Unrecovered falls in older adults – Current state of the art and preliminary analysis from the TRAIL study

Introduction:

Frail older adults who fall are often unable to get up without assistance. Such “unrecovered falls” (URFs) occur more frequently than injurious falls yet are particularly critical, as prolonged lying episodes significantly increase the risk of adverse health outcomes. Involving the assisting person in URF assessment may help reduce recall bias in self-reported falls. Because URFs are both common and clinically meaningful, they may serves as an efficient outcome measure, allowing for smaller sample sizes in fall prevention trials compared with those relying on injurious falls. This presentation summarizes the findings of a scoping review on URFs and introduces a newly developed URF reporting strategy, along with preliminary implementation results.

Method:

A systematic literature search of four databases was performed to identify studies reporting on falls in which individuals were unable to get up without assistance. Definitions, incidences, and reporting methods of URFs were extracted, and a URF reporting strategy was developed for an ongoing randomized controlled fall prevention trial using perturbation training in older adults with and without cognitive impairment (TRAIL). After the first year of follow-up (March 2026), all URFs collected within TRAIL to date have been analyzed according to key categorical characteristics (e.g., helping person, prior fall activity).

Results and conclusion:

No consented definition of URFs was identified. Incidence rates indicated that approximately 50% of falls were unrecovered. URFs were assessed using various self-report methods, typically fall calendars with follow-up calls or visits. In line with current recommendations, the newly developed URF reporting strategy combines (a) daily fall calendars, (b) monthly telephone calls, (c) proactive fall reporting, (d) semi-structured interview with fallers to obtain fall details, and (e) when necessary and possible, plausibility check of self-reported events through proxy interviews. Preliminary findings of its implementation within the TRAIL study corroborate findings of the literature.