Falls Resilience Framework: Advancing from Risk Reduction to Resilience Building in Older Adults

Despite extensive research and public health initiatives, progress in reducing the global burden of falls among older adults has remained limited, underscoring the need for new frameworks for prevention and management. We propose a resilience-based approach that emphasizes an individual's capacity to withstand, adapt to, and recover from fall-related stressors, complementing traditional risk mitigation models. Here, we present the Falls Resilience Framework, which systematically characterizes stressors and challenges across three mobility levels - full community ambulation, limited community ambulation, and indoor ambulation - and integrates key resilience resources: structure indicators reflecting baseline capacities, and dynamic indicators capturing adaptive responses. This framework delineates distinct outcome classes, from resilient adaptation to non-resilient decline, offering a nuanced understanding of fall resilience trajectories. Finally, we outline strategic directions to operationalize resilience-based assessments and interventions for falls, with the goal of advancing personalized strategies for fall prevention and management.