The newly organized Marion County Fall Prevention Coalition is working to address the reasons why our county tops all others in Florida for deaths from accidental falls.

Falls are a leading cause of injury-related deaths among adults ages 65 and older. The bad news is, Marion County is at the top of state charts for such deaths. The good news is, many falls can be prevented.

In 2022, the age-adjusted rate per 100,000 population of deaths from unintentional falls in Marion County was 25.0 compared to 12.2 for the state of Florida. The data, from a state-based Behavioral Risk Factor Surveillance System, is collected at the state level each year and at the county level every three years, thus the 2022 numbers.

A proclamation issued by Ocala Mayor Ben Maricano on September 25th, in recognition of Falls Prevention Awareness Week, notes it is estimated that 18.8 percent of Ocala citizens and 28.8 percent of Marion County citizens are 65 or older. Falls are a leading cause of fatal and nonfatal injuries among adults in the U.S. and, according to the Florida Department of Health, Bureau of Vital Statistics, are the leading cause of fatal and nonfatal injuries among people 65 and older in Marion County, leading to 178 deaths, 1,616 hospitalizations and 4,756 emergency department visits in 2022.
Along with the medical costs associated with them, falls can have many negative consequences for older adults. These include fear of falling again, forced relocation from the home, loss of independence and stress in the family. By reducing the chances of a fall, older adults can stay independent and have an increased quality of life.
Local officials are working to do something about that through the Marion County Fall Prevention Coalition. Leading the team is Amy O’Brien, HCA Florida Ocala Hospital’s injury prevention coordinator, trauma services. O’Brien, who has a master’s degree in public health, is working closely with Dr. Darwin Ang, the hospital’s trauma medical director, and several partners, including Marion Senior Services, Marion County Fire Rescue, Ocala Fire Rescue, the Marion County Sheriff’s Office, AdventHealth Ocala, Elder Options and the Florida Department of Health in Marion County.
She shares that at the health department, “part of their community health improvement planning process is identifying health issues in the community where we can collaborate, and we got together and decided to form a fall coalition. We started in August, and it’s just been growing. We’ve got Sumter County involved now because of The Villages. Our highest fall ZIP code, 32162, is in the southern part of Marion County and leads into Sumter County.”
Two other areas with high incidents of falls are homes in greater Ocala and the State Road 200 corridor.
“With the trauma center, falls is our top mechanism of injury, at 57 percent of our traumas last year,” O’Brien notes.
“Having an injury prevention coordinator like Amy is really unique to trauma because we’re actually trying to prevent injuries from happening and if you look at falls in particular, from 2013 to 2023 we had 17,000 admissions for falls,” notes Ang. “We see a lot of hip fractures and people think maybe a hip fracture is not so bad, but if you look at the one-year mortality risk it’s between 15 percent and 30 percent, and if you look at five-year mortalities it can be almost as high as 60 percent.”
Ang says other traumas with high mortality rates are neurologic and spine injuries.
“With the brain injury, the reason why that’s such a big player here is because everyone’s on blood thinners,” Ang states. “If they fall and hit their head, they tend to have more serious brain injuries even though it’s what we call a low-speed mechanism. It’s not a high-impact mechanism, but it has some of the most severe consequences.”
Ang says the average age of a trauma patient “for us is about 63 years old and the group that is the highest risk for falls is between 65 and 90 years old.”
He explains that age is an independent risk factor for falls, “but you have intrinsic and extrinsic risk factors. So intrinsics like age, you can’t change that; then there are medications and medical conditions like Parkinson’s disease, Alzheimer’s and dementia. Most of the prevention stuff is related to extrinsic factors like your environment, rugs, small pets, flip-flops. All those things can make you fall and a lot of preventing that is community education.”

KEEP MOVING
After someone is treated for injuries from a fall, they may be referred to a rehab center before they go home. Jennifer Martinez, executive director of Marion Senior Services, shares that once patients are home, they may not be amenable to using a walker or rollator out of stubbornness or pride.
“There is also the fear factor, that I’m going to fall again. So that leads people to be more sedentary, and then it becomes a vicious cycle,” Ang offers.
“The reason people who have falls have a high mortality rate is they develop complications from bed sores, they attract infections or pneumonia. All those things could be prevented if you were more active. If you’re not afraid to go to the bathroom when you need to instead of holding it in, you’re going to have less urinary tract infections. If you’re walking, you are breathing deeper,” Ang explains.
O’Brien says members of the coalition have received training for the Matter of Balance cognitive behavioral program, provided through Elder Options, which is helpful for those who have fallen and are in recovery. The team also plans to target different age groups by incorporating Stay Active and Independent for Life, or SAIL, an evidence-based strength, balance and fitness program for ages 65 and older that is designed to reduce fall risk.
“SAIL reduces fall risk by 41 percent if they stick with it,” she states. “As the saying goes, if you don’t move it, you lose it.”
Her plan is to offer a free SAIL class three days a week for one hour, over 10 weeks. It will be funded through the hospital. One of the innovative ways she plans to attract participants is to pair the program with bingo, which is popular at many independent living facilities.
“It’s a five-minute warm-up, 20-minutes of moderate aerobics and then time for moves for balance and strength. You do three bingo calls and some type of exercise, and instead of playing for money, we play for prizes related to fall prevention. I thought the coolest one was this light you put on the toilet that is motion activated so you can see in the dark. A lot of falls happen on the way to the bathroom.”

She also plans to target more active or younger populations, such as within 55-plus communities.
“A lot of them have community centers, with exercise programming already, so why not add an evidence-based fall program to that?” she shares.
O’Brien notes that fall prevention information can be provided through primary care doctors and that people can do a home safety assessment through a brochure the hospital can provide.
“If you live alone, have a neighbor or friend that you check in with it on a daily basis, and talk to your physician if you notice any change in the way you walk or your gait. Maybe you have cataracts starting, maybe you have an issue with hearing. There is postural hypotension, when you’re lying down and you get up too soon and feel dizzy. Even not staying hydrated. Not having grab bars in a bathroom,” she offers. “There are so many things that can cause a fall. It’s okay to ask for help. That is one of the things that I try to reassure people.”
People want to stay independent, and no one wants to give that up. One thing you can do is reduce risk, but after that it’s strength and balance training on a regular basis to keep everything going, she adds.
“Falls can be prevented, and our main goal is to take care of the community also in the front end,” Ang adds. “Your trauma center takes care of people in the back end by the time they get an injury, but we are a profession trying to make ourselves extinct. So, if we can prevent falls, we’ll be 50 percent less busy.”
Patricia Price, the chief nursing officer with AdventHealth Ocala, states that, “Our community is at the heart of everything we do, and we are grateful to be part of this important project focused on educating about fall risk and prevention. This is an excellent opportunity to make sure educational and safety information is being provided to our community members, and we look forward to being part of this coalition with so many amazing community leaders and organizations.”

BUILDING ON SUCCESS
Marion Senior Services has expanded on its elder co-responder program—which works with partners to help increase quality of care, reduce barriers and better serve at-risk seniors—to be more of a multidisciplinary team. Martinez says there are 22 partners involved, with the core groups being the Marion County Sheriff’s Office, the Ocala Police Department, Ocala Fire Rescue and Marion County Fire Rescue.
One area of focus is those who are high utilizers of the 911 system.
“Within the county, the first responders across all the agencies, collectively, I think I’m safe to say, we have reduced their high utilizer volume by at least 50 percent. I know for the sheriff’s office it’s 54 percent,” she explains. “We are number one in the state for fall deaths. Falling and breaking a hip can change your entire trajectory. When you fall and you lose your mobility, it cuts down on your quality of life. It’s like a waterfall, you forget about your finances and a lot of our seniors are already struggling financially. They’ll forget to pay their electric bill and get out of rehab and go home to no power, no food. They don’t have a way to get prescriptions. If we can provide care for these people, they wouldn’t have to call 911 and go to the hospital.”
Briana Kelley, Ph.D., is a human services counselor at MSS. She works with a team that is a hybrid of a co-responder and a mobile integrated health and mobile response team. Kelley was riding along on a recent day with OFR Capt. Chris Hickman and checking in on some high 911 utilizers.
“We have amazing partners with Ocala Fire Rescue and help with the community paramedicine program and being able to work together to identify medical needs as well as social barriers and figure out gaps and how to bridge them,” Kelley shares. “Capt. Hickman is able to do home safety assessments and go over their medications, for example.”
“Some of our crisis behavioral care coordinators are contacting the 55-plus communities to start building connections with residents and start talking to them about if they have fallen, ways to prevent another fall, and if they haven’t fallen, ways to strengthen themselves and put safety measures in place beforehand,” she adds.
“Why the fall coalition was such a necessary piece is that partnerships are going to help better the outcomes because anytime we have more than one entity at the table it helps to have more of a brainstorming with all the resources that are available,” Hickman offers.
“The fire service is trying to tackle issues that really affect our community, and the fall-related deaths are very pointed in the fact that we track the data by ZIP codes and that told us exactly where the falls were happening, the frequency, the time of day and all those factors that are contributing to deaths,” Hickman adds. “Our goal is to mitigate as many of these factors as we can to help increase the outcome and the value of our community, not to mention reduce unnecessary use of the 911 system and make room for more emergencies as the growth of our community continues to increase.”
As of July 1, 2023, the estimated population of Marion County, according to census data, was 409,959. The estimated population for 2024 is 423,481. In 2020, it was 375,908.
“We have exponential growth in this community,” Kelley offers. “Knowing that we already have an overwhelmed system and that it’s going to continue to be overwhelmed until we get something in place, we must figure out how to stop the bleed first. So, hopefully, if we can work in an intervention capacity, maybe eventually will be able to get the prevention in place.”

ALL ABOUT COLLABORATION
“We are always working with data and the data were showing we have core outcomes related to falls, and we know we are continuing to bring in that population demographic. We started asking, what can we do to make a difference? And Amy was on the same line, so we jumped on it and that’s how it all started,” notes Tracey Sapp, health education program manager for the Department of Health in Marion County. “Amy has been a great champion, and we have worked closely together to try to pull the right people to the table. With the health department, we want to increase awareness about the issue and help provide knowledge about the resources out there so we can reduce injury and death as it relates to falls.”
And, Sapp adds, “The people in Marion County deserve to live healthier and longer lives. And we want to work toward that with this coalition working together and collaborating to make the difference. I think one of the things we do best in Marion County is collaboration. We are even hiring a person dedicated to healthy aging and brain health and falls. That’s how dedicated we are to making sure we are making a difference. We’re early on with this and I’m proud of how far we’ve come and that this is a community that sees the need and that we are really rolling with it to make the changes.”

To inquire about presentations related to fall prevention, email amy.obrien@hcahealthcare.com, jmartinez@marionseniorservices.org or tracey.sapp@flhealth.gov