EXpress Prevent Rural oldEr Adults' fallS, fractureS and Dependency (EXPRESS)

Condition(s) studied

Investigational drug(s) / intervention(s)

AI-assisted, village doctors and express services-involved personalized fall prevention strategy: The EXPRESS trial implements a pragmatic, community-based, AI-assisted fall prevention strategy tailored to the needs of older adults in rural China. The intervention is structured around five core components-SAFER: 1. Screening: multidimensional fall risk screening and assessment tailored to rural older adults; 2. AI-assisted recommendations: AI-assisted personalized fall prevention recommendations; 3. Fitness: Tailored balance and strength training via Health Intervention Cartoon Brochure and Action Demonstration Video; 4. Events-based engagement: culturally integrated seasonal intervention packages following the traditional Chinese calendar; 5. Reach-home delivery: home delivery of fall prevention services through local couriers.

Study summary

Falls are the leading cause of injury-related death among individuals aged 65 and above in China. The incidence of falls shows a significant urban-rural disparity in China, with rural areas experiencing a markedly higher rate than urban regions. However, a systematic fall prevention strategy tailored to the needs of older people in rural China has not yet been established.

The EXPRESS study is a multicenter, cluster-randomized controlled trial designed to explore the effectiveness and health economic evaluation of an AI-assisted, village doctors and express services-involved, personalized fall screening and prevention strategy based on multidimensional risk profiling in reducing the incidence of falls and fall-related injuries among older people in rural China.

A total of 1,881 older individuals from 16 villages across four provinces in China (with four villages per province) will be recruited. These 16 rural areas will be randomly assigned to either the intervention group or the control group. The intervention group will receive the AI-assisted, village doctors and express services-involved personalized fall prevention strategy based on multidimensional fall risk screening and assessment, while the control group will follow routine primary health management practices.

The intervention period will last for one year, with randomization taking place after the baseline survey. The primary outcomes are the incidence of falls and fall-related injuries (including falls resulting in hospitalization and fractures, etc). Secondary outcomes include activity of daily living, quality of life, fall-related health literacy, depressive symptoms, cognitive function, dementia, physical function and performance, incidence of chronic non-communicable diseases, frailty, and sleep quality.

Eligibility

Primary outcome measure(s)

• Fall incidence within 12 months (rate of falls per person-year) — Months 3, 6, 9, 12 after baseline survey
  Defined as the number of falls divided by total person-time of observation. To minimize recall bias in fall measurement, three methods will be employed: self-recording by older adults or their family members on a calendar, quarterly in-person inquiries by delivery personnel, and final evaluation through interviews conducted by an assessment officer.
• Proportion of participants with ≥1 fall within 12 months — Months 3, 6, 9, 12 after baseline survey
  A dichotomous outcome (fallers vs. non-fallers) that reflects risk reduction at the individual level. The measurement method is consistent with the fall incidence.
• Fall-related injuries incidence within 12 months — Months 3, 6, 9, 12 after baseline survey
  Fall-related injuries included fractures, head injuries, hospitalizations, other events requiring medical attention. The measurement method is consistent with the fall incidence.

Trial sites (1)

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