Stigma and Behavioral Health

One theme that often goes overlooked in falls prevention is internalized ageism, masquerading as “stigma.” Many older adults are reluctant to report falls because they fear being seen as frail or dependent. Others worry that admitting to falls will lead to loss of independence, such as being moved to a care facility. This reluctance has significant consequences. If providers do not know that falls are happening, they cannot intervene. Moreover, unreported falls may go untreated, leading to more serious injuries over time.

Social workers are uniquely positioned to address these psychosocial barriers. By normalizing conversations about falls and creating spaces where older adults can share their experiences without judgment, social workers help reduce these barriers. They also play a role in integrating behavioral health into prevention, recognizing that fear of falling, depression, and anxiety are all critical factors that shape both risk and recovery.

Moving Toward Equity-Oriented Falls Prevention

Ultimately, falls prevention must be approached as an equity issue. Certain populations, particularly older adults of color and those living in under-resourced communities, face compounded risks due to structural inequities. They are more likely to live in unsafe housing, have limited access to affordable health care, and experience barriers to community participation. These inequities translate directly into higher risk of falls and worse outcomes after falls occur.

Social work’s commitment to equity makes the profession central to addressing these disparities. By advocating for systemic change, working to expand access to community-based programs, and ensuring culturally responsive care, social workers can help shift the focus of falls prevention from an individual responsibility to a shared social and health system responsibility.

Conclusion: Social Care is Falls Prevention

Falls are one of the greatest threats to the independence and quality of life of older adults. Preventing them requires attention not only to medical risks but also to the social and structural realities that shape health. Social workers, through their roles in care management, resource navigation, community engagement, and advocacy, bring critical expertise to this work. They ensure that prevention strategies are not only clinically sound but also socially and culturally feasible.

As we observe Falls Prevention Awareness Week, it is important to recognize the essential contributions of social work in this field. By centering social determinants of health, championing equity, and supporting community-based interventions, social workers make falls prevention more effective, more inclusive, and ultimately more impactful. We also want to encourage you to learn more about falls prevention programs available in your community, as well as falls prevention efforts happening nationally through the National Council on Aging and Rush Generations!