Falls resilience framework: advancing from risk reduction to resilience building in older adults

Despite extensive research and public health initiatives, progress in reducing the global burden of falls among older adults has remained slow, underscoring the need for complementary frameworks to guide prevention and management. We propose a resilience-based approach encompassing the full continuum of fall-related events: resisting destabilising challenges, mitigating injury when a fall occurs, and facilitating the recovery of function and mobility afterwards. To operationalise this approach, we present the falls resilience framework, which systematically maps fall-related stressors and challenges across three mobility levels: full community ambulation, limited community ambulation, and indoor ambulation. Within this framework, resilience is shaped by a combination of individual and contextual resources, encompassing social, environmental, health-care, organisational, and community dimensions. Resilience can be assessed through structure indicators reflecting baseline capacities and dynamic indicators capturing adaptive responses to challenges. The framework further defines outcome categories ranging from resilient adaptation to non-resilient decline, offering a more nuanced understanding of falls resilience trajectories beyond fall occurrence alone. Building on this framework, we outline strategic directions to implement resilience-based assessments and interventions, with the overarching goal of fostering more personalised approaches to fall prevention, injury reduction, recovery, and healthy ageing.