Preventing the Next Fall: Risk Factors for Recurrent Falls in Older Adults in Primary Care

Background:
Malaysia is projected to become an aged nation by 2030, with adults aged ≥60 years comprising approximately 15.3% of the population. As population ageing accelerates, primary care must address age-related conditions, including falls, which are a major cause of morbidity and functional decline among older adults. Recurrent falls represent a key opportunity for prevention, as they reflect underlying, modifiable risk factors. In Kuala Lumpur primary healthcare clinic, we assess the risks of fall and manage it with a multidisciplinary team comprising of staff nurses, medical assistants, medical officers, pharmacists, physiotherapists, occupational therapists, dentists, social workers and counsellor.

Methods:
A retrospective analysis of 201 adults aged ≥60 years attending a geriatric-serviced primary care clinic in Kuala Lumpur. Clinical records were reviewed for fall risk factors, medical comorbidities, history of falls, vision impairment, body mass index (BMI), bone mineral density (BMD), functional status (Barthel Index, Instrumental Activities of Daily Living [iADL], and Activities of Daily Living [ADL]), cognition (Mini-Mental State Examination), depression (Geriatric Depression Scale), postural hypotension, and sarcopenia (SARC-F). Risk factors were defined using standard clinical thresholds and reported as prevalence. Individualised interventions includes progressive resistance, balance training and nutritional optimisation. Timed Up and Go (TUG) performance was reassessed at 6 months.

Results:
This study population represented a high-risk group, with 75.1% reporting at least one fall in the preceding year. The most prevalent risk factors were ≥1 medical comorbidity (92.5%), prior falls (75.1%), and visual impairment (47.3%). Abnormal BMI and low BMD (osteopenia or osteoporosis) were each present in 40.8% of patients. Functional vulnerability was common, with iADL dependency in 33.3% and ADL dependency in 17.9%. Knee osteoarthritis was present in 30.8%, cognitive impairment (10.4%), depression (6.5%), postural hypotension (6.5%), and probable sarcopenia (5.5%) were less prevalent but clinically relevant. Among 50 patients with osteoporosis, 60.0% received bisphosphonate therapy. TUG performance reduced from 61.1% at baseline to 39.8% after 6 months, reflecting enhanced mobility, balance, and reduced fall risk. 

Conclusion:
As Malaysia transitions to an aged nation, recurrent falls will challenge primary care services. In Kuala Lumpur public clinic setting, primary care physicians play a central role in fall prevention through early identification of high-risk individuals and coordinated management of bone health, comorbidities, vision, and functional status within a multidisciplinary care model.