Association of Falls with Intrinsic Capacity in Community-Dwelling Older Adults: Findings from the Singapore SPICE Program

Background:

Falls are a leading cause of disability and dependency among older adults, yet their relationship with the multidimensional construct of intrinsic capacity (IC) remains underexplored. Understanding how declines in IC domains such as locomotion, cognition, vitality, and sensory function relate to falls can inform early preventive strategies aligned with the WHO Decade of Healthy Ageing framework.

Methods:

We analysed data from 692 robust or pre-frail community-dwelling adults aged ≥60 years screened under the SPICE (Screen, Prevent frailty, Inspire, Connect, Exercise / Eat) Program. Falls were defined as ≥1 fall in the past year. IC was assessed across locomotion (SPPB<10), cognition (MoCA <26), vitality (MNA-SF<12), psychological (PHQ9 >4), hearing, and vision combined with a composite IC score (0–5) representing the number of domains impaired. Binary logistic regression, adjusted for age, gender, and multimorbidity, was performed to determine associations between IC domains and the likelihood of any fall.

Results:

Overall, 17.3% of participants reported at least one fall. The prevalence of falls increased progressively with declining IC (from 10% in IC=0 to 75% in IC=5). Falls were more frequent among those with impaired locomotion (36% vs 19%), reduced vitality (15% vs 10%), cognitive impairment (45% vs 37%), psychological impairment (16% vs 6%) and vision impairment (54% vs 36%). Participants with ≥3 affected IC domains had had more than 2x higher fall prevalence compared to those with preserved capacity (28% vs 13%). For every 1-unit increase in the total IC (i.e., one additional domain impaired), the odds of falls increase by 1.7 times (OR 1.653, 95% CI 1.359 – 2.011; p<0.001).

Conclusion:

Declines across multiple IC domains significantly increase fall risk, highlighting the importance of multidimensional assessment. Screening for IC decline offers a holistic framework for early identification of at-risk older adults and aligns with population-level strategies for functional ageing and fall prevention.