Program Director/Principal Investigator (Last, First, Middle): Shah, Vallabh O and Herman Carla Native elders are essential to preserving the culture and history of tribal communities, but fall-related injuries can jeopardize their ability to age in place. The Zuni Pueblo is geographically isolated with limited access to rehabilitative and supportive services. Home health physical therapy services are unavailable at the Pueblo. Therefore, Zuni elders must choose between leaving their community and social network for rehabilitative care or remain in the community with unmet needs, and increased risk of not regaining their prior level of function. We propose to culturally tailor the traditional Physical Therapy delivered Otago Exercise Program (OEP), to evaluate its effectiveness in reducing falls risk and to empower elders and their families to engage in preventing falls in their community. Native Zuni CHRs will deliver OEP using novel consultation and telehealth with a Physical Therapist. The CHRs offer important advantage of speaking “Shiwi” (Zuni tribal language) and understanding Zuni traditions, family structures, and elders’ preferences for receiving health information. Our overall objective is to compare the effectiveness of a CHR-delivered, culturally-adapted OEP fall prevention program to the standard of care education-based fall risk management. Our disparity driven aims are: Aim 1: Foster a sustainable multi-directional, participatory collaboration between the Zuni’s tribal leadership, stakeholders, Zuni Indian Health Services, and University of New Mexico Health Sciences Center to enhance fall prevention training, education, and research; Aim 2: To culturally adapt the evidence-based OEP for use with the Zuni elder population. Approach: We will train CHRs to utilize the CDC STEADI toolkit for fall risk screening and education and CHRs will culturally adapt the education and OEP with input from Zuni elders; Aim 3: To compare the effectiveness of the adapted OEP to an education-based fall risk management usual care program in improving strength and balance and reducing falls risk. Approach: Screen 400 Zuni elders, aged 65yrs and older, to identify 200 elders with elevated fall risk. Randomize 200 Zuni elders at risk for falls into a 6-month OEP intervention versus education-based control; and Aim 4: To compare the effectiveness of the adapted OEP to an education-based fall risk management program in improving overall health status, self-management of daily activities, and social engagement. Approach: We will administer SF-12 Health Survey and Short Form PROMIS measures Self-Efficacy for Managing Daily Activities and Ability to Participate in Social Roles and Activities to all randomized participants, at baseline and 6 months, and during the final follow up visit at 12 months.