Protocol - Falls
Description
The respondent views a monthly calendar and notes the dates on which he or she fell to the ground during that month. Then, after the respondent receives the calendar by mail, an interviewer calls the respondent and asks a series of questions about each fall that appears on the calendar.
Specific Instructions
Staff who complete the telephone interview with the respondent must be properly trained to ask questions about the calendar, probe for more information, and answer questions. Staff must also complete a new form for each fall reported.
Availability
Protocol
COMPLETE THIS FORM FOR EACH FALL REPORTED ON THE FALL CALENDAR.
DATE OF FALL: __ __ /__ __/__ __ __ __ (MM/DD/YYYY)
IF MULTIPLE FALLS ON THIS DATE: (this survey is with regard to the # fall) ____ of (total # falls) ___ on this date
DATE OF INTERVIEW: __ __ /__ __/__ __ __ __ (MM/DD/YYYY)
Hi, this is [INTERVIEWER NAME] from the Mobilize Boston Study. How are you? I am calling to thank you for sending us the Falls Calendar that you completed for the month of [MONTH]. These questions should take only a few minutes:
IF ONE FALL, SKIP TO QUESTION 1.
IF MORE THAN ONE FALL:
I am going to ask you a series of questions about each fall you reported. First, I would like to ask you some questions about your most recent fall, which occurred on [DATE OF MOST RECENT FALL].
GO TO QUESTION 1.
[FOR EACH SUBSEQUENT FALL USE A NEW SURVEY FORM (MOVING FROM MOST RECENT TO MOST REMOTE FALL), SAY:]
We also note that you fell on [DATE OF FALL]. Now I would like to ask you about that fall.
1. Could you please describe to me, what happened when you fell on [DATE OF FALL].
[RECORD RS RESPONSE VERBATIM.]
[Proceed to administer PROBES 1A-1E on an AS NEEDED basis.]
Probe 1A. What were you doing (when you fell)?
[RECORD RS RESPONSE VERBATIM.]
Probe 1B. Where were you (exactly) when you fell?
[RECORD RS RESPONSE VERBATIM.]
If R already provided you with the information that fall occurred either inside or outside, then skip Probe 1C. If R did NOT provide you with the information that fall occurred either inside or outside, then probe. Check the answer even though not read.
Probe 1C. Did the fall happen inside, or outside?
1[ ]Inside
2[ ]Outside
8[ ]Refused
9[ ]Dont know/non-valid response
Probe 1D. [IF INSIDE FALL] Was the surface of the ground (floor) that you fell on wet or dry?
[IF OUTSIDE FALL] Was the surface of the ground (floor) that you fell on wet, dry, icy, or have snow?
[RECORD RS RESPONSE VERBATIM.]
8[ ]Refused
9[ ]Dont know/non-valid response
Probe 1E. When you fell, did you slip or trip on something (such as table leg, irregularity in floor or sidewalk surface, step, curb, ladder, clothing, or pet)? RECORD YES OR NO.
0[ ]No
1[ ]Yes
8[ ]Refused
9[ ]Dont know/non-valid response
Next, Id like to ask you a few more specific questions about your fall. You may already have told me some of this, but I need to make sure I have everything.
2. Did you fall all the way fall to the floor, ground or other lower level when you fell?
0[ ]No, participant did not fall to the ground [GO TO Q3]
1[ ]Yes, participant fell all the way to the ground [GO TO Q3]
8[ ]Refused [GO TO Q3]
9[ ]Dont know/non-valid response [GO TO Q3]
3. What type of shoes were you wearing (if any) when you fell?
[READ CHOICES ONLY IF NEEDED. IF R ANSWERS ANY RESPONSE OTHER THAN THE SEVERAL LISTED, SELECT (14) OTHER AND RECORD ANSWER VERBATIM IN SPACE PROVIDED.]
1[ ]Barefoot, wasnt wearing shoes or socks
2[ ]Socks, stockings, nylons or hose
3[ ]Athletic shoes, sneakers (tied or Velcro)
4[ ]Keds or similar flat-sole canvas shoe (tied or Velcro)
5[ ]Tied oxford shoes, or other tied shoe or buckle shoes (tied or Velcro)
6[ ]Slip-on shoe, loafer
7[ ]Slippers
8[ ]Pumps or high-heels
9[ ]Sandals
10[ ]Work boot or other boot with shoelaces
11[ ]Boots (pull-on)
12[ ]Thongs or flip-flops
13[ ]Special shoe (molded, brace, Aliplast shoe)
14[ ]Other, specify: ____________________
88[ ]Refused
99[ ]Dont know
If the fall was OUTDOORS, GO to Q4. If the fall was INDOORS, SKIP TO Q5. |
4. [only ask if R fell OUTDOORS, based on her/his description of fall]: When you fell (outdoors), which one of the following best describes how close you were to your home, when you fell? (Were you
1[ ]Just outside your home?
2[ ]Not right outside your home, but on the same block as your home? (within 400 feet)
3[ ]More than a block from home, but within 6 blocks (? mile) of your home? (more than 400 feet, but less than ? mile)
4[ ]More than 6 blocks (? mile) away from your home?
8[ ]Refused
9[ ]Dont know/non-valid response
5. Was the lighting good enough for you to see well, when you fell?
0[ ]No
1[ ]Yes
8[ ]Refused
9[ ]Dont know/non-valid response
6. Did you fall because of a health, or medical problem?
0[ ]No [SKIP TO Q8 DIZZY]
1[ ]Yes
8[ ]Refused
9[ ]Dont know/non-valid response
7. [IF YES] What was the health or medical problem? [RECORD VERBATIM]
8. Were you feeling dizzy or lightheaded when you fell?
0[ ]No
1[ ]Yes
8[ ]Refused
9[ ]Dont know/non-valid response
9. Did you faint, pass out, blackout or lose consciousness?
0[ ]No
1[ ]Yes
8[ ]Refused
9[ ]Dont know/non-valid response
10. Did you hurt yourself in any way when you fell?
0[ ]No [SKIP TO Q15 EMERGENCY ROOM]
1[ ]Yes
8[ ]Refused
9[ ]Dont know
11. [If YES] Did you break or fracture a bone? [If not sure, Probe: "Were you told by a doctor, or other health professional, that you fractured a bone?"]
0[ ]No [Skip to Q13 OTHER INJURY]
1[ ]Yes
8[ ]Refused
9[ ]Dont know
12. [IF YES] What bone(s) did you break or fracture? [do not read list, but check all that R mentions that doctor said fractured]
a[ ]Head/skull
b[ ]Face
c[ ]Neck or collar bone
d[ ]Ribs
e[ ]Back/ spine/ vertebrae
f[ ]Shoulder/ Upper arm
g[ ]Elbow
h[ ]Lower arm
i[ ]Wrist
j[ ]Hand/fingers
k[ ]Pelvis
l[ ]Hip
m[ ]Upper leg/ femur
n[ ]Knee
o[ ]Lower leg
p[ ]Ankle
q[ ]Foot/ toes
r[ ]Other
13. Now I am going to read, a list of some injuries, you may have had from your fall. Can you tell me, yes or no, if you had a:?
[READ ALL RESPONSES AND CHECK ANY THAT R RESPONDS YES]
a[ ]Dislocated joint?
b[ ]Sprain, pulled, or torn muscle, tendon or ligament?
c[ ]Bruise or swelling?
d[ ]Cut or Scrape?
e[ ]Another injury? [SPECIFY BELOW]
8[ ]Refused
9[ ]Dont know/non-valid response
14. [IF ANOTHER INJURY] Probe: Can you describe the injury? [RECORD VERBATIM.]
________________________________________________________
15. Did you go to the Emergency Room, or to the office of a doctor, or other health professional, because of the fall?
0[ ]No [next question]
If yes, Probe: Did you go to the emergency room, or doctors office (or both)?
1[ ]Yes, Emergency Room
2[ ]Yes, Doctors Office
3[ ]Yes, both the ER and the Doctors Office
8[ ]Refused
9[ ]Dont know
16. Were you admitted for an overnight stay, or longer, in the hospital following your fall?
0[ ]No
1[ ]Yes
8[ ]Refused
9[ ]Dont know
[If only one fall or final fall reported] That was our last question. Thank you for answering these important questions for the MOBILIZE BOSTON study. Do you have any questions before we hang-up? Great, be well, and thank you for continuing to participate in this important study. |
OR
[IF MORE FALLS WERE REPORTED] We are now finished with the questions for this fall: Now Id like to move on to our next set of questions. You also recorded a fall on: [...SEE SCRIPT ON PAGE 1] |
FOLLOWING SECTION (QUESTIONS 17-23 TO BE COMPLETED BY MOBILIZE BOSTON RESEARCH STAFF AFTER COMPLETING PHONE INTERVIEW WITH RESPONDENT. CODING RESPONSES BASED ON RESPONDENTS Q1 VERBATIM DESCRIPTION OF FALL AND ANSWERS TO PROBES 1A-1E.
17. Identify the ONE response that best describes what participant was doing when s/he fell. (See Probe 1A.)[CHECK ONLY ONE RESPONSE]
1[ ]Stepping on, or off, a curb;
2[ ]Getting into, or out of, a car or other vehicle
3[ ]Going up stairs (including a stoop)
4[ ]Going down stairs (including a stoop)
5[ ]Getting onto, or out of, a chair, sofa, bed or toilet;
6[ ]Walking;
7[ ]Standing
8[ ]Sitting or lying
9[ ]Other (not included above)
88[ ]Refused
99[ ]Dont know/non-valid response
18. Select the ONE response that best describes the location of where the fall occurred. (See Probes 1B-1C.)[CHECK ONLY ONE RESPONSE]
1[ ]Inside own home
2[ ]Inside someone elses home
3[ ]Inside other building
4[ ]Inside, other (e.g. train, subway, bus)
5[ ]Outdoors [SKIP TO Q 20]
8[ ]Refused
9[ ]Dont know/non-valid response
19. [If the fall occurred INSIDE,] Identify specific location of inside fall. (See Probes 1B.)
[CHECK ONLY ONE RESPONSE]
1[ ]Hallway
2[ ]Bathroom
3[ ]Bedroom
4[ ]Living room
5[ ]Dining room
6[ ]Kitchen
7[ ]Basement or Cellar
8[ ]Stairs/Stairwell (Inside)
9[ ]Escalator
10[ ]Moving Walkways (e.g., airport walkway)
11[ ]In a Train/Bus
12[ ]Other inside location
88[ ]Refused
99[ ]Dont know/non-valid response
20. [If the fall occurred outside,] Identify specific location of outside fall.
(See Probe 1B.)
1[ ]Stairs/Stairwell (outside)
2[ ]Garden or yard
3[ ]Sidewalk
4[ ]Street
5[ ]Curb
6[ ]Parking lot
7[ ]Other outside location
8[ ]Refused
9[ ]Dont know/non-valid response
21. Identify the Ground/Floor Surface Condition (See Probe 1D.)
1[ ]Wet
2[ ]Dry
3[ ]Snowy/icy
8[ ]Refused
9[ ]Dont know/non-valid response
22. Did participant slip or trip on something (such as, a table leg, irregularity in floor or sidewalk surface, step, curb, ladder, clothing, or pet)? (See Probe 1E.)
0[ ]No
1[ ]Yes
8[ ]Refused
9[ ]Dont know/non-valid response
23. Was participant knocked down by someone or something? (See Probe 1A.)
0[ ]No
1[ ]Yes
8[ ]Refused
9[ ]Dont know/non-valid response
For more than one fall on this date or in this month, begin another form.
MONTH YEAR ID # | ||||||
SUN | MON | TUES | WED | THURS | FRI | SAT |
1 | ||||||
2 | 3 | 4 | 5 | 6 | 7 | 8 |
9 | 10 | 11 | 12 | 13 | 14 | 15 |
16 | 17 | 18 | 19 | 20 | 21 | 22 |
23 | 24 | 25 | 26 | 27 | 28 | 29 |
30 | 31 | MAIL CARD PLEASE! | PLEASE MARK AN "F" ON EACH DAY YOU HAD A FALL, AND "N" ON EACH DAY YOU DID NOT FALL. | |||
PLEASE CIRCLE YOUR ONE BEST ANSWER. In the past month, how much bodily pain have you had? None Very Mild Mild Moderate Severe Very severe | ||||||
ONLY IF YOU HAD A FALL THIS MONTH, PLEASE ANSWER THE FOLLOWING QUESTIONS ABOUT THE FALL. IF YOU FELL MORE THAN ONE TIME THIS MONTH, PLEASE ANSWER THE QUESTIONS ABOUT THE FIRST FALL ONLY. [WE WILL CALL YOU TO ASK ABOUT YOUR OTHER FALLS] (Circle YES or NO) Did you injure yourself as a result of your fall? YES NO If YES, did you have any of the following (check all that apply): ___ hit your head hard (or head injury) ___ broken hip ___ other injury (_______________________) Did you go to the emergency room or stay overnight in the hospital because of the fall? (Circle YES or NO) Went to the emergency room because of the fall YES NO Stayed overnight in the hospital because of the fall YES NO | ||||||
Personnel and Training Required
The interviewer must be trained to conduct personal interviews with individuals from the general population. The interviewer must be trained and found to be competent (i.e., tested by an expert) at the completion of personal interviews. The interviewer should be trained to prompt respondents further if a "dont know" response is provided.
Equipment Needs
The PhenX Working Group acknowledges these questions can be administered in a computerized or noncomputerized format (i.e., paper-and-pencil instrument). Computer software is necessary to develop computer-assisted instruments. The interviewer will require a laptop computer/handheld computer to administer a computer-assisted questionnaire.Requirements
| Requirement Category | Required |
|---|---|
| Major equipment | No |
| Specialized training | No |
| Specialized requirements for biospecimen collection | No |
| Average time of greater than 15 minutes in an unaffected individual | No |
Mode of Administration
Interviewer-administered questionnaire
Lifestage
Senior
Participants
Ages 70 and older
Selection Rationale
This questionnaire was successfully administered to a large diverse elderly population in Boston, Massachusetts.
Language
English
Standards
| Standard | Name | ID | Source |
|---|---|---|---|
| Human Phenotype Ontology | Falls | HP:0002527 | HPO |
| caDSR Form | PhenX PX250601 - Falls | 6889596 | caDSR Form |
Derived Variables
None
Process and Review
Not applicable.
>Protocol Name from Source
Maintenance of Balance, Independent Living, Intellect, and Zest in the Elderly of Boston (MOBILIZE Boston)
Source
Maintenance of Balance, Independent Living, Intellect, and Zest in the Elderly of Boston (MOBILIZE Boston)
General References
Hannan, M. T., Gagnon, M. M., Aneja, J., Jones, R. N., Cupples, L. A., Lipsitz, L. A., . . . Kiel, D. P. (2010). Optimizing the tracking of falls in studies of older participants: Comparison of quarterly telephone recall with monthly falls calendars in the MOBILIZE Boston Study. American Journal of Epidemiology, 171(9), 1031-1036.
Leveille, S. G., Kiel, D. P., Jones, R. N., Roman, A., Hannan, M. T., Sorond, F. A., . . . Lipsitz, L. A. (2008). The MOBILIZE Boston Study: Design and methods of a prospective cohort study of novel risk factors for falls in an older population. BMC Geriatrics, 8, 16.
Protocol ID
250601
Variables
Export Variables| Variable Name | Variable ID | Variable Description | dbGaP Mapping | |
|---|---|---|---|---|
| PX250601_Falls_Activity | ||||
| PX250601010200 | What were you doing (when you fell)? | N/A | ||
| PX250601_Falls_Activity_Description | ||||
| PX250601170000 | Identify the ONE response that best more | N/A | ||
| PX250601_Falls_Activity_Location | ||||
| PX250601180000 | Select the ONE response that best describes more | N/A | ||
| PX250601_Falls_Bone_Fracture | ||||
| PX250601110000 | [If YES] Did you break or fracture a bone? more | N/A | ||
| PX250601_Falls_Bone_Fracture_Details | ||||
| PX250601120000 | [IF YES] What bone(s) did you break or more | N/A | ||
| PX250601_Falls_Completely | ||||
| PX250601020000 | Did you fall all the way fall to the floor, more | N/A | ||
| PX250601_Falls_Describe_Event | ||||
| PX250601010100 | Could you please describe to me, what more | N/A | ||
| PX250601_Falls_Dizzy_Lightheaded | ||||
| PX250601080000 | Were you feeling dizzy or lightheaded when more | N/A | ||
| PX250601_Falls_Emergency_Room_Doctor | ||||
| PX250601150000 | Did you go to the Emergency Room, or to the more | N/A | ||
| PX250601_Falls_Emergency_Room_Hospital | ||||
| PX250601270000 | Did you go to the emergency room or stay more | N/A | ||
| PX250601_Falls_Emergency_Room_Visit | ||||
| PX250601280000 | Went to the emergency room because of the fall? | N/A | ||
| PX250601_Falls_Faint_Unconscious | ||||
| PX250601090000 | Did you faint, pass out, blackout or lose more | N/A | ||
| PX250601_Falls_Health_Medical_Reasons | ||||
| PX250601060000 | Did you fall because of a health, or medical more | N/A | ||
| PX250601_Falls_Health_Medical_Reasons_Describe | ||||
| PX250601070000 | [IF YES] What was the health or medical more | N/A | ||
| PX250601_Falls_Hospital_Admitted | ||||
| PX250601160000 | Were you admitted for an overnight stay, or more | N/A | ||
| PX250601_Falls_Hospital_Overnight | ||||
| PX250601290000 | Stayed overnight in the hospital because of more | N/A | ||
| PX250601_Falls_Hurt_Yourself | ||||
| PX250601100000 | Did you hurt yourself in any way when you fell? | N/A | ||
| PX250601_Falls_Injure_Yourself | ||||
| PX250601240000 | Did you injure yourself as a result of your fall? | N/A | ||
| PX250601_Falls_Injure_Yourself_Description | ||||
| PX250601250000 | If YES, did you have any of the following more | N/A | ||
| PX250601_Falls_Injure_Yourself_Description_Other | ||||
| PX250601260000 | If YES, did you have any of the following more | N/A | ||
| PX250601_Falls_Injuries | ||||
| PX250601130000 | Now I am going to read, a list of some more | N/A | ||
| PX250601_Falls_Injuries_Other | ||||
| PX250601140000 | [IF ANOTHER INJURY] Probe: Can you describe more | N/A | ||
| PX250601_Falls_Inside_Ground_Conditions | ||||
| PX250601010500 | [IF INSIDE FALL] Was the surface of the more | N/A | ||
| PX250601_Falls_Inside_Location | ||||
| PX250601190000 | [If the fall occurred INSIDE,] Identify more | N/A | ||
| PX250601_Falls_Inside_Outside | ||||
| PX250601010400 | Did the fall happen inside, or outside? | N/A | ||
| PX250601_Falls_Knocked_Down | ||||
| PX250601230000 | Was participant knocked down by someone or more | N/A | ||
| PX250601_Falls_Lighting | ||||
| PX250601050000 | Was the lighting good enough for you to see more | N/A | ||
| PX250601_Falls_Location | ||||
| PX250601010300 | Where were you (exactly) when you fell? | N/A | ||
| PX250601_Falls_Outside_Location | ||||
| PX250601200000 | [If the fall occurred outside,] Identify more | N/A | ||
| PX250601_Falls_Outside_Proximity_Home | ||||
| PX250601040000 | [only ask if R fell OUTDOORS, based on more | N/A | ||
| PX250601_Falls_Shoes_Type | ||||
| PX250601030100 | What type of shoes were you wearing (if any) more | N/A | ||
| PX250601_Falls_Shoes_Type_Describe | ||||
| PX250601030200 | What type of shoes were you wearing (if any) more | N/A | ||
| PX250601_Falls_Slip_Trip | ||||
| PX250601010600 | When you fell, did you slip or trip on more | N/A | ||
| PX250601_Falls_Slip_Trip_Participant | ||||
| PX250601220000 | Did participant slip or trip on something more | N/A | ||
| PX250601_Falls_Surface_Condition | ||||
| PX250601210000 | Identify the Ground/Floor Surface Condition more | N/A | ||
Measure Name
Falls
Release Date
July 2, 2018
Definition
The frequency, potential causes, and outcomes of an individual's fall or falls.
Purpose
Falls are a leading cause of disability in older adult populations. By collecting details about falls, clinicians may be able to identify the causes of falls and reduce the risks.
Keywords
Fall, frail, Fracture, disability, elderly, geriatrics, Maintenance of Balance, Independent Living, Intellect, and Zest in the Elderly of Boston, MOBILIZE Boston, gerontology, aging
Measure Protocols
| Protocol ID | Protocol Name |
|---|---|
| 250601 | Falls |
Publications
Oyedeji, C. I., et al. (2022) The Sickle Cell Disease Functional Assessment (SCD-FA) tool: a feasibility pilot study. Pilot and Feasibility Studies. 2022 March; 8(1): 14. doi: 10.1186/s40814-022-01005-3