Health Inequities and Fall Risk: Analyzing the Association of the PROGRESS-PLUS Model and the Algorithm Proposed by the WFG

Introduction: Although global guidelines for fall prevention and management in older adults exist, using the algorithm from the World Guidelines for Falls Prevention and Management for Older Adults (WFG) in low- and middle-income countries is little explored. Evaluating the association between health inequities and fall risk can guide more effective and equitable interventions. The obhective of this study was to assess the association between health inequities, as defined by the PROGRESS-PLUS model, and fall risk according to the algorithm proposed by the WFG in older Brazilian adults. Methods: A cross-sectional study using data from 5,219 participants aged ≥60 years from the second wave of the Brazilian Longitudinal Study of Aging (ELSI-Brazil, 2019-21), a nationally representative study, was conducted. The outcome was the fall risk classification into three levels: low, intermediate, and high. Exposure variables included health inequities according to the PROGRESS-PLUS model (e.g., place of residence, race/skin color, sex, and occupation). Multinomial logistic regression analyses were conducted (with low risk as the reference category), incorporating groups of variables based on a theoretical model. Results: A positive association was found between intermediate fall risk and female sex, older age (70–79 and ≥80 years), macroregion of the country, poor self-perceived current life regarding income/employment, and monthly household income per capita. Additionally, female sex, older age (70–79 and ≥80 years), macroregion of the country, poor self-perceived current life regarding income/employment, education level, perceived discrimination, does not participate in organized social activities and physical disorder in the neighborhood were positively associated with high fall risk. Conclusion: Health inequities are associated with intermediate and high fall risk among older Brazilian adults. Social and health actions, along with integrated and intersectoral public policies targeting the reduction of social inequities and focusing on modifiable determinants, may contribute to fall prevention.