Fall risk assessment using the World Guidelines for Falls Prevention Algorithm: Evidence from the ELSI-Brazil study

Area of Science:

• Gerontology
• Public Health
• Epidemiology

Background:

• The World Guidelines for Falls Prevention and Management (WGF) offer a global algorithm for fall risk stratification in older adults.
• This algorithm utilizes either fall history (FH) or key questions (KQ) for screening.
• Limited evidence exists on the applicability of WGF in low- and middle-income countries and the comparative population estimates from FH versus KQ methods.

Purpose of the Study:

• To estimate national and regional fall risk prevalence in Brazil using both WGF screening methods (FH and KQ).
• To examine geographic variations in fall risk across different regions of Brazil.
• To assess the impact of using KQ versus FH on population estimates of fall risk.

Main Methods:

• A cross-sectional study utilizing data from the third wave of the Brazilian Longitudinal Study of Aging (ELSI-Brazil, 2023-2024).
• Participants aged 60 years and older were classified using the WGF algorithm based on FH or KQ (concern about falling, postural instability, gait speed ≤ 0.8 m/s, severity markers).
• Poisson regression adjusted for sociodemographic factors was employed to analyze regional differences in fall risk prevalence.

Main Results:

• Out of 7515 older adults, FH alone classified 82.2% as low risk, 7.8% as intermediate, and 10.0% as high risk.
• Using KQ, classifications were 50.4% low risk, 34.6% intermediate risk, and 15.0% high risk.
• The KQ approach revealed lower low-risk and higher intermediate-risk prevalence in the Northeast and Southeast compared to the South, with no regional differences for high-risk classification or FH-based results.

Conclusions:

• Operationalizing the WGF algorithm with KQ significantly increases the identification of intermediate fall risk compared to FH alone.
• An estimated 3.5 million older Brazilian adults may be at high risk of falls based on national estimates.
• Identified within-country regional disparities underscore the necessity for tailored fall prevention strategies addressing contextual variations.