By Dave DeFusco
Each year, one in three adults 65 and older experiences a fall—a staggering and often life-altering statistic. While fall prevention programs are common, most focus on hazards inside the home. But nearly half of all falls among community-dwelling older adults happen outdoors—in parks, on sidewalks, while crossing streets or using public transportation. A new program created by Briana Tucci, a student in the Katz School’s Occupational Therapy Doctorate, aims to address that gap.
Presented in May at the Graduate Symposium on Science, Technology and Health, Tucci’s research project, “Steady Steps Outdoors: An Outdoor Fall Prevention Program,” was designed to educate older adults about outdoor fall risks and provide occupational therapy practitioners with tools to support clients beyond the four walls of their homes.
“Outdoor falls are very different from indoor ones and most older adults aren’t aware of that,” said Tucci. “The risks are often environmental—cracked sidewalks, uneven curbs, inclement weather—and not always modifiable. That makes education and strategy absolutely essential.”
Tucci’s project had two clear goals: First, to design and implement a community mobility program for older adults that focused specifically on outdoor fall risks. Second, to create a resource sheet for occupational therapy practitioners to help integrate outdoor fall prevention strategies into their practice.
For the older adult component, Tucci partnered with the Clinton Older Adults Center, working directly with community-dwelling individuals 55 and older. Nine women between the ages of 69 and 87 participated in the in-person sessions. The curriculum addressed outdoor fall risk factors, personal risk factors, like medications or vision impairments, the use of assistive devices and strategies for navigating public transportation safely.
“We wanted to create a space where older adults could not only learn but also relate these strategies to their daily lives,” said Tucci. “It wasn’t just about giving them information, it was about giving them confidence.”
The results were promising. Nearly two-thirds of participants retained the information, reported that it was applicable to their daily routines and said they intended to apply the strategies when navigating the community.
The second part of the project focused on occupational therapy practitioners (OTPs). Tucci distributed a national survey through CommunOT, the American Occupational Therapy Association’s online community. The survey gathered baseline data on OTPs’ current knowledge and practices around outdoor fall prevention.
According to the survey results:
- 64% of OTPs said they currently address outdoor falls in sessions.
- Their strategies included education, functional mobility training, assistive aid recommendations, screening and assessments and even accompanying clients into the community to practice real-world skills.
- However, 67% said they would be more likely to implement outdoor fall prevention if they had better resources or training.
To meet that need, Tucci developed a comprehensive resource sheet based on evidence-based strategies. Practitioners who completed the survey received the sheet and were later asked to provide feedback.
“We found that OTPs are motivated and capable,” said Tucci, “but many don’t feel they have the tools or time to address outdoor falls properly. That’s something we can fix with the right resources and training.”
Tucci’s program is grounded in the Health Belief Model, a psychological framework that considers how people perceive health risks and the actions they take to avoid them. The model emphasizes awareness, perceived severity and cues to action, all of which were embedded in the Steady Steps Outdoors curriculum.
“We wanted them to understand that falls are preventable and that they have the power to take action,” said Tucci.
Her advisor, Dr. Alexandra Laghezza, formerly a member of the Katz School faculty and now a special assistant professor at Hofstra University, said Tucci’s program fills a critical gap in the literature and in practice.
“We’ve historically lumped indoor and outdoor falls together,” said Laghezza, “which has caused us to miss key risk factors unique to outdoor settings. This project not only separates the two but offers clear, actionable solutions. It’s time for occupational therapy to look outward—literally. The sidewalk, the crosswalk, the park trail—those are the new frontiers of fall prevention.”
