Guangzhou Community Elderly Fall Prevention Appropriate Technology Promotion Project
Phase: NA
Conditions: Fall, Old Age
Sponsor: Guangzhou Center for Disease Control and Prevention

Guangzhou Community Elderly Fall Prevention
Appropriate Technology Promotion Project Plan
 
 
 
 
Unique Protocol Id_GZCDC-ECHR-2025P0088
March 19 2026
NCT Number_NCT07458958
Guangzhou
Center
for
Disease
Control
and
Prevention

c
a
t
a
l
o
g
u
e
I. RESEARCH BACKGROUND 1...............................................................................................................................1
II. RESEARCH OBJECTIVES 1................................................................................................................................. 1
III. RESEARCH CONTENT 2..................................................................................................................................... 2
IV. RESEARCH METHODS 2..................................................................................................................................... 2
V. PROJECT EVALUATION 4.....................................................................................................................................4
VI. STATISTICAL ANALYSIS METHODS 9............................................................................................................ 9
VII. SAFETY ASSURANCE 10..................................................................................................................................10
8. QUALITY CONTROL 10....................................................................................................................................... 10
IX. ORGANIZATIONAL MANAGEMENT AND DIVISION OF RESPONSIBILITIES 12..............................12
X. RESEARCH FLOWCHART 13............................................................................................................................ 13
XI. SCHEDULE 14...................................................................................................................................................... 14
12. ATTACHMENT LIST 15.......................................................................................................................................15
ATTACHMENT 1 CODING RULES FOR STUDY SUBJECTS 16.......................................................................16
ANNEX 2 LIST OF COMMUNITIES/VILLAGES IN THE PROJECT AREA 17..............................................17
APPENDIX 3 SCREENING FORM FOR STUDY SUBJECTS 18........................................................................18
APPENDIX 4: RISK FACTORS OF HOME ENVIRONMENT AND RENOVATION RECOMMENDATIONS
FOR FALLS IN THE ELDERLY 20.......................................................................................................................... 20
APPENDIX 5 SURVEY AND ASSESSMENT TOOLS 22.......................................................................................22
ATTACHMENT 6: RECORD FORM FOR GUIDANCE ON ENVIRONMENTALASSESSMENT AND
IMPROVEMENT OF RESIDENTIAL AREAS 31...................................................................................................31
ATTACHMENT 7: FALL OCCURRENCE RECORD CALENDAR 32............................................................... 32
ATTACHMENT 8: SURVEY FORM ON WORKLOAD AND EXPENDITURE OF ELDERLY FALL
INTERVENTION PROJECTS BY MUNICIPAL PROJECT OFFICES 33......................................................... 33
ATTACHMENT 9: SURVEY FORM ON WORKLOAD AND COST EXPENDITURE OF THE ELDERLY FALL
INTERVENTION PROJECT BY DISTRICT-LEVEL PROJECT OFFICE 37................................................... 37
ATTACHMENT 10: SURVEY FORM ON WORKLOAD AND COST EXPENDITURE OF FALL
INTERVENTION PROGRAMS FOR ELDERLY IN PRIMARY HEALTHCARE INSTITUTIONS 39..........39
ATTACHMENT 11: SURVEY FORM ON FALL-RELATED EXPENSES DURING INTERVENTION PERIOD
FOR STUDY SUBJECTS 41.......................................................................................................................................41
ANNEX 12 EMERGENCY RESPONSE PLAN TEMPLATE FOR PROJECT ACTIVITIES IN ADVERSE
WEATHER CONDITIONS 45................................................................................................................................... 45
ANNEX 13 REQUIREMENTS FOR QUALITY CONTROL WORK AT THE INVESTIGATION AND
ASSESSMENT SITE 48.............................................................................................................................................. 48
ATTACHMENT 14 FOLLOW-UP RECORD FORM FOR STUDY SUBJECTS 49........................................... 49

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Guangzhou Community Elderly Fall Prevention Appropriate Technology
Promotion Project Plan
1、Research Background
Population aging is a significant issue and challenge currently faced by China. The "2023
Statistical Bulletin on the Development of Civil Affairs" shows that by the end of 2023, the
number of people aged 60 and above in China had exceeded 297 million, accounting for 21.1% of
the total population, officially entering a "deeply aging" society. The health problems brought by
aging have become increasingly prominent. Falls are the leading cause of injury and death among
the elderly, regarded as a precursor to death or severe injury. Once a fall occurs, the elderly
population may face adverse events such as physical injuries, psychological trauma, reduced
quality of life, or even death. Studies show that the fall rate among community-dwelling elderly
people aged 60 and above in China is 12.4%, while in Guangzhou it is 19.3%, which is relatively
high nationwide. China has a large elderly population in urban communities, making health
protection and risk prevention under the concept of active aging increasingly crucial. At present,
most elderly people in our city live in communities, and approximately 61.7% of falls occur at
home or in other community environments. Communities are the main battleground for
implementing the strategy of "prevention first, shifting the focus forward, and sinking the center
of gravity" to prevent and control chronic diseases. However, there are currently no
evidence-based, scientific, systematic intervention technologies, models, or tools that can be
directly promoted in our city's communities.
In 2024, the Guangzhou Center for Disease Control and Prevention (CDC) selected a series
of replicable health education components for fall prevention based on preliminary work,
literature review, and field research, and implemented a pilot project in Baiyun District,
Guangzhou, to prevent falls among the elderly. According to previous research findings,
environmental assessment guidance has demonstrated significant efficacy in preventing falls
among community-dwelling elderly individuals. Building on these results, this project aims to
adopt environmental assessment guidance as an intervention measure, targeting elderly residents
in Huadu District communities. A randomized controlled trial will be conducted to further

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validate the effectiveness of environmental assessment guidance in preventing falls among
community-dwelling elderly individuals, while exploring implementation barriers, facilitators,
and the acceptability, fidelity, and feasibility of the intervention during its rollout. This initiative
seeks to provide scientific references and practical tools for fall prevention services tailored to
primary healthcare institutions in our city, ultimately achieving the goals of reducing fall
incidence and improving the quality of life among the elderly.
II. Research Objectives
(1) General Research Objective
This study, conducted as a randomized controlled trial, aims to investigate the effectiveness
of environment-based assessment-guided interventions in reducing fall incidence among elderly
residents in eight community sites across Huadu District. The research
will identify
implementation barriers and facilitators, while systematically evaluating the intervention's
acceptability, fidelity, and feasibility during scaling-up. The findings will provide evidence-based
support for broader application, ultimately achieving the dual objectives of lowering fall rates and
improving quality of life for the elderly through citywide implementation.
(2) Specific Objectives
Through interventions targeting the population, the following outcomes are achieved within 6
months and 12 months after the implementation of the intervention:
1. With the elderly residents in Huadu District communities as the intervention subjects, this
study further validates the efficacy of the intervention measures from the preliminary pilot project
in preventing falls among community-dwelling elderly through randomized controlled trials, and
clarifies the practical role of these measures in reducing the incidence of falls among
community-dwelling elderly.
2. Conduct in-depth analysis of the obstacles and facilitators encountered during the
implementation of the intervention, identify key factors influencing its successful advancement,
and provide evidence for optimizing the implementation process.
3. Evaluate the acceptability, fidelity, and feasibility of the intervention during its
implementation, assess the acceptance level among community elderly individuals and relevant

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staff, measure whether the core content and implementation standards can be maintained during
promotion, and determine the practical operability of its application in different community
settings, thereby laying the foundation for subsequent broader-scale implementation.
III. Research Content
This study enrolled eligible elderly individuals aged 60 years and above from 8
communities in Huadu District. Basic information, fall occurrence and awareness, fall efficacy,
and standing-walking ability were collected through questionnaires. Participants were randomly
assigned to an intervention group and a control group. The intervention group received
personalized modification recommendations based on environmental assessment results, along
with free distribution and guidance on the use of anti-slip mats and night lights, as well as brief
safety education. The control group served as a blank control. The intervention lasted for 12
months, during which monthly follow-ups were conducted to collect data on fall occurrences in
both groups. Post-intervention, the incidence of falls and knowledge awareness of fall prevention
were compared between the two groups. The entire study was conducted with standardized
training for evaluators, standardized intervention tools to ensure research quality, and strict
adherence to ethical requirements to protect participants' rights.
IV. Research Methods
The researchers selected eligible elderly individuals as study subjects from the elderly
population using the Study Subject Screening Form (Appendix 3), employing methods such as
questionnaires and scale assessments.
(1) Study Subjects
Eight community health service centers (clinics) in Huadu District, Guangzhou City were
included in the study area. When sampling, residential committees (villages) with as consistent
socio-economic development status, population age, and gender ratio as possible were considered,
while ensuring balanced sample distribution. The principle of cost-effectiveness and feasibility of
the sampling scheme were also taken into account. Eligible elderly individuals were selected as

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intervention
subjects
through
centralized
public
recruitment,
door-to-door
recruitment,
face-to-face interviews, and on-site evaluations, and then randomly assigned to the intervention
group and control group.
1. Inclusion and Exclusion Criteria for Study Subjects
(1) Inclusion criteria:

Ages 60 to 80, including 60 and 80

Living in the community

Expected to reside at current place of residence within the next 12 months

The ability to walk 50 meters without assistive devices
(2) Exclusion criteria:

Exclusion of subjects with acute illnesses or acute phases of chronic diseases

elderly individuals who explicitly decline participation in the 12-month follow-up
(3) Proportion requirements for recruitment targets
To enhance the homogeneity of the study subjects, the following gender and age criteria may
be referred to for recruitment:
①Male population accounts for 20%, female population for 80%; ②60-65 years old
population accounts for 30%-35%; ③66-70 years old population accounts for 30%-35%; ④
71-75 years old population accounts for 30%-35%; ⑤76-80 years old population accounts for
less than 10%.
(II) Sample Size Estimation
Based on scientific calculations and practical work requirements, this project requires a total
of 320 participants. Each group needs a sample size of n=160, with 40 individuals recruited per
sub-district (town).
(3) Intervention Groups
The study subjects were randomly assigned using a completely randomized method.
Statisticians independent of the research team generated random numbers via computer to
allocate the 8 community health service centers (clinics) recruited subjects to two experimental
condition groups. After grouping, homogeneity of key variables (including age, gender, and fall

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risk assessment scores) between the control group and intervention group was verified. Following
assignment, a basic information database for the subjects was established. This study
implemented blinding only for data collectors and analysts.
(4) Main Intervention Activities
1. Intervention timing and intensity
The intervention group was given home fall environmental risk factors assessment and
renovation guidance once in the 4th-6th week after baseline survey.
2. Intervention Methods, Intervention Content, and Intervention Tools
(1) Intervention Content
①
Assess the indoor environmental factors related to falls in the elderly's daily living
environment, including the living quarters, corridors, or courtyards;
②Provide on-site guidance for identified environmental risk factors, and prepare two written
environmental assessment and remediation proposals: one to be archived and entered by the
investigator, and the other to be retained for use by the investigated party.
③Provide at least the following services: night light, anti-slip mat for the bathroom, fall
prevention warning signs, and double-sided adhesive carpet mats. Regions with adequate
resources are encouraged to offer additional renovation services.
(2) Intervention Methods
After appointment, the project staff conducted fall risk assessments at the intervention group's
homes during scheduled visits.
(3) Intervention Tools
When conducting guidance on the assessment of fall risk factors in home environments,
project
staff
primarily
utilize
the
"Home
Environment
Risk
Factors
and
Renovation
Recommendations for Elderly Falls" (Appendix 4) to evaluate each item and provide renovation
suggestions. Other intervention tools include night lights, anti-slip mats, fall prevention warning
signs, double-sided tape, and other assistive devices.
3. Intervention Implementation Personnel
Trained project community social workers or community health service center staff.

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4. Implementation Record
During the assessment of home environment risks, with the consent of the research subjects,
records such as images, videos, and text should be used to document the assessment time,
participants,
assessment
process,
results,
and
guidance
recommendations.
The
"Home
Environment Assessment and Improvement Guidance Work Record Form" (Appendix 6) should
be completed. Special attention should be paid to collecting before-and-after comparisons of
environmental modifications.
V. Project Evaluation
The project evaluation includes baseline survey evaluation, effect evaluation and economic
evaluation.
(1) Baseline Survey and Assessment
1. Baseline status of the study subjects before intervention (baseline survey)
(1) Implementation Time
January 2026 – March 2026.
(2) Survey subjects
All the elderly in the study group.
2. Baseline survey assessment content
(1) Basic demographic information: name, gender, age, address, contact details, ethnicity,
cohabitation status, occupational status, educational level, etc.
(2) Physical activity status: Daily physical activity content.
(3) Medical conditions and medication status: types and quantities of diseases, types and
quantities of medications.
(4) Fall-related information: specific details of fall events occurring within the past year, and
the level of fall efficacy.
(5) Standing-to-Walking Test: A functional mobility assessment tool.
(6) Evaluation Methods and Tools
①appraisal procedure

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According to the different evaluation contents, the questionnaire survey, on-site observation
and other methods were selected for evaluation.
②Assessment Tools
Self-administered questionnaire: basic demographic information, physical activity status,
disease and medication status, and fall occurrence (falling incidents within the past year).
Existing scales for measurement: The Elderly Fall Effectiveness Scale (EFSS) and the
Quality of Life Scale (QLS).
The specific assessment methods and tools are provided in Annex 5.
Table 1 Overview of Assessment Content, Methods, and Tools for Project Baseline
Survey
Evaluation content
appraisal
procedure
Assessment tool
classify
project
Basic demographic
information
Name,
Gender,
Age,
Address,
Contact
Information,
Ethnicity,
Education Level, Accommodation
Status, Occupation Status
questionnaire
survey
Annex 5: Survey and
Assessment Form (Part
1)
Illness, Medication
Medical conditions
Types and quantities of diseases,
types
and
quantities
of
medications
questionnaire
survey
Annex 5: Survey and
Assessment Form (Part
2)
Information about
falls
Fall event, history of falls
questionnaire
survey
Annex 5: Survey and
Assessment Form (Part
3)
Knowledge, Belief, and Practice
Related to Falls
questionnaire
survey
Annex 5: Survey and
Assessment Form (Part
4)
fall efficacy
Scale
measurement
Annex 5: Survey and
Assessment Form (Part
5)
Quality of Life Scale
Activities of Daily Living (ADL)
Status
scales survey
Annex 5: Survey and
Assessment Form (Part
VI)
tread
Stand-up-walk test
spot test
Annex 5: Survey and
Assessment Form (Part
7)
(7) Main Evaluation Indicators
①Indicators reflecting the occurrence of falls: incidence rate of falls (number), per capita

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incidence rate of falls (number), and occurrence of fall-related injuries
Incidence rate of human casualties (number), incidence rate of falls and injuries (number).
②Reaction fall efficacy: scores on the fall efficacy assessment scale.
③Reflecting daily living ability: Quality of life scale scores.
(II) Process Evaluation (Intervention Phase)
1. Evaluation Time
February 2026-February 2027 (full project implementation period)
2. Evaluation Object
Study subjects and project team staff.
3. Assessment Content and Methods
(1) Satisfaction of research subjects with group activities
After completing the intervention on household environmental assessment, guidance, and
improvement in the community, the satisfaction level should be inquired and recorded in
Attachment 6, the 'Household Environmental Assessment and Improvement Guidance Work
Record Form'.
(2) Home visit guidance and assistance in environmental improvement
For households that have completed on-site visits, evaluate the implementation of guidance
and assistance in modifying hazardous environmental factors. Calculate the completion rate of
on-site guidance and assistance for environmental modifications (number of households actually
visited and assisted
×
100%). The record form is provided in Appendix 6, "On-site
Environmental Assessment and Improvement Guidance Work Record Form."
(3) Effect Evaluation
The study aims to evaluate the intervention effects at 6 months and 12 months after the
intervention begins. The assessment of fall occurrence is conducted by collecting relevant data
through a fall diary; changes in fall efficacy, knowledge, belief, and practice are measured
through on-site survey tests.
1. Data collection on fall occurrence in the study subjects
(1) Evaluation Object

609
All subjects in the study group.
(2) Assessment Time
From January 2026 to December 2026, monthly data on falls were collected from the start of
the intervention through its full 12-month period.
(3) Assessment Content
Basic information on falls, the same as the baseline survey assessment.
(4) Evaluation Methods and Tools
①The study subjects used the "Fall Occurrence Record Calendar" (Appendix 11) to
document whether falls occurred.
②Staff collect the "Monthly Fall Occurrence Record Calendar" on a monthly basis and
conduct detailed investigations into the recorded fall times using the "Elderly Fall Occurrence
Survey Form" (Part 3 of Appendix 6) from the baseline survey.
2. First efficacy evaluation (at 6 months after the initiation of the first intervention)
(1) Evaluation Object
All subjects in the study group.
(2) Assessment Time
The assessment time for all study subjects should be calculated from the date of completion
of the baseline survey evaluation. The first efficacy evaluation should be conducted after 6
months (with the control assessment time within ±7 days).
(3) Assessment Content
The evaluation content includes: knowledge, attitude, and behavior related to falls, daily
living ability and fall efficacy, as well as risk factors of home environment for elderly falls and
renovation suggestions (including the elimination of risk factors).
(4) Evaluation Methods and Tools
Same baseline survey assessment methods and tools (Annex 6 Parts 3, 4, 5, 6, 7).
3. Second efficacy evaluation (at 12 months after the initiation of the first intervention)
(1) Evaluation Object
All subjects in the study group.

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(2) Assessment Time
The assessment time for all study subjects should be calculated from the date of completion
of the baseline survey evaluation. A second efficacy evaluation should be conducted after 12
months (with the control assessment time within ±7 days).
(3) Assessment Content
The assessment includes: the same as the "Home Environment Risk Factors and
Recommendations for Elderly Fall Prevention" (Annex 4) and the baseline survey content (Annex
5 Parts 3, 4, 5, 6, 7).
(4) Evaluation Methods and Tools
The same baseline survey evaluation methods and tools.
(4) Economic Evaluation
From the social perspective, targeted cost-effectiveness and cost-utility analyses can help
evaluate the actual efficacy of interventions in preventing falls among the elderly, thereby
providing data support for government decision-makers to formulate rational intervention
policies.
1. Municipal Project Office
(1) Collection time: 6 months after intervention completion (after the 6-month assessment)
and 12 months after intervention completion (after the 12-month assessment).
(2) Data Collection Items: The municipal project office's intervention cost assessment
primarily covers two components: direct expenditure on implementation and time investment.
Direct costs include travel, venue, expert, program, manual production, and survey tool expenses.
Time investment encompasses the municipal project office's time allocated to project design,
preparation,
initiation
and
management,
primary
training
delivery,
secondary
training
participation, and supervision activities.
(3) Collection method: The principal responsible person of the municipal project office shall
independently complete the "Investigation Form on Workload and Cost Expenditure of the
Elderly Fall Intervention Project" (Attachment 8) based on the detailed financial expenditure
records.
2. District-level Project Office

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(1) Collection time: 6 months after intervention completion (after the 6-month assessment)
and 12 months after intervention completion (after the 12-month assessment).
(2) Data Collection Items: The district-level project office's intervention cost collection
primarily includes two categories: direct expenditure for implementing fall prevention programs
and time investment. Direct expenditure covers survey questionnaires, measurement tools, home
environment improvement supplies, and labor costs. Time investment encompasses participation
in primary training, secondary training, recruitment/screening of community seniors, baseline
surveys, intervention implementation, process evaluation, and outcome assessment.
(3) Collection method: The principal responsible person of the district-level project office
shall independently complete the "Investigation Form on Workload and Cost Expenditure of
Elderly Fall Intervention Project" (Attachment 9) based on the detailed financial expenditure
records.
3. Primary healthcare institutions
(1) Collection time: 6 months after intervention completion (after the 6-month assessment)
and 12 months after intervention completion (after the 12-month assessment).
(2) Data Collection Items: The intervention cost assessment for grassroots project offices
primarily comprises two components: direct expenditure on implementing fall prevention
programs and time investment. Direct costs include expenses for printing questionnaires,
purchasing assessment tools and home environment improvement supplies, as well as labor fees.
Time investment for fall prevention programs covers activities such as attending primary and
secondary training sessions, recruiting/screening community seniors, conducting baseline surveys,
implementing interventions, and performing outcome evaluations.
(3) Collection method: The principal responsible person of the grassroots project office shall
independently complete the "Investigation Form on Workload and Cost Expenditure of the
Elderly Fall Intervention Project" (Attachment 10) based on the detailed financial expenditure
records.
4. Collection of Relevant Costs for the Study Subject
(1) Collection time: From the start of intervention to the end of final line assessment, data
were collected monthly (accompanied by a fall diary).

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(2) Collection content: The fall-related costs of the study subjects primarily include
outpatient/emergency visits, hospitalization expenses, medication costs, nutritional supplement
expenses, as well as home care and nursing/childcare service fees incurred due to falls during the
project period.
(3) Collection method: Staff from the grassroots project office used the "Investigation Form
on Fall-Related Expenses During Intervention Period of Study Subjects" (Appendix 11) to obtain
data through face-to-face interviews, combined with medical expense records and financial
documents of the elderly.
Since a single fall in the study subject may result in different types of expenses, when staff
members fill out the "Investigation Form on Fall-Related Expenses During Intervention Period"
(Appendix 11), they should record the corresponding sections of Appendix 5 Part 3 based on the
actual treatment methods used by the study subject. Possible treatment scenarios include
self-management (Appendix 11 Part 1), outpatient/emergency visits (Appendix 11 Part 2),
hospitalization (Appendix 11 Part 3), out-of-hospital rehabilitation (Appendix 15 Part 4), and
follow-up examinations (Appendix 11 Part 5). If the study subject requires hospitalization, the
final expenses should be recorded upon discharge. The collected information should not duplicate
data
from
the
previous
month.
For
rehabilitation
treatments,
those
received
during
outpatient/emergency visits are included in the outpatient/emergency expense form (Appendix 11
Part 2), those during hospitalization are counted toward the total hospitalization expenses
(Appendix 11 Part 3), and out-of-hospital rehabilitation is recorded under out-of-hospital
rehabilitation expenses (Appendix 11 Part 4).
VI. Statistical Analysis Methods
(1) Data Collection
All research data collection and management will be conducted via the REDCap platform.
After the initial database is established, it will undergo further verification and cleanup to identify
logical errors and missing values. Telephone follow-ups with participants will be conducted to
confirm and correct any discrepancies, ultimately resulting in the final database.
(II) Data Organization and Analysis

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Statistical analysis was performed using SPSS 20.0. Differences in baseline demographic
characteristics, disease characteristics, prior fall history, and levels of social support between the
two groups were compared, with variables showing significant differences being adjusted in
subsequent analyses. This study planned to evaluate the intervention using intention-to-treat (ITT)
analysis. Descriptive analysis: Statistical descriptions were conducted for primary and secondary
outcome variables, intervention implementation, and other confounding factors. Independent
samples t-tests (for continuous variables, such as the Geriatric Fall Effect Energy Scale score,
Quality of Life Scale score, and Geriatric Fall Knowledge, Belief, and Practice Scale score) and
chi-square tests (for categorical variables, such as attitudes toward the intervention strategy and
fall incidence rate) were used to compare intergroup differences.
The study will employ the Incremental Cost-Effectiveness Ratio (ICER) to evaluate
economic benefits, which represents the additional cost required to achieve each incremental unit
of effect.
VII. Security Assurance
（1）When conducting various activities such as screening, assessment, training, and
exercise for the project, the primary principle should be to ensure the safety and physical health
of the study subjects.
（2）During all screening and assessment procedures, participants should be clearly
informed of the testing methods and potential risks. The program may conduct demonstrations,
and participants are permitted to practice before formal measurements. Staff should remind
participants to perform within their capabilities and not to pursue "good results" in the test
outcomes.
（3）When conducting various assessment activities, staff should pre-cleanse hazardous
factors in the environment, removing slippery, uneven surfaces, obstacles, and other potential
environmental hazards that may cause injuries to study subjects. Additionally, seating or similar
facilities should be provided for study subjects to rest.
(4) Staff members shall prepare first-aid medications and relevant equipment at all project
sites, and each on-site operation shall be conducted with personnel capable of performing primary

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on-site first aid.
VIII. Quality Control
(1) Quality Control in the Development Process of Project Proposals and Related
Intervention Tools
At different stages, by organizing experts from various fields, the overall project plan,
investigation and evaluation plan, intervention implementation plan, and other work plans were
demonstrated; the design and use of various investigation and evaluation questionnaires,
checklists, and record forms were reviewed; and the content and forms of interventions were
validated.
(II) Quality Control of Data Collection
1. Standardized Tools and Methods
standardize survey, measurement, and assessment methods and tools.
2. Training
Conduct standardized training and assessment for researchers involved in data collection,
focusing on the evaluation of work plans, technologies, and tools related to information gathering.
Only those who pass the assessment may commence their duties.
3. On-site verification of data collection
All investigation, measurement, and evaluation activities must be accompanied by
corresponding on-site verification and quality control measures. This primarily involves on-site
verification of questionnaires and measurement items, as well as repeated measurements of
selected study subjects. Specific methods are detailed in the "Requirements for On-site Quality
Control in Investigation and Evaluation" (Appendix 13).
4. Data Entry and Cleaning
Establish and utilize REDCap to create a unified data entry file based on survey
questionnaires or forms, with preliminary logical validation configured. Randomly select over
20% of the already entered questionnaires for secondary validation to ensure data entry quality.
Develop standardized data cleaning protocols and document the data cleaning process.
(3) Quality Control of Intervention Group Activities

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1. Standardize the content, methods, and tools of group activities
Develop a unified programme for group activities, using a unified training manual and tools.
2. On-site evaluation of the quality of intervention group activities
The on-site evaluation team from municipal and district-level disease control institutions
conducted quality assessments of household environmental guidance.
(4) Loss to Follow-up Management
1. Definition of lost-to-follow-up subjects:
In this study, loss to follow-up was defined as: 1) subjects explicitly declining to continue
intervention via SMS, WeChat mini-program, or telephone; 2) subjects withdrawing from the
study due to adverse health outcomes, including hospitalization for somatic or psychological
disorders. Subjects hospitalized due to accidental injuries were not considered as withdrawal from
the study but were recorded as health outcomes.
2. Control for loss of study subjects
(1) Incentives
During the project implementation period, each community health service center utilized
local resources and advantages to provide certain free medical and health services (non-related to
fall prevention) or a degree of material rewards, while maintaining continuous contact and
communication with the study participants, encouraging them to participate in project evaluations
and follow-up activities.
(2) Follow-up confirmation
The project staff conducts at least one follow-up visit per month with the study participants
via telephone, home visits, or face-to-face communication to confirm their presence and
encourage continued participation in the study. Follow-up information is recorded in the "Study
Participant Follow-up Record Form" (Appendix 14).
(3) Use project activities to understand absenteeism
For participants who should have attended the activity but did not during the submission of
the monthly fall report card or periodic efficacy evaluation, the reason for absence should be
investigated on-site or by telephone on the same day, and whether they can continue to participate
in the project should be assessed. Participants should be encouraged to persist in attending

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subsequent project activities.
3. Management of Lost-to-Follow-up Subjects
For subjects who experience loss to follow-up, the reasons for their withdrawal from the
study should be meticulously documented in the 'Subject Follow-up Record Form' (Appendix 14).
Where feasible, an efficacy assessment should be conducted for them.
4. Monthly Reporting System for Research Subject Information
The loss of follow-up of the subjects in the two study groups was reported monthly.
(5) Pollution Control
1. Avoid interference from other projects
During the intervention period, the project community should refrain from participating in
other similar studies or projects that may affect the intervention outcomes. All relevant project
implementation activities in the project community during the intervention period shall be
documented.
2. Treatment of contamination between study groups
Comply with the project protocol, and participants in each group shall not engage in
activities of other groups during the intervention period for any reason. Any such behavior must
be immediately stopped and truthfully recorded.
IX. Organizational Management and Division of Responsibilities
(1) Guangzhou Center for Disease Control and Prevention
Oversee the project's overall operations, including developing work plans, organizing expert
reviews, conducting pilot trials, and implementing interventions, evaluations, and final summaries.
Lead primary-level training programs, manage quality control, and provide operational guidance.
Select project sites based on the plan and define the responsibilities of collaborating units.
Coordinate with all partner organizations within the jurisdiction to conduct training, implement
interventions, ensure quality control, guide evaluations, and oversee operational supervision.
(II) Project Site District Centers for Disease Control and Prevention
According to the project plan, responsible for implementing and coordinating intervention
activities in the project community/department, conducting training, evaluation, quality control,

6017
and daily project management.
(3) Community Health Service Center (Town Health Center)
Organize and implement all project tasks within the jurisdiction, and ensure compliance with
all quality control requirements.

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XI. Schedule
Schedule
job content
2025
2026
2027
July–October
November
December
January-Fe
bruary
March
April-May
July-Augu
st
October to
December
January to
December
Analyze the results
of the preliminary
project to derive the
intervention plan
Refine the research
protocol and
register the trial
number
ethical review
Start, Training
Screening of study
subjects, baseline
survey and
evaluation,
grouping
intervene
process evaluation,
quality assessment,

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monthly fall
follow-up
First efficacy
evaluation
second efficacy
evaluation
Third Effect
Evaluation
Data cleaning and
analysis
Results Release
Note: For reference only. The actual implementation time should align closely with the schedule.

6021
XII. List of Attachments
Annex 1 Coding Rules for Project Research Subjects
Annex 2 List of project area communities/villages
Appendix 3 Screening Form for Study Subjects
Appendix 4 Risk Factors of Home Environment and Renovation Recommendations for Elderly
Falls
Annex 5 Survey Assessment Tool
Annex 6 Record Form for Guidance on Environmental Assessment and Improvement of
Residential Areas
Annex 7 Fall Occurrence Record Calendar
Attachment 8: Survey Form on Workload and Expenditure of Elderly Fall Intervention Projects
by Municipal Project Offices
Annex 9: Survey Form on Workload and Cost Expenditure of the Elderly Fall Intervention
Project by District-level Project Office
Attachment 10: Survey Form on Workload and Cost Expenditure of Fall Intervention Programs
for Elderly in Primary Healthcare Institutions
Appendix 11 Survey Form on Fall-Related Expenditures During Intervention Period for Study
Subjects
Annex 12 Emergency Response Plan Template for Project Activities in Adverse Weather
Conditions
Annex 13 Requirements for on-site quality control during investigation and evaluation
Appendix 14 Follow-up Record Form for Study Subjects

6022
Appendix 1 Coding Rules for Study Subjects
Research subject coding rules
1. This study implements the principle of unique coding for each enrolled subject. Once the
subject's code is confirmed, it will be used as the unique identifier throughout the entire study.
2. The code consists of 6 digits, each with a distinct meaning: □□□□□□
(1) First and second digits: Street code (see Annex 2 for specific codes).
Third: Community/Village Code
（2）Fourth: Group code
The intervention group was 1, and the control group was 2.
(3) Fifth and sixth positions: Serial numbers of study subjects within the community.
Start from 01 and number them sequentially.
3. Upon completion of coding assignment in each project community, a coding
table shall be generated and submitted for archiving. The coding shall not be altered,
and each study subject shall be assigned a unique code throughout the entire project
duration.

6023
Annex 2 List of project area communities/villages
List of communities/villages in the project area
Note: Forty participants were recruited from each community and randomly assigned
to the intervention group or control group by the municipal project office.
Street code
(2 people)
Street/Township
Sample size (people)
01
Huadu District Second People's Hospital
40
02
Xinhua Community Health Service Center
40
03
Xinya Street Qingbu Community Health
Service Center
40
04
Xinhua Street New Street Community
Health Service Center
40
05
Hua Dong Town Hua Qiao Health Center
40
06
Huadong Town Beixing Health Center
40
07
Huadong Town Central Health Center
40
08
Tanbu Town Central Health Center
40

6024
Appendix 3 Screening Form for Study Subjects
Part 1 Screening Information (Part A)
A1 Gender: ①Male ②Female
A2 Birth date: _________ year ______ month ______ day
[Note] If the elderly cannot recall the date, the birth date on the ID card or household
registration book shall prevail.
The actual age of A3 is ______ years.
[Note] Actual age refers to the age calculated by subtracting the survey date from the
actual birth date of the survey subject. For example: if the survey subject was born
on September 21,1960, and the survey date is August 18,2025, then the actual age of
the survey subject is 65 years.
★A4 Over the past two years, how many times have you fallen?
[Note] A fall is recorded regardless of whether injury occurs after the fall.
This question serves as the most critical inclusion criterion. For instance, if an elderly
individual reports having experienced falls in the past two years, on-site inquiries
should be conducted to gather details regarding the occurrence of falls or medical
treatment received, thereby excluding potential recall errors in the elderly
population.
If no falls have occurred, record 0 times. The eligibility for intervention should be
determined based on the results of question A5.
★A5 Are you worried about falling?
①Very worried ②A little worried ③Never thought about it ④Not worried
[Note] Selection of ①or ②indicates concern about falls, warranting further
investigation. For those selecting ③or ④with a score of 0 on question A4 (non-fallers),
screening is terminated as they are not eligible for intervention.
Would A6 like to participate in a two-month (approximately once a week) health
education activity on fall prevention?
1 Willing ②Unwilling
[Note] Participants who refuse to participate cannot be enrolled as intervention subjects,
and screening will be terminated.
A7 Education level:
1 Illiterate, semi-literate ②Primary school ③Junior high school ④High school or
vocational school and above
⑤No formal education, but possesses basic literacy skills

6025
[Note] Survey participants selected as option 1 cannot be included in the intervention
group. Verify whether screening subjects with primary school education level possess
basic literacy skills. If not, select option 1 and exclude the participant. For those without
primary school education but capable of self-directed reading and simple writing, select "
⑤No formal schooling but with basic literacy skills" to include them in the intervention
program.
A8 Will you continue to live at your current address for the next six months?
①Yes ②No ③Not sure
[Note] Individuals who may relocate from their current residence within the next 6 months
or who may remain away from their current residence for an extended period are ineligible
as intervention subjects, and screening will be terminated.
Can A9 walk independently?
①Yes ②No
[Note] Conduct on-site observation and interview the subjects. Independent walking
includes the ability to walk using crutches independently. Subjects who are unable to walk
independently, such as those in wheelchairs or requiring assistance for walking, are
excluded, and the screening is terminated.
How does an A10 investigator assess the communication skills of the subject under
investigation?
1 Inability to hear clearly
②Inability to articulate clearly
③Inability to
comprehend the investigator's intent ④Ability to communicate normally
[Note] To ensure the smooth implementation of the course, participants' ability to
communicate normally will be assessed. Those unable to communicate effectively will be
disqualified from the project, and the screening process will be terminated.
A11 Do you want to confirm whether the respondent can be included in the project as
an intervention subject?
①Yes. According to the coding rules,
the intervention subject number is
code □□□□□□

6026
②deny
[Note] Cases meeting the following exclusion criteria should be excluded. For situations
that cannot be determined temporarily, expert advice may be sought. The exclusion criteria
for the study are as follows:
①In the acute phase of a disease or during an acute exacerbation of a chronic condition;
②Individuals with hearing, visual, or cognitive impairments, or those who self-reported
neurological or psychiatric disorders such as epilepsy or dementia, rendering them unable
to communicate, interact, or learn normally;
③Self-reported patients with diseases of the heart, brain, kidney, liver, respiratory system,
hematological system, etc., and those who are intolerant to exercise (as determined by
physician recommendation or on-site assessment);
④Patients with clearly defined balance-disrupting disorders (e.g., vestibular/cerebellar
system pathologies, vertigo, Ménière's disease, etc.).
Investigator: _______ Date of Investigation: _______ year, _______ month, _______ day
Continue with the baseline survey.

6027
Appendix 4 Risk Factors of Home Environment and Renovation Recommendations for Elderly Falls
project
frequently asked questions
The more "√" marks you draw, the more dangerous
th
i
t b
R
th
tl
Improvement suggestions
hazards
Clear
d
lighting
□Lighting is not installed in the activity area for the
elderly
Install lighting in all activity areas for older adults
□Insufficient, excessive, glaring, or flickering
illumination
The illumination should have a certain intensity, with soft light that is neither
glaring nor flickering. Do not use exposed bulbs for lighting.
□Difficulty turning on or off the lighting when
entering the room at night or getting up at night
□Adjust the position of lighting switches to facilitate easy operation for elderly
individuals at doorways and beds. Use remote-controlled lamps or sensor-activated
□Do not use night lighting tools such as night lights
and flashlights
Use tools such as a night light or flashlight
The ground
is wet and
slippery.
□Slippery ground due to water, oil, or other
substances
Place mats or anti-slip pads in areas with frequent water or oil exposure (e.g.,
bathrooms, kitchens, sinks). Promptly clean up water and oil from the floor. Adjust
furniture positions and replace inappropriate tools to minimize the likelihood of
li
id
l
hi
t th fl
□The floor or flooring material is too smooth
□Replace the non-slip flooring with anti-slip materials. Use carpets or mats. Apply
anti-slip paint to the floor.
□The floor becomes smooth due to waxing or
polishing
Avoid waxing or using polish on the floor
carpet
□The edges of the raised carpet and mat
Replace the carpet or mat. Keep the carpet and mat flat.
□Loose, slippery carpet or mat
Remove the carpet or mat. Use double-sided tape to secure the carpet or mat.
footstep
threshold
□The threshold is too high.
Remove excessively high thresholds. Add warning signs at the thresholds to make
them more visible.
□The steps are too high.
Add warning signs at the steps to make them more visible. Remove the steps. Install
handrails or furniture/equipment that provides support near the steps.
obstacle
Furniture, clutter, or temporary items in corridors and
passageways
□Rearrange furniture positions to ensure unobstructed pathways. Remove clutter
and temporary items from corridors and passageways. Reduce the quantity of

6028
project
frequently asked questions
The more "√" marks you draw, the more dangerous
th
i
t b
R
th
tl
Improvement suggestions
hazards
Clear
d
Furniture
selection
and
placement
□The sofa, chair, or bed is too high or too low
Adjust the height of sofas, chairs, and beds so that your feet can fully touch the
ground when sitting on them
□Toilet height is either too high or too low
□Adjust the toilet seat to the correct height. Use the toilet seat.
□When getting up from a sofa, chair, or bed, there
are no armrests or supports available
Use sofas, chairs, or beds with armrests, or install armrests near them, or place
furniture that provides support.
Furniture
selection
and
placement
□The furniture contains a large amount of glass, or
fragile and sharp materials as decoration
□Avoid using glass furniture whenever possible. Minimize or eliminate the use of
furniture or decorations containing fragile or sharp materials.
□Furniture is not stable, such as chairs with wheels,
tables that are easily assembled etc
Use sturdy furniture and avoid chairs with wheels. Repair or replace unstable
furniture in your home
□Furniture placement hinders elderly individuals'
movement indoors, such as obstructing pathways or
□Adjust furniture placement to avoid obstructing indoor corridors and prevent
elderly residents from taking detours
□Cabinets, drawers, or shelves for storing food,
condiments, and daily necessities that are too high or
Adjust storage cabinets, drawers, and shelves to appropriate heights to ensure that
elderly individuals can access daily necessities without climbing or excessive
If you need to change shoes upon entering, there are
no seats for the elderly in the shoe changing area
Add tools such as a seat and shoe rack at the shoe-changing station
No
handrails or
supports
□No handrails in the toilet, bathtub, or shower area
Install handrails next to toilets, bathtubs, and showers
□There are no handrails in indoor areas with stairs,
steps or ramps
Install handrails on indoor stairs, steps, and ramps
corridor
stairs
□The stairwell or staircase has no lighting or
insufficient lighting
Increase lighting. Repair damaged lamps.
□There are miscellaneous items piled up beside the
stairway
□Clear corridors and staircases of clutter, ensuring unobstructed access
The edge of the stair steps is not visible
Use bright, colorful paint or warning signs on the steps
□The stair steps are damaged
□Provide timely warnings and repair damaged steps
pet
□Pets don't have a fixed resting spot at home
□Assign a fixed resting area for your pet to avoid them resting in the passage
□Pets in the home are not easy to be found
□Wear a bell on your pet to increase visibility

6029
Annex 5 Survey Assessment Tool
Guangzhou Community Elderly Fall Prevention Promotion Project
Survey Evaluation Form
Dear elderly friend,
Falls pose a serious threat to the health of the elderly. To understand the incidence of
falls among local elderly individuals and their related balance function, health status,
comorbidities, medication use, and physical exercise, as well as to better prevent falls and
improve the health of the elderly, we have designed this survey questionnaire. Please
provide all information truthfully, and our staff will assist you in completing this survey.
We appreciate your valuable time and support for this initiative.
project group
February 2026
—————————————————————————————————
Note: Except for the questions labeled "self-reported by the elderly," all other
questions were completed by the surveyors.
Code number □□□□□□(consistent with the screening questionnaire)
A1 Name: ________
PART I. BASIC INFORMATION (PART A)
A2 Ethnic Groups: ①Han Chinese ②Other ethnic groups: _________
A3 Address: _______ District, ___________ Road/Streets, _______ Community, _____
Floor, _____ Unit, Room _____
A4 phone: A4a Home phone: ___________ A4b Mobile phone: ___________
A5 Cohabitation Status: ①Living alone ②Living with spouse only ③Living with
children
④Others: _______________

6030
A6 Care methods: ①Self-care ②Care by relatives ③Care by caregivers/nannies ④
Others
A7 Cane/Assistive Device Usage: ①Used ②Unused
Part II Health-Related Conditions in Older Adults (Part B)
(Inquirer asks)
B1. How would you describe your current level of physical weakness? ①Strong ②Strong
③Average ④Weak ⑤Very weak
B2 Do you need help with daily activities? ①Partially ②Basically ③Not at all ④Not
at all
B3 Have you experienced any mood changes in the past month? ①Yes (skip to B4) ②No
(skip to B5)
B4 For the past month, has your poor mood affected your daily life (e.g., sleep, work)? ①Yes
②No
Have you been diagnosed with the following conditions by a doctor at a community
health service centre or higher level of medical institution?
B5 diabetes
①Yes ②No
B12 Kidney Disease
①Yes ②No
B6 Hypertension
①Yes ②No
B13 stroke
①Yes ②No
B7 osteoarthritis
①Yes ②No
B14 visual impairment
①Yes ②No
B8 COPD
①Yes ②No
B15 cancer
①Yes ②No
B9 Osteoporosis
①Yes ②No
B16
memory-related
disorders
①Yes ②No
B10 Heart Disease
①Yes ②No
B17 Other diseases:
B11 Dyslipidemia
①Yes ②No
Have you been taking the following medications continuously for the last 3 months?
B18 antidepressant
①Yes ②No
B25 hypoglycemic
agent
①Yes ②No
B19 anti-anxiety drug
①Yes ②No
B26 Nonsteroidal
Anti-inflammatory
Drugs (NSAIDs)
①Yes ②No
B20 hypnotic drugs
①Yes ②No
B27 Analgesics
①Yes ②No

6031
B21 Anticonvulsant
①Yes ②No
B28 Dopamine drugs
①Yes ②No
B22 Antipsychotic
drugs
①Yes ②No
B29 anti-Parkinson's
disease drug
①Yes ②No
B23 Antihypertensive
Agents
①Yes ②No
B30 vasodilator
①Yes ②No
B24 diuretic
①Yes ②No
B31 Others:

6032
Part III Information Related to Falls in the Elderly (Part C)
Code number □□□□□□□(consistent with the screening questionnaire)
C1b Over the past year, how many times have you fallen? (Select 0 times, this section does not
require an answer)
Note: Please recall the circumstances of each fall in order and fill in the table below. If more than 3
falls occur, please fill in the blank space on the right or add another table.
Enter the code of your selected option in the table on the right
The first
time
The
second
time
The third
time
C2 When did the fall occur?
____ year
____ moon
____ year
____
moon
____ year
____
moon
C3
What is the specific time period of the fall?
Enter the time in 24-hour format, such as "17:30"
When elderly individuals have difficulty recalling, encourage them
to attempt as much as possible, with a recommended starting
point of 6:00 AM.
The morning can be recorded as 10:00; the noon as 12:00; the
afternoon as 15:00;
The evening can be recorded as 18:00; the night can be recorded
as 23:00
___:___
___:___
___:___
C4
Where did the fall occur? (Single-choice question)
C4-1 Family:
①
Bedroom ②
Kitchen ③
Bathroom ④
Living Room ⑤
Entrance Hall ⑥Balcony ⑦Indoor Stairway ⑧Courtyard ⑨
Skywell
⑩Other indoor areas of the home: _____
Outside the C4-2 family:
⑪Staircases or corridors ⑫Roads within the residential complex
⑬Public areas within the residential complex (excluding roads)
⑭
Roads outside the residential area ⑮
Other areas outside the
residential area (excluding roads): _________
C5
Were the following environmental factors present at the time of the
fall?

6033
（multiple choice ）
1 No environmental hazards
②
Slippery ground
③
Uneven
ground ④Too dim lighting
⑤Steep slope of pavement or stairs ⑥Presence of obstacles ⑦
Absence of protective measures such as crutches or handrails
⑧Inappropriate clothing ⑨External force (pushed or bumped by
others) ⑩Others: ____ ⑪Unclear
C6
Activity at the time of fall:
①Sports activities ②Leisure activities ③Work ④Household chores
⑤Driving or riding in a vehicle ⑥Taking a shower ⑦Using the
toilet
⑧Walking ⑨Others: _____ ⑩Unclear
C7
Injury site? (Select the most severely injured area)
①No injury (mark ①and skip to question C12)
②Head ③Face ④Neck ⑤Upper Limbs
⑥Lower limbs ⑦Trunk ⑧Multiple sites
C8
What kind of injury did you suffer? (Please select the most severe
injury)
①Fracture ②Superficial injury/contusion/abrasion
③Sharp instrument injury/open wound ④Dislocation/torsion/strain
⑤Compression injury
⑥Concussion/Cerebral contusion and laceration ⑦Visceral organ
injury
⑧Burns ⑨Other (specify): _______ ⑩Unclear
C9
How to manage a fall injury?
①Hospitalization ②Outpatient and emergency treatment (skip to

6034
C11)
③Handle it yourself (skip to C11) ④Do not handle it, just rest
(skip to C11)
⑤No treatment, no rest (skip to C12)
C10
How many days are hospitalized? (No days are counted as 0 days,
half a day as 0.5 days)
sky
sky
sky
C11
How long have you been resting after this fall injury (resting time
refers to the duration of cessation of usual daily activities,
including treatment time and hospitalization time)? (Days are not
counted as 0; the smallest unit is half a day, counted as 0.5 days)
sky
sky
sky
C12
Description of the fall process? (Describe the direct cause and process
of the fall)
ZabcC1 Investigator:
ZabcC2 Date of survey: Year Month Day

6035
Part IV Knowledge, Attitude, and Behavior Related to Falls in the
Elderly (Part D)
(Older adults self-reported)
Instructions: Please share your honest opinions. Your feedback greatly helps our work.
Answering method: Mark the option number with " ○", e.g., "1.". If you have any
questions, feel free to ask our survey staff.
Do you think the following statement is correct?
project
option
D01 The risk of falls increases with age.
1. Correct
2. Incorrect
3. Uncertain
D02 Falls can cause death in the elderly.
1. Correct
2. Incorrect
3. Uncertain
D03 Home is the most common location for
falls among the elderly.
1. Correct
2. Incorrect
3. Uncertain
D04 Poor vision affects balance function and
increases the risk of falls.
1. Correct
2. Incorrect
3. Uncertain
D05 Certain medical conditions (e.g.,
hypertension, heart disease) may increase the
risk of falls.
1. Correct
2. Incorrect
3. Uncertain
Sudden sitting up or standing up in D06 can
increase the risk of falls.
1. Correct
2. Incorrect
3. Uncertain
Individuals who have experienced a fall in
D07 are more likely to experience another
fall.
1. Correct
2. Incorrect
3. Uncertain
Concomitant use of more than four
medications increases the risk of falls.
1. Correct
2. Incorrect
3. Uncertain
D09: Others' crutches can be used directly.
1. Correct
2. Incorrect
3. Uncertain
Walking for 10 minutes daily can help prevent
falls.
1. Correct
2. Incorrect
3. Uncertain

6036
Do you agree with the following views?
project
option
D11 falls in the elderly are
preventable.
1. Very agree
2. Agree
3. Don't
know
4.
Disagree
5. I
strongly
disagree.
D12 reduces the risk of falls
by
decreasing
physical
activity.
1. Very agree
2. Agree
3. Don't
know
4.
Disagree
5. I
strongly
disagree.
Using a cane is a sign of
aging in D13.
1. Very agree
2. Agree
3. Don't
know
4.
Disagree
5. I
strongly
disagree.
Even if no injury is present
after a D14 fall, the family or
physician
should
be
informed.
1. Very agree
2. Agree
3. Don't
know
4.
Disagree
5. I
strongly
disagree.
Have you engaged in any of the following behaviors over the past 3
months?
project
option
D15 actively learn knowledge and skills to
prevent falls.
1. Always
2.
Frequently
3.
Occasionally
4. Never
In daily life, D16 will take precautions to
prevent falls.
1. Always
2.
Frequently
3.
Occasionally
4. Never
When choosing shoes, D17 prioritizes slip
resistance.
1. Always
2.
Frequently
3.
Occasionally
4. Never
When getting up in the morning, first lie
flat for a while, then sit for a while, and
finally get out of bed to move around.
1. Always
2.
Frequently
3.
Occasionally
4. Never

6037
D19 Use a non-slip mat when bathing.
1. Always
2.
Frequently
3.
Occasionally
4. Never
Turn on the light or use a night light when
using the toilet at night.
1. Always
2.
Frequently
3.
Occasionally
4. Never

6038
Part V: Elderly Fall Effect Energy Scale (Part E)
(Older adults self-report/face-to-face interview)
Instructions: We will now ask you some questions about your concern about falling.
For each activity below, consider how much you would worry about falling if you were to
do it.
If you are not currently performing this activity (e.g., someone is helping you buy
groceries), imagine you are now doing this activity. Pay attention to the degree of falls.
Select the option that best describes your situation.
If you have any questions, you can ask the on-site staff at any time.
title
1
Ignore
2
A little
attention
3
Very
concerned
(Very
4
Extreme
concern
E01 Home Cleaning
E02 Dressing and undressing
E03 Cooking Rice
E04 Showering
E05 Buying things, shopping
E06 Stand up from the chair or sit
down
E07 Going up/down stairs
E08 Walks near home
E09: Pick up objects from above or
from the ground
E10 Transfer Call
E11
is
walking
on
a
slippery
ground.
E12 Visit relatives and friends
E13 Walks through crowded areas
E14 on rough roads (e.g. poorly
maintained or unpaved)
E15 up/down slope
E16 goes to an event, such as an
activity center
Investigator:
Date
of
investigation:
Year
Month
Day
Investigator: Date of investigation: Year Month Day

6039
Part VI Quality of Life Scale (Part F)
(Inquirer asks)
SF-12 Quality of Life Scale
project
option
F1
Overall, your health status is
①Very good ②Good ③Good
④Average (neither good nor
bad) ⑤Poor
F2
Does your current health condition limit your ability to
perform moderate-intensity activities such as moving tables,
cleaning or mopping floors, playing ball games, or
practicing tai chi?
①There are significant
limitations ②There are some
limitations ③There are no
limitations
F3
Does your current health condition affect your ability to
walk upstairs?
①There are significant
limitations ②There are some
limitations ③There are no
limitations
F4
How much of the past two weeks have you actually done
less work or other activities than you expected because of
your health?
①It often happens. ②Most of
the time.
③Sometimes ④Occasionally
⑤Never
F5
How much time in the past two weeks have you been less
attentive to your work or other daily activities because of
your health?
①Often ②Most of the time ③
Sometimes ④Occasionally ⑤
Never
F6
How much of the past two weeks have you actually done
less work or other activities than you expected because of
your mood (e.g. feeling depressed or anxious)?
①Often ②Most of the time ③
Sometimes ④Occasionally ⑤

6040
Never
F7
How much time over the past two weeks have you been less
attentive to your work or other daily activities due to
emotional factors such as feeling depressed or anxious?
①Often ②Most of the time ③
Sometimes ④Occasionally ⑤
Never
F8
How much has your physical pain affected your daily work
(including going to work and doing housework) over the
past two weeks?
①No impact at all ②Minimal
impact ③Some impact ④
Significant impact ⑤Extremely
significant impact
F9
How many hours have you felt calm in the last two weeks?
①Often ②Most of the time ③
Sometimes ④Occasionally ⑤
Never
F10
How many hours have you felt energetic in the past two
weeks?
①Often ②Most of the time ③
Sometimes ④Occasionally ⑤
Never
F11
How many times in the past two weeks have you felt bad,
depressed or down?
①Often ②Most of the time ③
Sometimes ④Occasionally ⑤
Never
F12
How much time have you spent on social activities (e.g.
visiting relatives and friends) in the past two weeks due to
your health or emotional problems?
①Often ②Most of the time ③
Sometimes ④Occasionally ⑤
Never
Total
Investigator:
ZefF1
Date
of
measurement:
Year
Month
Day
Investigator: ZefF1 Date of measurement: Year Month Day
Part VII "Stand-Up-Walk" Timing Test (Part G)

6041
Stand-up-walk Test Record Form
number of times
Time:. seconds
Accessibility Tools
1. None 2. Single crutch
3. Crutches 4. Walking aids
G01
G04
G02
G05
G03
G06
Final test result
G00
Note: The final test result is the average of three measurements. A 10-second test video of
the tester must be recorded.
Zuptogo1 Tester:
Zuptogo2 Date of survey: Year Month Day

6042
Annex 6 Record Form for Guidance on Environmental Assessment and Improvement of Residential Areas
Subject ID
(6 people)
Home visit
assessment
time
Appraiser
name
Feedback
assessment
result
Provide guidance
on environmental
improvement
Satisfaction of the elderly/caregivers
with the guidance of this assessment
remarks
1.Yes 2.No
1. Yes 2. No
1. Satisfied 2. Neutral 3. Unsatisfied
1.Yes 2.No
1. Yes 2. No
1. Satisfied 2. Neutral 3. Unsatisfied
1.Yes 2.No
1. Yes 2. No
1. Satisfied 2. Neutral 3. Unsatisfied
1.Yes 2.No
1. Yes 2. No
1. Satisfied 2. Neutral 3. Unsatisfied
1.Yes 2.No
1. Yes 2. No
1. Satisfied 2. Neutral 3. Unsatisfied
1.Yes 2.No
1. Yes 2. No
1. Satisfied 2. Neutral 3. Unsatisfied
1.Yes 2.No
1. Yes 2. No
1. Satisfied 2. Neutral 3. Unsatisfied
1.Yes 2.No
1. Yes 2. No
1. Satisfied 2. Neutral 3. Unsatisfied
1.Yes 2.No
1. Yes 2. No
1. Satisfied 2. Neutral 3. Unsatisfied
1.Yes 2.No
1. Yes 2. No
1. Satisfied 2. Neutral 3. Unsatisfied
1.Yes 2.No
1. Yes 2. No
1. Satisfied 2. Neutral 3. Unsatisfied
1.Yes 2.No
1. Yes 2. No
1. Satisfied 2. Neutral 3. Unsatisfied
1.Yes 2.No
1. Yes 2. No
1. Satisfied 2. Neutral 3. Unsatisfied
1.Yes 2.No
1. Yes 2. No
1. Satisfied 2. Neutral 3. Unsatisfied
1.Yes 2.No
1. Yes 2. No
1. Satisfied 2. Neutral 3. Unsatisfied
Note: If you provide environmental improvement services beyond the project requirements, please enter them in the Remarks field.
Signature of the Appraiser: Year Month Day
Signature of

6043
the Appraiser: Year Month Day
Annex 7 Fall Occurrence Record Calendar
Fall Occurrence Log Calendar
June 2025
1
2
3
4
5
6
7
filling explanation
1
2
This calendar is provided for the project
team to collect information on falls
among the elderly.
3
4
5
6
7
8
9
●If you fall, mark the date with the word
'fall' whether you are injured or not.
10
11
12
13
14
15
16
17
18
19
20
21
22
23
●Submit the monthly calendar to the
local project team as required by local
regulations.
24
25
26
27
28
29
30
●Enter follow-up results into the
monthly calendar database
(Questionnaire Star) on a monthly basis.

6044
Attachment 8: Survey Form on Workload and Expenditure of Elderly Fall
Intervention Projects by Municipal Project Offices
Investigation
on
workload
and
expenditure
of
elderly
fall
intervention project in municipal project office
Filler: _______ Date: ____ year __ month __ day
Part 1: Drafting of programmes, manuals, etc.
Complete project plan workload
number
Person
(Name)
Annual salary
(RMB)
professional
ranks
and
titles
Time (days)
job
content
remarks
Complete project plan expenditure
Expert fee
number
Expert
Name
professional
ranks
and titles
Cost (RMB)
job content
remarks
Conference fees
project name
RMB/day
fatalism
Amount (RMB)
remarks
site use fee
Amount
or
square
meters
board and lodging
unobstructed
----
----
go ：
return ：
overall ：
other
amount to
---
---
material printing postage
project name
Yuan
per
copy
Number
of
copies
Amount (RMB)
remarks
scheme

6045
Trainee Manual
Staff Handbook
Fall Calendar
Mail fee
----
----
Video
Shooting
and
Production
----
----
other
Proportion
allocated
to
intervention
group: __%
amount to
----
----
Part 2: Launching Training (Level 1 Training)
Training workload
number
Participants
(Name)
Annual salary
(RMB)
professional
ranks
and
titles
Time (days)
job
content
remarks
Municipal Project Office
District/County-level Project Office
primary healthcare institutions
training expenditure
Expert fee
number
Expert
(Name)
professional ranks
and titles
Cost (RMB)
job content
remarks
Conference fees
project name
RMB/day
fatalism
Amount (RMB)
remarks
site use fee
Amount
or
square

6046
meters
board and lodging
unobstructed
----
----
go ：
return ：
overall ：
other
amount to
---
---
Part 3: Supervision
Supervision workload
number
Person
(Name)
Annual
salary
(RMB)
professional
ranks
and
titles
Time
spent
on
work
(days)
job
content
remarks
Municipal Project Office
District-level project offices and primary healthcare institutions
supervisory expenditure
project name
RMB/day
fatalism
Amount (RMB)
remarks
site use fee
Amount
or
square
meters
board and lodging
unobstructed
----
----
go ：
return ：
overall ：
other

6047
amount to
---
---
Part IV: Screening-Data Collection
Expenditure
project name
RMB/day
fatalism
Square meters (or
amount)
remarks
Quality control
(intervention
implementation and
data collection)
Proportion
allocated to
intervention
group: __%
Venue fee 1
(intervention)
Proportion
allocated to
intervention
group: __%
Venue fee 2 (Data
collection:
screening-assessment)
Material cost 1
(questionnaire,
measurement tools)
----
----
Material cost 2
(improvement of
----
----

6048
family environment)
other
Proportion
allocated to
intervention
group: __%
amount to
----
----
service charge
CNY/person/day
number of
people
fatalism
aggregate
amount
Screen
base line
intervene
Proportion
allocated to
intervention
group: __%
DA
other
amount to
----
----
-----
Form instructions:
1. Annual salary (2024): The total annual income, including basic salary, bonuses, and
allowances, before tax.
2. Professional Title: Junior, Intermediate, Senior (including Associate Senior). Leave
blank if no professional title is held. In case of title change, the title during project
participation shall prevail.
3. Meeting expenses: Please provide accurate details for venue fees, accommodation,
meals, transportation, etc. If no venue fees apply (e.g., the user unit has no fee-based
meeting rooms), simply enter the meeting room area in square meters.
4. Fill in working hours truthfully, with the smallest unit being 0.5 days.

6049
Annex 9: Survey Form on Workload and Cost Expenditure of the Elderly Fall
Intervention Project by District-level Project Office
Investigation on workload and cost expenditure of elderly fall intervention
project in district-level project office
Name of the district-level project office:
Filler: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Part 1: Workload
Implementation
personnel
Annual salary
(RMB)
professional
ranks and
titles
Time (days)
remarks
Recruitment/Screening
baseline survey
Implement interventions
Proportion
allocated to
intervention
group: __%
Proportion
allocated to
intervention
group: __%
Proportion
allocated to
intervention
group: __%
Proportion
allocated to
intervention
group: __%
DA
Part Two: Expenditure

6050
project name
RMB/day
fatalism
Square meters
(or amount)
remarks
Quality control
(intervention
implementation and
data collection)
Proportion
allocated to
intervention
group: __%
supervisor
Proportion
allocated to
intervention
group: __%
Venue fee 2 (Data
collection:
screening-assessment)
Material cost 1
(questionnaire,
measurement tools)
----
----
Material cost 2
(improvement of
family environment)
----
----
other
amount to
----
----
service charge
CNY/person/day
number of
people
fatalism
aggregate
amount
Screen
base line
intervene
Proportion
allocated to
intervention
group: __%
DA
other
amount to
----
----
-----
supervisory expenditure
project name
RMB/day
fatalism
Amount (RMB)
remarks
site use fee
Amount or square
meters
board and lodging
unobstructed
----
----
go ：
return ：
overall ：

6051
other
amount to
---
---
Form Instructions: 1. Annual Salary (2024): This includes the individual's basic salary,
bonuses, and subsidies, all calculated as pre-tax income.
2. Professional Title: Junior, Intermediate, Senior (including Associate Senior). Leave
blank if no professional title is held. In case of title change, the title during project
participation shall prevail.
3. Meeting expenses: Please provide accurate details for venue fees, accommodation,
meals, transportation, etc. If no venue fees apply (e.g., the user unit has no fee-based
meeting rooms), simply enter the meeting room area in square meters.
4. Fill in working hours based on actual time, with the smallest unit being 0.5 days.
5. If supervision and quality control are the same task, only one entry is required.
6. Data collection: including field investigation and data entry.
Attachment 10: Survey Form on Workload and Cost Expenditure of Fall
Intervention Programs for Elderly in Primary Healthcare Institutions
Investigation on workload and cost expenditure of fall intervention program for
the elderly in primary health care institutions
Community name:
divide into groups ：
group
Filler:
Date: ___ year ___ month ___ day
Part 1: Workload
Implementation
personnel
Annual salary
(RMB)
professional
ranks and
titles
Time (days)
remarks
Recruitment/Screening
baseline survey

6052
Implement interventions
DA
Part Two: Expenditure
project name
RMB/day
fatalism
Square meters (or
amount)
remarks
Venue fee 1
(intervention)
Site fee 2 (data
collection,
screening-assessment)
Material cost 1
(questionnaire,
measurement tools)
----
----
Material cost 2
(improvement of
family environment)
----
----
other
amount to
----
----
Form Instructions: 1. Annual Salary (2024): This includes the individual's basic salary,
bonuses, and subsidies, all calculated as pre-tax income.
2. Professional Title: Junior, Intermediate, Senior (including Associate Senior). Leave
blank if no professional title is held. In case of title change, the title during project
participation shall prevail.
3. Meeting expenses: Please provide accurate details for venue fees, accommodation,
meals, transportation, etc. If no venue fees apply (e.g., the user unit has no fee-based
meeting rooms), simply enter the meeting room area in square meters.
4. Fill in working hours based on actual time, with the smallest unit being 0.5 days.
5. Data collection: including field investigation and data entry.

6053
Appendix 11 Survey Form on Fall-Related Expenditures During Intervention
Period for Study Subjects
Code: □□□□□□(six digits, please verify carefully)
Investigation Form on Fall-Related Expenses During the Intervention Period of
the Study Subjects
(Inquirer asks)
1. How many times did you fall this month?
①1 time ②2 times ③3 times (Complete one form per time)
1A. This questionnaire is for the cost collection of the first fall?
2. Is it a new fall in this month? ①Yes ②No
3. What type of medical insurance do you have? (Multiple selections allowed)
①Urban Employee Basic Medical Insurance (Medical Insurance) ②Urban Resident
Basic Medical Insurance ③Urban and Rural Residents' Medical Insurance ④New
Rural Cooperative Medical Scheme (New Rural Cooperative Medical) ⑤Three
Guarantees and One ⑥None of the above
4. How did you handle this fall? (Multiple answers allowed)
①Self-Handling: Complete the "Part 1 (A) Self-Handling Related Expense Survey"
②
Outpatient/Emergency
Management:
Complete
the
"Part
II
(B)
Outpatient/Emergency-Related Cost Survey"
③Hospitalization: Complete the "Part III (C) Hospitalization-Related Expense
Survey"
④Outpatient Rehabilitation: Complete the "Part IV (D) Outpatient Rehabilitation
Cost Survey"

6054
⑤Re-examination: Complete the "Part V (E) Re-examination Cost Survey"
⑥No intervention: End of investigation
Please complete the survey form according to your actual situation.

6055
Part 1 (A): Self-Handling of Related Costs
A1. Did you receive care (at home)
after this fall?
①husband or wife
②Children and other relatives: ______ (relationship
to the study subject), totaling ___ days, averaging
_____ hours per day, with an annual salary of _____
yuan.
______
(relationship
with
the
research
subject),
totaling ___ days, averaging _____ hours per day, with
an annual salary of _____ yuan. (Add as needed)
③Nursing aide/nanny: _____ yuan
④Not receiving care
A2. What is the cost of purchasing the
medication (including supplies such as
cotton swabs and gauze)?
_____ Yuan
A3. What is the cost of purchasing
nutritional and health supplements this
time?
_____ Yuan
A4.
Transportation
for
purchasing
medications/health supplements?
①Taxi (Cost: ______ yuan)
②Private
car (distance
from home
to
medical
institution ______ kilometers)
③Ambulance (Cost: ______ yuan)
④Others, modes of transportation:
，Yuan
Instructions for completion: 1. If no medication is purchased this time and household
stock is used, the value of the utilized drugs/ supplies must be converted into
monetary terms.
2. Expenses for nutritional supplements and medications: The following two scenarios
shall be included in the expenses: (1) The study subject or their spouse purchases
nutritional supplements or medications due to a fall; (2) The study subject entrusts a
relative to purchase nutritional supplements or medications. Expenses for nutritional
supplements brought by relatives or friends during visits due to a fall shall not be
included.
3. If care (such as nursing aides or housekeepers) was provided prior to the fall, only
the additional costs incurred due to the fall shall be included (for example, if the
monthly cost was 3,000 yuan before the fall and increased to 3,500 yuan due to

6056
increased workload after the fall, the additional cost of 500 yuan shall be included).
Part B: Investigation of costs associated with outpatient/emergency services
B1. Which type of medical institution
do
you
visit
for
outpatient
and
emergency treatment?
①General hospital (including general practice hospitals,
excluding traditional Chinese medicine hospitals)
②Specialized hospitals (e.g., orthopedic hospitals)
③traditional Chinese medical hospi tal
④Community Health Service Center (Station)/Township
Health Center
⑤PDC
What
is
the
total
cost
of
B2.
Outpatient and Emergency Services
(including
medical
service
fees,
examination
fees,
medication
fees,
rehabilitation expenses, etc.)?
respect
yuan, of which the out-of-pocket amount
Yuan 。
B3. Transportation for Medical Visits
①Taxi (Cost: ______ yuan)
②Private car (distance from home to medical institution
______ kilometers)
③Ambulance (Cost: ______ yuan)
④Others, mode of transportation:, yuan
Explanation of the terms: 1. Medical service fee: The original drug markup,
registration fee, and consultation fee. If the local reform has not been implemented, it
should be directly interpreted as the registration fee.
2. For rehabilitation services provided in outpatient or emergency departments, the
rehabilitation costs shall be included in the outpatient or emergency department
expenses.
Part 3 (C): Survey on Hospitalization-Related Costs
C1.
Number
of
hospitalization days this
month
_____ days (from ____ year ____ month ____ day to ____ year ____
month ____ day)

6057
C2.
Caregiver
during
hospitalization
(multiple
choice)
①husband or wife
②Children and other relatives:
______ (relationship with the research subject), totaling ___ days,
averaging _____ hours per day, with an annual salary of _____ yuan.
______ (relationship with the research subject), totaling ___ days,
averaging _____ hours per day, with an annual salary of _____ yuan.
(Add as needed)
③Nursing staff and housekeepers: _____ yuan
C3. What is the total cost
of this hospitalization?
______ yuan, with ______ yuan to be paid out-of-pocket.
C4. What is your
discharge diagnosis?
C5.
Mode
of
transportation for medical
visits
①Taxi (Cost: ______ yuan)
②Private car (distance from home to medical institution ______
kilometers)
③Ambulance (Cost: ______ yuan)
④Others, modes of transportation:
，Yuan
Instructions for completion: 1. If the study subject is hospitalized due to a fall during
this month's follow-up, the next month's follow-up must continue to inquire whether
the subject has been discharged and whether there are any related hospitalization costs.
Starting from the month of discharge, each subsequent follow-up must also inquire
whether the subject has undergone re-examination or rehabilitation therapy.
2. Rehabilitation performed during hospitalization shall be included in the total
hospitalization expenses.
Part IV (D): Outpatient Rehabilitation
number of times
The first time
The second time
D1.
Rehabilitation
Date
__ month __ day, __ year
__ month __ day, __ year
D2.
Rehabilitation
Costs
Total, Self-paid
Total, Self-paid
D3.
Rehabilitation
transportation
options?
①Taxi (Cost: ______ yuan)
①Taxi (Cost: ______ yuan)

6058
②Private car (distance from home to
medical
institution
______
kilometers)
②Private car (distance from home to
medical
institution
______
kilometers)
③Ambulance (Cost: ______ yuan)
③Ambulance (Cost: ______ yuan)
④Others, mode of transportation:,
yuan
④Others, mode of transportation:,
yuan
D4. Caregiver during
rehabilitation
(multiple-choice
question)
①husband or wife
2
husband or wife
②Children and other relatives:
______ (relationship to the study
subject), totaling ___ days, with an
average daytime duration of _____
hours and an annual salary of _____
yuan.
______ (relationship with the
research subject), totaling ___ days,
with an average daytime duration of
_____ hours and an annual salary of
_____ yuan. (Add as needed)
②Children and other relatives:
______ (relationship to the study
subject), totaling ___ days, with an
average daytime duration of _____
hours and an annual salary of _____
yuan.
______ (relationship with the
research subject) Total ___ days,
average daytime hours _____,
annual salary level _____ yuan.
(Add as needed)
③Nursing staff and housekeepers:
_____ yuan
3
Nursing aide, nanny: _____ yuan
Note: Not for in-hospital rehabilitation. Only non-emergency outpatient and inpatient
rehabilitation expenses are included. For example, rehabilitation services provided by
rehabilitation companies.
Part 5 (E): Re-examination Fees
E1.Recheck Date
___/____/___
E2. Re-examination fees (medical service fees,
examination fees, medication fees, etc.)
_____ Yuan
E3. Recheck the transportation method?
①Taxi (Cost: ______ yuan)
②Private car (distance from home to
medical institution ______ kilometers)
③Ambulance (Cost: ______ yuan)
4
Other, Transportation:, Yuan

6059
Investigator: ______ Date of investigation: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

60
Annex 12 Emergency Response Plan Template for Project Activities in Adverse
Weather Conditions
Emergency Response Plan Template for Project Activities in Adverse Weather
Conditions
This emergency response plan is formulated to ensure the safety and health of
elderly participants in the project, prevent accidents and potential health risks caused by
adverse weather conditions such as rain, snow, lightning, strong winds, haze, high
temperatures, and power outages, and to minimize the occurrence of emergencies under
adverse weather conditions.
I. Guiding Principles
Thoroughly implement the requirements and principles for ensuring the safety of
elderly participants in project activities, adhering to the principle of prioritizing safety
and prevention. Proactively carry out preventive measures against adverse weather
conditions to guarantee the orderly progress of project operations.
II. Definition of Adverse Weather
Severe weather conditions such as strong winds/tropical storms, heavy rain or
downpours, snow/snowstorms, thunderstorms, hail, dense fog, haze, and extreme heat.
The contingency plan will be activated when the following weather conditions occur
or are occurring during the project event day.
1. High winds: Winds of level 5 or above are not recommended for travel.
2. Heavy rain or rainstorm: Heavy rain or rainstorm, not suitable for travel.
3. Snow/Blizzard: Snowfall or heavy snow accumulation on main roads makes
travel difficult for the elderly, and they should avoid going out.
4. Lightning and hail: Avoid going out during thunderstorms or hailstorms.
5. Haze: PM2.5 levels exceeding 200 (during moderate to severe haze
conditions)
indicate
that
travel
and
outdoor
activities
are
not
recommended.

60
6. Heavy fog: visibility less than 50 meters, travel is not recommended.
7. High temperature: The meteorological station has issued a high-temperature
warning, and travel is not recommended.
8. Other weather conditions that are not suitable for elderly people to travel or
participate in project activities.
III. Trigger Mechanism of the Contingency Plan
The community weather monitors check the weather forecast on the official website
of the local meteorological station before leaving work the day before the project activity
(before 16:00) to decide whether to activate the emergency plan.
IV. Emergency Response
In the event of adverse weather conditions prior to a project activity, the project
team shall suspend the current activity; the project team staff shall notify the elderly
participants in advance and document the incident in the records.
In the event of sudden adverse weather during the implementation of project
activities, the project team shall, based on the prevailing circumstances, adhere to the
principle of prioritizing safety, ensuring health, and emphasizing prevention. Measures
such as suspending project activities or canceling them on-site shall be taken as
appropriate, and a safe venue shall be provided for the elderly to temporarily rest.
V. Emergency Procedures
(I) General Procedures
1. Prior to project activities, when advance conditions meeting the activation criteria
of this emergency response plan emerge or are anticipated, the severe weather
information monitor shall immediately consult the head of the severe weather emergency
response task force regarding plan activation, with the task force leader issuing relevant
instructions.
2. Upon activation of the emergency response plan, the severe weather information
monitor shall immediately notify all members of the leadership group and community
project activity organizers either in person or by telephone.

60
3. The personnel responsible for organizing community project activities shall
notify each elderly individual via both telephone and text message. The notification
content shall include: explicitly informing the elderly of the postponement of the project
activities and providing possible alternative schedules. Records of the notification
process and outcomes shall be maintained.
4. The head of the emergency response team for severe weather will determine the
resumption time of project activities based on weather conditions.
(II) Precautions
1. A dedicated individual shall be assigned to monitor severe weather information.
2. Each member of the project team is entitled to propose the activation of the
severe weather contingency plan to the project leadership team leader.
3. The head of the severe weather emergency response task force shall report and
file with the superior project management department upon activating the severe weather
emergency plan.
4. In the event of sudden rainfall, snowfall, or other adverse weather conditions with
short remaining time before the project activity commencement, project staff shall
promptly implement measures such as laying anti-slip mats and setting up warning signs
to eliminate hazardous factors in the project activity environment.
5. In the event of severe weather during the project activities, the on-site responsible
person may terminate the activities at any time based on the situation and establish a
temporary rest area for elderly participants to take a break. Simultaneously, a report shall
be submitted to the head of the severe weather emergency response leadership group,
who shall then report and file the incident with the superior administrative department.
VI. Personnel Composition and Division of Responsibilities for the Severe Weather
Emergency Response Leadership Group
1. Team Leader: XXX (Director of XXX Community Health Service Center) is fully
responsible for emergency command, including timely activation and termination of
emergency plans, as well as issuing activation orders.
2. Deputy Leader: XXX (Director of XXX Department at XXX Community Health
Service Center) shall promptly consult the leader based on the severity of adverse

60
weather conditions, and report the initiation and termination of the proposal to the
municipal and district Centers for Disease Control and Prevention (CDC).
3.Members:
The XXX (Severe Weather Information Monitor, XXX Department of XXX
Community Health Service Center) must consult the team leader when halting practice
due to adverse weather conditions. Upon receiving the restart order, they shall notify
other leadership team members and provide clear explanations to residents.
The XXX (XXX Community Health Service Center, XXX Department) is
responsible for notifying the event organizers to activate the contingency plan.
XXX (primary convener of the project activity organization) is responsible for
notifying the elderly members of the group.

60
Annex 13 Requirements for on-site quality control during investigation and
evaluation
Investigation and assessment of on-site quality control
requirements
To enhance the quality of fieldwork in this research survey and evaluation, ensure
the accuracy of assessment data, and promptly identify quality issues arising from field
operations, these work requirements are hereby established. All units are requested to
comply accordingly.
I. Purpose of Quality Control
The following objectives are to be achieved through quality control at the site of
survey and assessment:
1. Reduce missing items and wrong entries at the source, and avoid obvious logical
errors.
2. Identify and promptly correct any errors in the field investigation and
assessment methods.
3. The results showed that the surveyor's subjectivity can reduce the impact on the
evaluation results and increase the measurement accuracy.
II. Responsibilities of Quality Control Officer
Each assessment site shall appoint a dedicated on-site quality control officer. The
officer must be proficient in the technical requirements and quality control essentials of
each survey assessment, and be familiar with the on-site organizational procedures and
division of responsibilities. Their primary duties include: conducting on-site inspections
of all survey assessment operations to promptly identify and rectify issues; performing
on-site verification of information collected during the day to verify and correct any
discrepancies immediately; collecting, summarizing, and analyzing quality control issues
related to survey assessments, and reporting and sharing them in a timely manner.
The superior project unit has the responsibility to carry out quality control work on

60
the site of investigation and evaluation.
III. Key Components and Content of Quality Control
Survey and evaluation personnel, along with quality control staff, must conduct
on-site verification of collected data before participants leave the field. The verification
should include: clarity of handwriting in questionnaire and scale responses, identification
of missing or omitted items, detection of outliers, and identification of logical
inconsistencies. Identified issues must be accurately documented, promptly corrected,
and shared with relevant staff for collective learning. Personnel or projects demonstrating
substandard performance in survey evaluations should undergo additional training,
targeted quality control, or reassignment to more suitable roles.
Appendix 14 Follow-up Record Form for Study Subjects
Study subject follow-up record form (telephone/in-home/face-to-face)
CODE Number □□□□□□
Follow-up
date
fl.up
form
Recent health
status
(self-reported)
Did you
fall?
Average
weekly
frequency of
outdoor
activities
over the past
month
other
Follow-up
Officer

60
First time:
YTD
1. Phone
2.
Home
visit
3.
Face-to-face
1. Good
2. General
3. Not good
1. Yes
2. No
Almost every
day
2. 4-5 times
per week
Second time:
YTD
1. Phone
2.
Home
visit
3.
Face-to-face
1. Good
2. General
3. Not good
1. Yes
2. No
Almost every
day
2. 4-5 times
per week
Third time:
YTD
1. Phone
2.
Home
visit
3.
Face-to-face
1. Good
2. General
3. Not good
1. Yes
2. No
Almost every
day
2. 4-5 times
per week
Fourth time:
YTD
1. Phone
2.
Home
visit
3.
Face-to-face
1. Good
2. General
3. Not good
1. Yes
2. No
Almost every
day
2. 4-5 times
per week
Fifth time:
YTD
1. Phone
2.
Home
visit
3.
Face-to-face
1. Good
2. General
3. Not good
1. Yes
2. No
Almost every
day
2. 4-5 times
per week
6th time:
YTD
1. Phone
2.
Home
visit
3.
Face-to-face
1. Good
2. General
3. Not good
1. Yes
2. No
Almost every
day
2. 4-5 times
per week
The 7th time:
YTD
1. Phone
2.
Home
visit
3.
Face-to-face
1. Good
2. General
3. Not good
1. Yes
2. No
Almost every
day
2. 4-5 times
per week

60
The 8th time:
YTD
1. Phone
2.
Home
visit
3.
Face-to-face
1. Good
2. General
3. Not good
1. Yes
2. No
Almost every
day
2. 4-5 times
per week
The 9th time:
YTD
1. Phone
2.
Home
visit
3.
Face-to-face
1. Good
2. General
3. Not good
1. Yes
2. No
Almost every
day
2. 4-5 times
per week
10th time:
YTD
1. Phone
2.
Home
visit
3.
Face-to-face
1. Good
2. General
3. Not good
1. Yes
2. No
Almost every
day
2. 4-5 times
per week
The
11th
time:
YTD
1. Phone
2.
Home
visit
3.
Face-to-face
1. Good
2. General
3. Not good
1. Yes
2. No
Almost every
day
2. 4-5 times
per week
The
12th
time:
YTD
1. Phone
2.
Home
visit
3.
Face-to-face
1. Good
2. General
3. Not good
1. Yes
2. No
Almost every
day
2. 4-5 times
per week
* During follow-up visits, the "Monthly Fall Occurrence Record Calendar" can be
collected simultaneously, and the "Elderly Fall Occurrence Survey Form" should be
completed.