Identification of predictors for the first fall occurrence in older adults: a longitudinal study

• Grant number: 24/18834-0
• Support Opportunities: Regular Research Grants
• Start date: November 01, 2025
• End date: October 31, 2028
• Field of knowledge: Health Sciences - Physiotherapy and Occupational Therapy
• Principal Investigator: Daniela Cristina Carvalho de Abreu
• Grantee: Daniela Cristina Carvalho de Abreu
• Host Institution: Faculdade de Medicina de Ribeirão Preto (FMRP). Universidade de São Paulo (USP). Ribeirão Preto , SP, Brazil
• Associated researchers: Andressa da Silva de Mello ; Anielle Cristhine de Medeiros Takahashi ; Cristine Homsi Jorge ; Eduardo Ferriolli ; Francisco José Albuquerque de Paula

Abstract

Falls are the leading cause of injury and accidental death among older adults. With increasing life expectancy, a rise in fall incidence and related injuries is anticipated. However, despite the significant public health impact of falls, there remain considerable gaps in understanding the determinants of a first fall in older adults. Objectives: To investigate whether socioeconomic, behavioral, environmental, clinical/health-related, biochemical, and physical-functional performance factors can predict the occurrence of a first fall over a 12-month prospective period in community-dwelling older adults. Methods: Individuals aged 60 years or older, of both sexes, with no history of falls in the 12 months prior to enrollment will be included. A comprehensive baseline assessment will be conducted to characterize the sample (including age, sex, weight, height, lifestyle habits, and medication use). Questionnaires will be administered to evaluate cognitive, nutritional, and emotional status, hearing and vision capacity, fear of falling, lower limb performance, physical activity level, sleep quality, urinary incontinence, pain presence, and home hazard risk factors. Body composition will be assessed via bioelectrical impedance analysis. Sedentary behavior and physical activity levels will be measured using accelerometry. Balance and physical-functional tests will include the Balance Evaluation Systems Test (BESTest), tandem gait, usual and dual-task gait speed, 1-minute sit-to-stand test, 6-minute walk test, handgrip strength, and isometric strength of hip abductors and knee extensors. Blood collection for biochemical analysis of markers related to muscular, metabolic, neurobiological conditions and chronic systemic inflammation will be scheduled seven days after the initial assessment, coinciding with the return of the accelerometer to the research laboratory. Following the baseline assessment, participants will be monitored monthly for fall events via telephone follow-up over a 12-month period. The data will be presented as mean (SD) and frequency. A Cox regression will be performed for each explanatory variable to estimate its individual association with time to first fall. A final multivariate model will be constructed based on the most relevant variables from each domain. Each thematic domain will be analyzed using its own multivariate model, including the variables from that block. Kaplan-Meier curves will be used to describe the cumulative probability of remaining fall-free over time, stratified by key variables. Comparisons between curves will be performed using the log-rank test. Data will be analyzed using R statistical software (version 4.3.2 or higher), adopting a 5% significance level (p < 0.05). Expected results: This study aims to advance the understanding of risk factors associated with the first fall in older adults-factors that remain insufficiently recognized. The findings may support the development of screening tools specifically designed for older adults without a prior history of falls. This is critical, as the occurrence of a first fall increases the risk of a subsequent fall by 50% within the following 12 months. (AU)