Development of a Four-Dimensional Fall Prevention Model for Older Adults in Satun Province.

Abstract

      This research and development study aimed to examine the situation and risk factors for falls, develop a four-dimensional fall prevention model, and evaluate its implementation in Satun Province, Thailand. The situational assessment included 450 older adults. Model development involved 15 experts and focus group discussions with 27 older adults and caregivers. A 12-week quasi-experimental study was conducted with 45 participants each in the intervention and comparison groups, followed by implementation across seven districts involving 810 participants. Data were collected using a four-dimensional risk assessment, fall and injury records, the Berg Balance Scale (BBS), EQ-5D-5L, and satisfaction questionnaires. Analyses included descriptive statistics, paired t-tests, Welch’s t-tests, fall incidence rate ratios, and content analysis.

      The findings showed that 11.6% of older adults reported falls during the preceding 12 months; among those who fell, 40.4% sustained injuries. The model comprised screening, risk classification across four dimensions, individualized activities, referral, follow-up, and documentation and evaluation. Complete pre–post data were available for 42 intervention and 44 comparison participants. The intervention group demonstrated a greater improvement in BBS scores than the comparison group, with a mean difference in change of 2.75 points (95% CI: 1.89–3.60; p < .001). Between-group differences in EQ VAS changes and fall incidence rates were not statistically significant. During district-wide implementation, 708 participants had complete pre–post data. Mean BBS scores increased from 45.10 to 46.80, and EQ VAS scores increased from 65.42 to 67.63. However, the proportion of participants reporting falls increased from 28.25% to 29.80%. Satisfaction was high among older adults, caregivers, and healthcare personnel.