Who falls and why? Navigating the physiological and psychological contributors in fall outcomes among self-perceived unhealthy middle-aged and older adults in India

Incidental falls are a leading cause of mortality and serious injury among elderly persons, particularly those who perceive themselves as unhealthy. This study aimed to examine the impact of physiological and psychological factors on fall outcomes among Indian adults with negative self-rated health (SRH). Secondary data from the first wave (2017–18) of the Longitudinal Ageing Study in India were analyzed, including 10,326 respondents aged 45 years and above with poor or very poor self-rated health. Multivariate logistic regression models were used to examine associations between physiological and psychological factors and three fall outcomes (fall, multiple falls, and fall-related injuries). Analyses accounted for age-group differences (45–59 vs. ≥60 years) and state-level variation in fall prevalence. Among adults with poor SRH, 14.5% reported at least one fall, 7.1% multiple falls, and 6.8% fall-related injuries. Fall prevalence was higher among women, adults aged ≥60 years, rural residents, those with no schooling, and physically inactive individuals. Chronic pain showed the strongest association with falls (aOR=1.61), multiple falls (aOR=1.54), and injuries (aOR=1.47). Sensory impairments (visual: aOR=1.15; hearing: aOR=1.28), functional limitations (ADL limitations: aOR=1.21 for falls; mobility impairment: aOR=1.30 for multiple falls), and psychological factors (depressive symptoms: aOR=1.05 for falls; cognitive impairment: aOR=1.33 for injuries) were also significant predictors. Physiological and psychological factors, particularly chronic pain and sensory impairments substantially increase fall risk among Indian adults with poor SRH. The higher risk among older adults and notable state-level variation underscore the need for age- and region-specific fall prevention strategies.