Preplanned Studies: Evaluation of the Effectiveness of “5E” Comprehensive Injury Prevention Strategy for Fall Prevention Among the Rural Elderly — Six Pilot Villages, Yunnan Province and Chongqing Municipality, China, 2018–2023

As of 2021, China has entered a phase of moderate aging, with a significant projected increase in the elderly population over the next decade due to a second baby boom starting in 1962. This demographic shift poses significant challenges for national finances, social healthcare services, and home assistance. Falls are the primary cause of fatal injuries and illnesses among Chinese individuals over 65 years old (1). Research indicates that about 1/3 of 65-year-olds and half of 80-year-olds have experienced a fall, with a high likelihood of recurrence for those with a history of falls. Prompt prevention and diagnosis of falls using clear criteria can yield visible results quickly (2). Preventing and managing falls among the elderly is a key priority for facilitating healthy and active aging in China. Domestic researchers have successfully implemented the “5E” strategy — Education, Environmental modifications, Engineering improvements, Enforcement measures, and Evaluation — to mitigate fall risks among elderly inpatients (3-4). Nonetheless, there is a scarcity of studies evaluating the efficacy of group-based fall prevention interventions for rural older adults.

This study aims the effectiveness of a group-based comprehensive intervention strategy to prevent falls in older adults through a prospective cohort study conducted from October 2022 to September 2023. Using random cluster sampling, six project townships were chosen from Yunnan Province and Chongqing Municipality, with one project village selected from each township. The survey involved 1,536 rural elderly individuals aged 60 and above across 6 project villages. Baseline data from 1,276 rural elderly individuals aged 60 and over from the same villages collected from November to December 2018 was used for self-control. The research was part of the “Community Participation to Promote Rural Elderly Health – Phase II” project by the National Health Commission (NHC). Inclusion criteria included individuals aged 60 and above residing in the project area for at least six months, while exclusion criteria involved severe mental illness, paralysis, and epilepsy.

The research team implemented a detailed, household-level investigation by deploying a specifically designed questionnaire. This questionnaire encompassed a wide array of topics, capturing essential resident demographics, lifestyle choices, daily activity capabilities, overall physical health, and impressions of the intervention project. The multifaceted “5E” strategy for injury prevention was employed, focusing on the following dimensions: 1) Provision of targeted health education, which addressed themes such as fall prevention and awareness, handling falls, the significance of physical activity, and safety measures associated with exercise. 2) Modification of the living environment in an age-sensitive manner, entailing upgrades such as smoothing out uneven surfaces, enhancing lighting in communal areas, bathroom repairs, handrail installations, and setting up fitness equipment. 3) Dispensation of age-friendly assistive devices that included items like reading glasses for presbyopia, portable commodes, walking sticks, and crutches aimed at reducing the fall risk for the elderly. 4) Oversight of the entire intervention process, from the development and procurement of necessary resources to the actual execution and subsequent assessment of the interventions. 5) Conducting risk evaluations for potential recurrent falls. Evaluation metrics involved measuring the frequency of falls, defined as the percentage of participants who reported experiencing a fall in the preceding year, as well as quantifying re-fall risk. For assessing re-fall risk, we employed the endorsed scoring systems of the Fall Risk For Older People-Community Setting (FROP-Com) (5) and the Falls Risk Assessment Tool (FRAT) (6), resulting in a comprehensive 37-point score with 13 primary factors, comprising: fall history, medications influencing fall risk, medical conditions affecting balance and flexibility, paresthesia occurrences, sleep quality, health literacy, urinary incontinence, nutritional health, environmental safety assessment, level of physical activity, proficiency in everyday activities, engagement in physical exercise, and emotional well-being.

Data analysis was performed using SPSS statistical software (version 27.0, SPSS Inc., Chicago, IL, USA). This study was approved by the Ethics Review Committee of the National Center for Women and Children’s Health, China CDC, under the protocol (Ethics Review Number: FY2018-07). Before the intervention, participants were well-informed about the study procedures and provided their informed consent.

The initial data indicated that 159 individuals suffered falls; however, in the subsequent survey, only 33 reported falls. The prevalence of falls decreased from 12.46% to 2.15% following the intervention (Table 1). The mean scores for the reassessment of fall risk decreased from 9.64±2.99 to 7.79±2.44. Analysis using a regression model revealed that regular physical activity [odds ratio (OR): 0.34, 95% confidence interval (CI): 0.16, 0.72] and a positive attitude (OR: 0.22, 95% CI: 0.07, 0.64) were protective factors, while sleep disturbances (OR: 2.86, 95% CI: 1.21, 6.77) and hearing impairment (Wald χ²=8.46, P=0.037) were identified as risk factors for falls. Visual impairments such as blurred vision can be corrected with the use of presbyopia glasses (Table 2). The ratio of falls attributed to intrinsic factors versus environmental factors was approximately 1∶1. Slippery surfaces or obstacles in the surroundings (33.33%) were identified as the primary causes of falls (Table 3).