In Conversation with Elline Eliasoff on Designing Effective Balance and Fall Prevention Programs

Designing effective balance and fall prevention programs starts with a deep understanding of how and why falls occur — especially in older adults, where more than 30% experience a fall each year, often with significant injury or loss of independence.

A well-crafted program doesn’t simply offer a set of exercises; it targets strength, balance, mobility, and postural control while also addressing risk factors like medication side effects, sensory changes, and environmental hazards.

Evidence shows that multi-component physical exercise — combining balance challenges, strength training, and mobility work — can reduce fall rates and improve functional performance when tailored to individual needs. Moreover, a truly effective approach involves more than movement: it requires ongoing assessment, thoughtful progression, and collaboration among caregivers, clinicians, and families to ensure safety and meaningful outcomes.

By integrating clinical insight with person-centered goals, these programs not only lessen the risk of falls but also enhance confidence, independence, and quality of life.

To shed some light on the same, we interviewed a home care industry expert to bring her perspective on designing effective balance and fall prevention programs.

Let us now delve into what she has to say about designing effective balance and fall prevention programs.

Question 1: What is your process for initial client assessment — what domains do you evaluate (mobility, balance, environment, medical history, risk factors)?

My initial assessment includes a review of vitals, strength, range of motion, proprioception, sensation, and balance. I also evaluate medications, medical history, fall history, and the safety of the home environment. In addition, I complete a brief cognitive assessment and have an in-depth conversation with the older adult to understand their needs, preferences, and goals.

Question 2: How frequently do you recommend re-evaluating or updating care plans, especially for clients whose needs may change over time?

Care plans are written and reviewed on an ongoing basis, they are a fluid document. Once a client reaches a stable “cruising altitude” where things are running smoothly and they are supported at the appropriate level of independence and need, the review becomes semi-annual unless there is a change in their status.

Question 3: What decision-making framework or evidence-based standards do you follow in designing interventions such as fall-prevention or balance programs?

I assess gait, range of motion, anatomical alignment, arthritis, and overall mobility. The program is designed around these findings and incorporates a progressive approach to base of support changes.

I also evaluate vision, the vestibular system, muscle strength, and conduct a medication review. A balance and fall prevention program must be progressive, consistently challenging a person’s core strength, postural control, and vestibular system in a safe and structured way. Moreover, preventing falls isn’t just about balance — routine hearing and vision checks are key, because clear senses keep seniors steady on their feet.

Question 4: How do you coordinate with external parties — home care agencies, therapists, equipment vendors, family members, and physicians — to implement a comprehensive care strategy?

I coordinate with external parties through consistent communication and structured care plan meetings. Written care plans are developed, shared with the entire care team, and used as the foundation for implementing a unified and comprehensive strategy.

My goal is to ensure that every provider and family member understands their role so the plan is carried out effectively and supports the individual’s needs.

Question 5: How do you define and measure outcomes (e.g. reduction in falls, improved mobility, patient satisfaction, independence), and in what timeframe?

I define outcomes by looking at changes in functional performance, confidence, and safety over time. Outcomes are measured through a reduction in falls, fewer near-miss incidents, improved gait quality, increased mobility, and the individual’s ability to perform daily activities with greater independence.

I also rely on patient feedback, caregiver feedback, satisfaction, and my client’s perception of safety and stability. I am additionally looking at strength and core stability.

Timeframes vary based on the person’s medical history, strength, cognition, and consistency with the program. In general, meaningful improvements can be seen within eight to twelve weeks, with ongoing progress measured through periodic reassessments and updates to the care plan.

In conclusion

In closing, Elline’s insights remind us that effective balance and fall prevention programs are both science and art — grounded in evidence, but tailored to the individual. It’s not about a one-size-fits-all routine; it’s about understanding each person’s strengths, challenges, goals, and environment and adapting the plan as they evolve. 

With thoughtful assessment, ongoing communication, and collaboration among caregivers, clinicians, and families, these programs can significantly reduce falls, build confidence, and enhance independence. As Elline demonstrates, when we prioritize safety without sacrificing dignity, older adults can truly age on their own terms with resilience and grace.