Prevalence of Fall Risk and Its Association with Multimorbidity and Frailty among Older Adults in Community and Clinic Outpatient Settings in India

Abstract Background: Falls are a major public health concern among older adults, particularly in the presence of frailty and multimorbidity. However, the interrelationship between these factors remains insufficiently explored in low- and middle-income settings. This study aimed to examine the association between multimorbidity, frailty, and fall risk and to estimate the prevalence of fall risk among older adults in community settings and outpatient settings in India. Materials and Methods: A cross-sectional study was conducted among 320 adults aged ≥60 years (174 community outpatient setting—recruited and 146 outpatient clinic attendees; mean age 70.2 ± 6.4 years; 55.9% female) in an urban Indian setting. Multimorbidity was defined as the presence of ≥2 chronic conditions, frailty was assessed using the FRAIL scale, Fall risk using Timed Up and Go Test, and Falls Efficacy Scale—International. Associations were evaluated using modified Poisson regression with robust variance estimation, and the mediating role of frailty was examined using counterfactual mediation analysis. Results: The overall prevalence of high fall risk was 66.9% (214/320). High fall risk was observed in 126 of 148 frail individuals (85.1%) compared with 88 of 172 nonfrail individuals (51.2%). Multimorbidity was present in 77.2% of participants. Multimorbidity (adjusted prevalence ratio (PR) =1.56; 95% confidence interval (CI): 1.17–2.07) and frailty (adjusted PR = 1.60; 95% CI: 1.34–1.91) were independently associated with a higher prevalence of fall risk. Counterfactual mediation analysis suggested only a modest indirect pathway through frailty, with much of the association occurring through frailty-independent pathways. Conclusions: Multimorbidity and frailty were independently associated with a higher prevalence of fall risk among older adults. Early identification of frailty and integrated management of chronic conditions may help reduce fall risk and improve healthy ageing.