Multicomponent Falls Prevention in Community-Dwelling Older Adults: A Twenty-Four Month Four-Arm Cohort: Fall Mechanisms, Intervention Effectiveness, and Modifiable Predictors in Three Hundred and Twenty-Six Adults

Abstract

Falls are among the most consequential preventable adverse events in older adults, producing substantial morbidity, mortality, hospital admissions, institutionalisation, and fear-related activity restriction. Multicomponent intervention programmes addressing the multiple intersecting risk factors are recommended by international guidelines. We undertook a 24-month four-arm cohort study of 326 community-dwelling adults aged 65 and older with at least one fall risk factor, comparing multicomponent intervention (n=82), exercise-only intervention (n=82), education-only intervention (n=82), and usual care (n=80). Fall-free survival at 24 months differed substantially: 64% in multicomponent, 52% in exercise-only, 38% in education-only, and 24% in usual care. Multicomponent intervention reduced recurrent fall rates by 64% versus usual care and reduced fall-related fractures by 58%. Berg Balance Scale was strongly correlated with fall count (r = -0.62) supporting its operational use for risk stratification. Strongest predictors of recurrent falls included low Berg Balance Scale, prior fall, polypharmacy, postural hypotension, visual impairment, cognitive impairment, frailty, and vitamin D deficiency. Multicomponent intervention engagement and home safety modifications were strongly protective.

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