Review the scenario and design a 5-item instrument that is appropriate for the scenario :

You are the Director of the Department of Aging for Baltimore County. You conducted a falls prevention education and outreach program that ended 2 years ago for community dwelling older adults and care givers. The Centers for Disease Control and Prevention (CDC) funded this program and now wants the Department of Aging to evaluate the program. 

One of your goals for the program was to decrease the number of falls on older adults living in Baltimore County by 20% by the end of the program. Develop a data collection instrument for this program that can be used to determine if there are any improvements in the risks for falls among the former program participants