Falls Prevention Survey

The Rhode Island Department of Health has identified falls as the leading cause of emergency department visits. Among adults aged 65 and older, about 25% (roughly 43,000 individuals) reported experiencing at least one fall in the past year. (https://health.ri.gov/injury-prevention/falls-prevention) We would like to understand which fall education strategies are important to you. Your feedback will help us implement effective fall prevention programs to support Rhode Islanders.

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* 1. What is your gender?

Female

Male

Other (specify)

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* 2. What is your age?

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* 3. What is your race?

American Indian or Alaska Native

Asian or Asian American

Black or African American

Hispanic or Latino

Middle Eastern or North African

Native Hawaiian or other Pacific Islander

White

Another race

Prefer not to answer

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* 4. What is your ethnicity?

Hispanic/Latino

Not Hispanic/Latino

Prefer not to answer

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* 5. Did someone help you complete this survey?

Yes

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* 6. If yes, what is your relationship with the person who helped you?

Child

Parent

Professional

Sibling

Spouse or Companion

Other (please specify)

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* 7. What is your zip code?

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* 8. Do you live:

Alone

With family

In a Senior Living Community

Other (please specify)

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* 9. Have you experienced a fall in the past 12 months?

Yes

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* 10. Did the fall result in an injury?

No injury

Minor injury (i.e. scrapes, bruises, temporary discomfort, etc.)

Serious injury (i.e. significant impairment, confusion, fractures, injury requiring medical attention)

Not sure

Not applicable

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* 11. How did you respond to the fall?

Called Emergency Services

Notified a family member

Notified a Physician or care provider

Used Life Alert or other notification system

Used the internet to gather information on falls

Did nothing

Not applicable

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* 12. How concerned are you about future falls?

Very concerned

Somewhat concerned

Neither concerned or unconcerned

Somewhat unconcerned

Very unconcerned

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* 13. Are you currently using any fall prevention strategies? For example, participating in a falls prevention program, removing fall hazards in my home, and speaking to my doctor.

Yes

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* 14. What type of fall prevention strategy are you currently using?

I have installed grab bars in my home

I participate in an exercise program(s)

I talk to my pharmacist or primary care provider about medications that may increase my risk of falls

I removed clutter from my home

I use mobility aids (i.e. walker, cane)

Other (please specify)

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* 15. Would educational resources be helpful to you? Educational resources include brochures, text messaging, and safety videos.

Yes

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* 16. What types of educational resources are most helpful to you?

Bilingual materials

Home safety assessment

In-Person workshops

One-to-one education with a peer or Community Health Worker

Online videos

Motivational text messaging

Phone consultations

Printed brochures

Other (please specify)

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* 17. Would you like to receive information about fall prevention and home safety?

Yes

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* 18. How often would you like to receive information about fall prevention and home safety?

Weekly

Monthly

Quarterly

Yearly

Other (please specify)

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* 19. What is your preferred method of communication to receive information about falls prevention and home safety?

In-person

Mail

Phone

Text message

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* 20. Could we contact you to participate in a fall prevention community advisory committee?

Yes

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* 21. Please enter your contact information

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* 22. Please enter your email address

Thank you for taking the time to complete this survey. Please contact us at 401-432-7217 with any questions or to learn more about our services.
This project is supported by the Administration for Community Living (ACL), U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $290,000. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement by, ACL/HHS, or the U.S. Government.