Gerontology & Injury Prevention

Falls Prevalence and Its Risk Assessment Tools Among Malaysian Community-Dwelling Older Adults: A Review

Abstract and Background

Falls in older adults represent a major global health issue, contributing to serious injuries, loss of independence, institutionalisation, and death. Globally, the prevalence of falls among older adults ranges from approximately 30% to 50%, with considerable variation depending on the population studied, the setting (community-dwelling, hospitalised, or institutionalised), and the methodology employed. Falls are not an inevitable consequence of ageing; rather, they result from a complex interaction of intrinsic factors (such as muscle weakness, balance impairment, cognitive decline, and chronic diseases) and extrinsic factors (such as environmental hazards, inappropriate footwear, and medication effects).

In Malaysia, the older population is growing rapidly. Projections indicate that Malaysia will become an aged nation by 2030, when persons aged 65 and above will comprise 15% of the total population. This demographic shift creates an urgent need for preventive strategies that address age-related health challenges, with falls prevention among the highest priorities given the substantial morbidity, mortality, and healthcare costs associated with fall-related injuries.

This scoping review, published in the Malaysian Journal of Public Health Medicine in 2018, aimed to pool available information on the prevalence of falls and the risk assessment tools that have been used or validated among Malaysian community-dwelling older adults, providing a foundation for evidence-based falls prevention programmes in the Malaysian context.

Methodology

The review employed a scoping review methodology to systematically identify, select, and synthesise the available literature on falls among Malaysian community-dwelling older adults. Electronic databases searched included MEDLINE Complete, CINAHL, Rehabilitation and Sports Medicine Source, and SPORTDiscus (via EBSCOHOST), as well as Science Direct, PubMed, Cochrane Library, Embase, and Google Scholar. Inclusion and exclusion criteria were applied to identify studies reporting on falls prevalence or falls risk assessment among community-dwelling older adults in Malaysia.

Twelve studies were identified that met the inclusion criteria and were included in the final review. Data extracted from each study included study design, sample characteristics, falls prevalence estimates, risk factors assessed, and risk assessment tools employed.

Falls Prevalence in Malaysia

The review found that falls prevalence among Malaysian community-dwelling older adults varied widely across the included studies, ranging from 4.2% to 61%. This broad range reflects differences in study methodology, including variations in how falls were defined, the recall period used, the age threshold for defining older adults (some studies used 60 years, others 65 years), and the sampling strategies employed. Studies using more active recruitment methods and shorter recall periods tended to yield lower prevalence estimates, while those using broader definitions and longer recall periods reported higher rates.

A commonly cited estimate is that approximately 18% of community-dwelling older adults in Malaysia report experiencing at least one fall in the past 12 months. This figure is somewhat lower than global averages, which may reflect the inclusion of relatively younger and more active older adults in some Malaysian studies, as well as differences in physical activity patterns, housing environments, and footwear practices between Malaysia and other settings.

Among those who experienced a fall, approximately 28% were identified as recurrent fallers at an 18-month follow-up, indicating that a substantial minority of fallers are at continuing risk and would benefit from targeted secondary prevention interventions.

Risk Assessment Tools

The review evaluated various falls risk assessment tools that have been used or validated in the Malaysian context. These ranged from simple clinical tests such as the Timed Up and Go (TUG) test and self-rated questionnaires to more comprehensive multifactorial assessment tools including the Physiological Profile Assessment (PPA). The review emphasised the need for a rapid, easy-to-use self-assessment tool that could enable older adults or their caregivers to identify falls risk early, facilitating timely intervention.

Subsequent to this review, researchers at Universiti Kebangsaan Malaysia developed the Falls Screening Mobile App (FallSA), which combines questionnaire-based and physical performance-based assessments in a mobile application format. Testing of FallSA demonstrated high acceptance among older persons (80% agreeing on its suitability as a self-screening tool), significant moderate concurrent validity when compared with the PPA, and excellent test-retest reliability.

Risk Factors in the Malaysian Context

Research on falls among Malaysian older adults has identified several key risk factors including diabetes, arthritis, urinary incontinence, poor self-rated health, higher body mass index, lower handgrip strength, depression, reduced physical activity, visual impairment, and instability during turning activities. Environmental factors including home hazards and community infrastructure characteristics also play a role, though these have been less extensively studied in the Malaysian context.

A notable finding from Malaysian research is the importance of turning instability as a falls risk factor, with some studies showing that turning performance, along with visual acuity and back pain, accounted for a substantial proportion of the variance in falls risk. This finding has implications for both screening and intervention design.

Implications for Public Health

As Malaysia’s population ages, falls prevention will become an increasingly important component of public health strategy. The review highlights several priorities including the need for standardised falls surveillance systems that can provide reliable population-level prevalence estimates, the development and validation of culturally appropriate screening tools that can be deployed in primary care and community settings, the implementation of evidence-based falls prevention programmes that address the multifactorial nature of falls risk, and the integration of falls prevention into existing chronic disease management programmes.

Limitations

The wide variation in falls prevalence estimates across the included studies, while informative about the range of the problem, limits the ability to derive a single definitive prevalence figure. The scoping review methodology, while appropriate for mapping the available literature, does not include the formal quality assessment characteristic of systematic reviews. The review was limited to studies conducted among community-dwelling older adults and does not address falls in institutional or hospital settings.

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