Sex-specific fall trajectories and self-reported risk factors in community-dwelling older adults: Evidence from DO-HEALTH

Introduction: Falls are a major concern in later life, yet how fall patterns evolve over time, and whether these patterns differ between women and men, remains poorly understood. This study investigated sex-specific fall trajectories over three years among generally healthy European older adults and identified baseline self-reported factors associated with higher-risk trajectories.

Method: We conducted a secondary analysis of DO-HEALTH, a multicenter randomized controlled trial enrolling community-dwelling adults aged ≥70 years across seven European sites. Participants reported falls every three months over three years. Group-based trajectory modeling identified sex-stratified fall patterns. Weighted logistic regression, informed by LASSO variable selection, examined baseline self-reported sociodemographic, health, and lifestyle factors associated with trajectory membership.

Results: Among 1958 eligible participants (mean age 74.9 years; 62% women), two fall trajectories emerged for each sex. Women showed a predominant low-fall-frequency pattern (n=1020, 84.7%) and a smaller group with persistently higher fall frequency (n=185, 15.3%). Living alone was the only self-reported factor linked to the higher-fall trajectory in women. Among men, most demonstrated a stable low-fall-frequency pattern (n=651, 86.5%), whereas a minority exhibited an increasing fall trajectory over time (n=102, 13.6%). Men in the increasing trajectory were more likely to report baseline fatigue, mobility limitations, pain or discomfort, and marginally more often lived alone. Higher self-rated health was also associated with increasing falls in men.

Conclusion: Distinct sex-specific fall trajectories highlight different longitudinal risk profiles for women and men. Self-reported measures, particularly living situations and indicators of physical well-being, may support early identification of individuals at higher risk of falling. These findings reinforce the need for sex-specific approaches to fall-risk assessment and prevention.