Falls among older adults in rural India have emerged as a significant public health concern, particularly in emergency settings. The prevalence of fall-related injuries in this demographic is alarmingly high, with studies indicating that up to 46.8% of older individuals in rural areas have experienced a fall in the past year [1]. This figure surpasses the national average, underscoring the urgent need for targeted interventions [1]. The consequences of such falls are profound, often leading to severe injuries that necessitate emergency care. In rural India, where healthcare infrastructure is limited, the burden on emergency departments is substantial. Injuries resulting from falls commonly include fractures, head trauma, and soft tissue injuries, which can lead to long-term disability and increased mortality among the elderly [2]. Several risk factors contribute to the high incidence of falls in this population. Intrinsic factors such as advanced age, female gender, chronic diseases (e.g., diabetes, hypertension), and the use of walking aids have been identified as significant predictors [1]. Extrinsic factors, including environmental hazards like poor lighting, uneven surfaces, and inadequate footwear, further exacerbate the risk [3]. Despite the critical nature of this issue, there is a paucity of comprehensive data on fall-related injuries among older adults in rural India, particularly those presenting to emergency departments. This study aims to fill this gap by assessing the prevalence of fall-related injuries in this setting and identifying associated risk factors. The findings are expected to inform the development of targeted interventions to mitigate the risk of falls and improve the quality of emergency care for older adults in rural India. The aim of the study is to determine the prevalence and identify the associated risk factors of fall-related injuries among older adults presenting to emergency departments in rural India.

Type of Study: A hospital-based cross-sectional observational study. Place of study: Emergency department of selected rural healthcare centers or hospitals in India. Study Duration: 12 months from 1 July 2024 to 30 June 2025. Study Population: Older adults aged 60 years and above presenting with fall-related injuries. Inclusion Criteria: • Patients aged ≥60 years. • Presented to emergency with a fall-related injury. • Provided informed consent (or consent from guardian/caregiver if required). Exclusion Criteria: • Fall due to major trauma (e.g., road traffic accidents). • Patients with incomplete medical records. • Unwilling to participate. Sample Size: 50 Injured Patients. Statistical Analysis: For statistical analysis, data were first entered into a Microsoft Excel spreadsheet and subsequently analysed using SPSS (version 27.0; SPSS Inc., Chicago, IL, USA) and GraphPad Prism (version 5). Continuous numerical variables were summarized as mean ± standard deviation, while categorical variables were expressed as counts and percentages. The Z-test (Standard Normal Deviate) was employed to assess significant differences between proportions. For comparisons involving means, the student’s t-test was used, with the corresponding p-value obtained from the t-distribution table. A p-value ≤ 0.05 was considered statistically significant, indicating rejection of the null hypothesis in favor of the alternative hypothesis.

Table 1: Prevalence of fall in Last 12 Months History of Falls Number of Participants Percentage (%) Yes 18 36 No 32 64 Total 50 100 Table 2: Number of fall among Those Who Fell Number of Falls Number of Participants Percentage (%) Single fall 12 66.7 Multiple falls 6 33.3 Total 18 100 Table 3: Age Distribution and Fall History Age Group (years) Falls (n=18) No Falls (n=32) p-value 60–69 7 15 0.45 70–79 8 12 ≥80 3 5 Table 4: Gender and Fall History Gender Falls (n=18) No Falls (n=32) p-value Male 10 18 0.87 Female 8 14 Table 5: Comorbidities and Fall History Comorbidity Falls (n=18) No Falls (n=32) p-value Hypertension 10 14 0.4 Diabetes Mellitus 5 8 0.72 Vision impairment 6 4 0.08 Table 6: Environmental Risk Factors Environmental Factor Falls (n=18) No Falls (n=32) p-value Uneven flooring 12 10 0.02 Poor lighting 8 6 0.15 Clutter at home 7 5 0.18 Table 7: Fall-Related Injuries Type of Injury Number of Cases Percentage (%) Fracture 6 33.3 Bruises 7 38.9 Head injury 3 16.7 Soft tissue injury 2 11.1 Total 18 100 In our study comprising 50 older adults from rural India, 18 participants (36%) reported a history of falls in the past 12 months, while the remaining 32 participants (64%) had no history of falls during the same period. This indicates that over one-third of the study population experienced falls, highlighting a significant prevalence of fall-related events among older adults in this rural setting. Among the 18 participants who reported a history of falls, 12 individuals (66.7%) experienced a single fall, while 6 individuals (33.3%) had multiple falls in the past 12 months. This suggests that the majority of fall incidents in our study population were isolated events rather than recurrent falls. In our study, the distribution of falls across different age groups showed that among participants aged 60–69 years, 7 individuals experienced falls while 15 did not. In the 70–79 years group, 8 participants had falls compared to 12 without falls, and among those aged ≥80 years, 3 experienced falls versus 5 who did not. The association between age group and history of falls was not statistically significant (p = 0.45). In our study, of the 18 participants who experienced falls, 10 were male and 8 were female, while among the 32 participants with no history of falls, 18 were male and 14 were female. The association between gender and fall occurrence was not statistically significant (p = 0.87). In our study, among the 18 participants who experienced falls, 10 had hypertension, 5 had diabetes mellitus, and 6 had vision impairment. Among the 32 participants without falls, 14 had hypertension, 8 had diabetes, and 4 had vision impairment. None of these comorbidities showed a statistically significant association with fall occurrence, with p-values of 0.40 for hypertension, 0.72 for diabetes mellitus, and 0.08 for vision impairment, indicating that these conditions did not significantly influence fall risk in our study population. In our study, environmental factors were assessed for their association with falls. Among the 18 participants who experienced falls, 12 had uneven flooring at home, 8 had poor lighting, and 7 had cluttered surroundings. In comparison, among the 32 participants without falls, 10 had uneven flooring, 6 had poor lighting, and 5 had clutter at home. Uneven flooring was significantly associated with fall occurrence (p = 0.02), whereas poor lighting (p = 0.15) and home clutter (p = 0.18) did not show a statistically significant association. In our study, among the 18 participants who experienced falls, the most common injuries were bruises, observed in 7 cases (38.9%), and followed by fractures in 6 cases (33.3%). Head injuries were noted in 3 participants (16.7%), and soft tissue injuries occurred in 2 participants (11.1%).

In our study, 36% of older adults in rural India experienced at least one fall in the past year, with 33.3% reporting multiple falls. This prevalence aligns with previous studies reporting high fall rates among rural elderly populations in India [4,5]. The majority of falls were single incidents, consistent with findings from Pitchai et al., where isolated falls were more common than recurrent falls [6]. Regarding age and gender, no statistically significant associations with fall occurrence were observed in our study, which contrasts with studies showing higher fall risk among individuals aged ≥80 years and females [7,8]. The lack of significance may be attributed to our small sample size and the specific rural context. Comorbidities such as hypertension, diabetes, and vision impairment did not show significant associations with falls in our population. Other studies, however, have identified chronic diseases, walking disabilities, and dementia as important fall risk factors [9, 10,11]. These discrepancies may reflect differences in population characteristics and healthcare access between rural and urban settings. Environmental factors, particularly uneven flooring, were significantly associated with falls in our study, corroborating prior findings that poor home environments contribute to fall risk [12,13]. Poor lighting and clutter, though not statistically significant in our cohort, have been highlighted as risk factors in other studies [12,14]. In terms of injury outcomes, bruises (38.9%) and fractures (33.3%) were the most common injuries, consistent with previous reports of fall-related injuries among older adults in India [15]. The relatively high proportion of fractures in our study may reflect the rural setting, where falls may occur on harder surfaces or from greater heights.

In our study of 50 older adults from rural India, over one-third (36%) reported experiencing at least one fall in the past 12 months, highlighting a substantial prevalence of fall-related events in this population. Most falls were isolated incidents, with only a third of fallers experiencing multiple events. Age, gender, and common comorbidities such as hypertension, diabetes mellitus, and vision impairment did not show a statistically significant association with fall occurrence, suggesting that these factors may not be primary determinants of falls in this rural cohort. Environmental hazards, particularly uneven flooring at home, were significantly associated with falls, emphasizing the critical role of modifiable home conditions in fall prevention. The most frequent injuries observed were bruises and fractures, indicating a considerable risk of morbidity among older adults following falls. Overall, our findings underscore the need for targeted preventive strategies in rural communities, including environmental modifications, fall awareness programs, and interventions to reduce injury severity. Addressing modifiable risk factors in the home environment could substantially lower the incidence and impact of falls, improving health outcomes and quality of life for older adults in rural India.

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