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Table 1 Patient assessment questionnaires

From: Older adult falls prevention behaviors 60 days post-discharge from an urban emergency department after treatment for a fall

Family and Provider Engagement with Fall Prevention: Response options for all questions were Yes or No, except for Question 4, for which the response was number of days.
 (1) Since you were discharged on [date] for your fall injury, have you spoken to a healthcare provider about the fall you had?;
 (2) During the last two months, have you talked to your healthcare provider(s) about things you can do to reduce your chance of falling?;
 (3) During the last two months, have you talked with your healthcare provider(s) about how your medications might influence your chance of falling?;
 (4) Can you recall how many days after you were discharged from the emergency department on [date] that you spoke to your healthcare provider about the fall you had?;
 (5) During the last two months, have you talked with your pharmacist about how your medications might influence your chance of falling?;
 (6) During the last two months, have you talked with your healthcare providers, including eye doctor or optometrist, about how your vision might influence your chance of falling?;
 (7) During the last two months, have you talked with family members about things you can do to reduce your chance of falling?;
 (8) During the last two months, have you talked with friends about things you can do to reduce your chance of falling?
Falls Prevention Program Participation
 (1) During the last two months, have you contacted or attempted to contact a falls prevention program offered in your community? If participants answered Yes, they were asked Question 2; if they answered No, they answered Question 3.
 (2) During the last two months, have you participated in any community-based falls prevention programs or exercise programs, such as Tai Chi, Stepping On, or Matter of Balance? If they answered Yes, they were asked
 (a) What was the name of the program?
 (b) Where did the program meet;
 (c) When did the program start? (M/D/Y);
 (d) When did the program end? (M/D/Y);
 (e) Are you going to the program now? (Yes, No);
 (f) Usually, for how many minutes does the program session last (# of MINS);
 (3) How likely is it that you will participate in a community-based falls prevention program in the next year? Would you say it was (response options: very unlikely; somewhat unlikely; neither likely nor unlikely, somewhat likely, very likely).
Post discharge falls assessment
 (1) Since you were enrolled in this study two months ago, on (date), have you had any additional falls? (Yes/No);
 (2) About how many times have you fallen in the last two months since (date)? (Total number of falls);
 (3) Did any of the falls you had in the last two months require medical attention? (Yes/No);
 (4) Was the medical attention you received at an emergency department? (Yes/No); (5) Number of times they had been treated for fall injury there since enrollment.