Development of a fall prediction model for community-dwelling older adults in South Korea using machine learning: a secondary data analysis

Purpose: This study aimed to develop a fall prediction model for community-dwelling older adults using machine learning.Methods: The present study was conducted with a secondary data analysis that used data from the 2020 national survey of older Koreans. Among 10,097 participants, data 177 were excluded due to incompleteness and 9,920 were included in the final analysis. Because of data imbalance, upsampling was performed to increase the number of individuals who fell. Forty-five independent variables for fall prediction were selected based on the fall risk factors from previous studies and univariate statistical analysis. The data were split into training and testing sets at an 80:20 ratio. Three machine learning algorithms—logistic regression, random forest, and artificial neural network—were used to develop a fall prediction model.Results: The random forest model outperformed the others, with an area under the curve of .91, accuracy of .94, precision of .94, recall of .74, and F1 score of .83. An analysis of feature importance revealed that satisfaction with health condition, visual difficulty, instrumental activities of daily living, performance of 400m walk, and cognitive ability were the top five features for fall prediction.Conclusion: The fall prediction model developed using machine learning demonstrated high model performance, implying its suitability for use as a primary screening tool for fall risk. Subjective satisfaction with one’s health should be considered as an important factor in predicting falls in community-dwelling older adults. It is necessary for community health nurses to reinforce positive health awareness by continuous disease management and physical function improvement for older adults to prevent falls.