Fall risk stratification in older adults: low and not-at-risk status still associated with falls and injuries

Falls guidelines recommendations for individuals classified as 'not-at-risk' range from no further actions to offering education and exercises. However, there is a scarcity of prospective studies analysing the rate of falls and injuries in this not-at-risk group to inform recommendations.

To prospectively estimate the rate of falls and injuries in older adults considered 'not-at-risk' for falls.

Prospective cohort study.

Geriatric Medicine Clinics.

Community-dwelling older adults aged 65 and older.

Falls risk stratification was operationalised by adapting the Centers for Disease Control and Prevention's Stopping Elderly Accidents, Deaths and Injuries algorithm. Associations of risk strata (screened not-at-risk vs. at-risk) with incident falls and injuries were estimated using incidence rate ratios [adjusted incident rate ratio (aIRR), Poisson regression model]. Associations between slow gait speed (<1 m/s) and injurious falls were estimated by risk strata using hazard ratios (adjusted hazard ratio, Cox and Poisson regression model).

Of 403 participants, 64% of at-risk individuals fell during the follow-up compared to 41.3% in the not-at-risk group, whilst injurious falls were reported by 63.2% of the not-at-risk group and by 59.7% of the at-risk group. At-risk individuals had a higher rate of falls (aIRR = 3.91, 95% CI: 3.30-4.64, P < .001) but a similar rate of injurious falls as the not-at-risk individuals (aIRR = 1.26, 95% CI: 0.93-1.71; P = .11). Not-at-risk individuals with slow gait speed sustained injurious falls at twice the rate (aIRR = 1.83, 95% CI: 1.12-3.91, P = .008) than those without slow gait speed.

Being screened as not-at-risk for falls does not mean no risk at all. Routinely and universally assessing gait speed could identify not-at-risk individuals who are likely to sustain injuries after a fall and could benefit from primary prevention.