Country-Level Burden Profiles for Fall-Related Nursing Service Planning in Older Adults

Falls are a source of disability, mortality, and loss of independence in later life, but evidence is usually presented as an epidemiologic burden rather than as comparative burden patterns that can inform nursing management and service planning.

We conducted an ecological, age-sex-stratified study using GBD 2023 data for 204 countries and territories from 1990 to 2023. All countries and territories with the required GBD 2023 estimates were included. The analysis focused on adults aged 60 years or older to align with global older-adult service-planning conventions and the first older-adult GBD age band. Main indicators were incidence rate, years lived with disability (YLD) rate, YLDs per 1000 falls, deaths per 100,000 falls, YLD share of disability-adjusted life years (DALYs), and the share of YLDs contributed by adults aged 85 years or older. Four standardized domain scores were combined into an exploratory country-level burden-profile framework. Sensitivity analyses evaluated oldest-old thresholds, percentile cutoffs, number/rate-only reconstruction, sex-specific models, and replacement of the prevention indicator with the age-standardized incidence rate for falls.

In 2023, among adults aged 60 years or older, the global incidence rate of falls was 6600.3 per 100,000, the YLD rate was 1842.8 per 100,000%, and 69.5% of fall-related DALYs were attributable to YLDs. The exploratory framework grouped countries into five country-level burden profiles: 14 prevention-intensive countries, 43 rehabilitation-intensive countries, 43 mortality-intensive countries, 14 long-term-care-intensive countries, and 90 mixed-profile countries, with the mixed profile being the largest group. Of the 90 mixed-profile countries, 43 had multiple domains above threshold and 47 had no single domain above threshold. Across countries, incidence ranged from 417.7 to 27,003.8 per 100,000, YLD burden ranged from 152.6 to 795.2 YLDs per 1000 falls, deaths per 100,000 falls ranged from 335.4 to 6803.2, and the 85+ share of YLDs ranged from 1.58% to 28.53%. Women had higher incidence and YLD rates than men, whereas men had higher YLDs per 1000 falls and deaths per 100,000 falls. Sensitivity analyses showed partial but non-uniform stability across specifications: 13 countries changed profile classification when the oldest-old threshold was shifted from 85+ to 80+ years and 10 changed when the prevention domain was rebuilt using the age-standardized incidence rate for falls, whereas 34 changed under the 80th-percentile threshold and 73 under the number/rate-only specification.

Fall-related burden in older adults showed distinct country-level patterns across prevention, rehabilitation, mortality-related burden, and long-term support. Reorganizing burden structure beyond incidence alone may help describe cross-national differences relevant to service planning. These ecological profiles summarize country-level burden configurations that can support comparative nursing management review when interpreted alongside local workforce and service-use data.

These ecological profiles may serve as starting points for local review when interpreted alongside measured workforce, infrastructure, and service-use data. Prevention-intensive profiles identify countries with comparatively high fall incidence; rehabilitation-intensive profiles identify countries with comparatively high nonfatal postfall burden ratios; mortality-intensive profiles identify countries with comparatively high fatal burden ratios; long-term-care-intensive profiles identify countries in which fall-related disability is more concentrated in adults aged 85 years or older; and mixed profiles identify either overlapping high-burden domains or no single dominant domain.