Falls amongst older people in Southeast Asia: a scoping review

Highlights

• The falls scenario among community-dwelling older people in Southeast Asia was slightly different than the Western studies.

• The investigation on falls in Southeast Asia is in infancy while many replicating other international studies.

• Limited number of intervention studies was conducted in Southeast Asia.

• Intervention for falls in Southeast Asia might require different approach suitable with the local and cultural context.

• More feasibility and joint studies among the ASEAN countries are warranted due to limited economic capacity and expertise.

Abstract

Objectives

The older population in the Southeast Asian region is accelerating and is expected to surpass the proportion of the ageing population in North America and Europe in the future. This study aims to identify the research literature related to falls among older people in Southeast Asia, to examine current practice and discuss the future direction on falls prevention and interventions in the region.

Study Design

A scoping review design was used.

Methods

A systematic literature search was conducted using the Medline, CINAHL, AMED, Ageline, PsycINFO, Web of Sciences, Scopus, Thai-Journal Citation Index, MyCite and trial registries databases.

Results

Thirty-seven studies and six study protocols were included, from Thailand, Malaysia, Singapore, Vietnam, Indonesia and the Philippines. One-sixth of the studies involved interventions, while the remainder were observational studies. The observational studies mainly determined the falls risk factors. The intervention studies comprised multifactorial interventions and single interventions such as exercises, educational materials and visual correction. Many of the studies replicated international studies and may not have taken into account features unique to Southeast Asia.

Conclusion

Our review has revealed studies evaluating falls and management of falls in the Southeast Asian context. More research is required from all Southeast Asian countries to prepare for the future challenges of managing falls as the population ages.

Introduction

Falls among community-dwelling older people are a major issue worldwide. While this health issue also applies to Southeast Asia, published literature on falls in this region remains limited and difficult to access. The Association of Southeast Asian Nations (ASEAN) consists of nine countries namely Brunei, Cambodia, East Timor, Indonesia, Laos, Malaysia, Myanmar, the Philippines, Singapore, Thailand and Vietnam.¹ The proximity of these countries to the equator ensures minimal temperature fluctuations all-year long, with heavy monsoon rains and flooding being the major environmental threats. There is great diversity in economic wealth and educational levels within these countries, as well as population movement in this highly populous region with a total population near to 700 million.1, 2, 3 Each country in the region has its own distinct language with only Singapore, Malaysia and the Philippines having a high level of English usage.² The population in the ASEAN region is growing at an accelerated rate, and the proportion of its older population will surpass that of South Asia, North America and Europe in 2050.⁴

Falls will become an increasing concern as the population ages.5, 6 Published evidence from other regions around the world have linked falls to osteoporotic fractures, head injury, institutionalization and psychological consequences including fear of falling and depression.⁷ However, regional variations in falls incidence exist with Asian countries reporting a lower incidence compared to Western nations.8, 9 Therefore, robust epidemiological and intervention studies are needed in this region to establish potential differences in the characteristics of falls in the region. While published international guidelines for falls prevention have been in existence for some time, the applicability of these guidelines in Southeast Asia is unclear in view of the potential regional differences in the characteristics and risk factors for falls. We, therefore, conducted a scoping review with the objectives of identifying and synthesizing the results of published studies on the epidemiology, risk factors, risk assessment instruments and interventions for falls in older adults published from the ASEAN countries. We followed the revised methodological steps for conducting scoping reviews outlined by Colquhoun et al.¹⁰