How can we improve fall risk sensitivity and specificity in older adults?

Abstract Background Frailty is a complex and evolving condition that may affect physical, psychological, social, and economic well-being, especially in older adults. It has been associated with increased vulnerability to adverse outcomes, including a heightened risk of falls. These events can impact individual health and healthcare systems. This study explores the potential of a wearable device to support fall risk identification and inform public health strategies. Methods The “Rome Tor Vergata” Reference Site for Active and Healthy Ageing organised Prevention Days for individuals aged 65 and older. Participants underwent assessments for early frailty detection. Fall risk was evaluated using the Howdy Senior wearable device (developed by Comftech), along with the Fall Risk Questionnaire (FRQ) and the Timed Up and Go (TUG) test. Results The sample included 52 participants over 65, of whom 21 had fallen at least once in the past year. The TUG test showed a borderline significant difference between fallers and non-fallers (14.84 vs. 20.19 seconds, p = 0.049), but the threshold used did not reliably distinguish fall risk. In contrast, the Howdy Senior device identified significant differences in step count (p < 0.01), anteroposterior acceleration (p < 0.01), and gait irregularity (p < 0.05). FRQ results were not consistently different between groups. Conclusions Wearable technology may offer a data-informed approach to exploring fall risk in older adults. Fallers in this sample walked more cautiously-taking more steps with lower acceleration. These early findings suggest that wearable devices could support fall risk assessment in primary care, though further research is needed. Key messages • Howdy Senior may offer more reliable fall risk indicators than traditional tools. • Integrating wearables into primary care could support earlier identification and prevention.