Climate-sensitive fall risk in ageing populations: a public health perspective

Falls among older adults are a leading cause of injury, disability and mortality worldwide, with an estimated 684,000 fall deaths each year and the greatest fatal burden among adults older than 60 years. Current multifactorial fall prevention stratifies risk at the level of the individual and the clinical encounter, and treats environmental hazards largely as static features of the home. It therefore cannot answer a question that matters for population-level prevention: when, where and for whom does fall risk rise? This Perspective argues that a meaningful component of fall risk is time-varying and arises from the coincidence of an acute environmental hazard (ice, heavy rainfall, flooding, heat or cold) with a specific vulnerability phenotype in a person who is exposed at that moment. We propose an exposure–vulnerability coincidence framework that separates established associations from proposed pathways, specifies effect modifiers (heat-sensitising medicines, frailty, outdoor mobility, drainage and surface quality, residential setting) and states six falsifiable hypotheses. We then set out a concrete agenda: which meteorological indicators should be linked to which fall outcomes, how local alert thresholds can be derived from lagged exposure–response curves, which population groups should be targeted when thresholds are crossed, and which outcomes, evaluated with interrupted time-series or stepped-wedge designs, would show that a climate-informed strategy adds value beyond conventional fall prevention. The framework does not replace multifactorial assessment; it adds a temporal dimension that enables anticipatory, targeted and evaluable public health action as populations age and extreme weather becomes more frequent.