Abstract for: A Health Policy Analysis to Preventing Falls among Older Adults: Current Reality, Dynamics and Ways Forward in Singapore

Falls among older adults are a leading cause of injury-related morbidity and mortality, yet large-scale prevention initiatives remain underdeveloped in many settings. In Singapore, falls account for 85% of geriatric trauma cases and 40% of injury-related deaths among older adults. Despite the availability of community-based physical activity programmes, systematic and targeted national falls prevention strategies are lacking. This study aims to examine how Singapore can implement a national falls prevention initiative through an in-silico pre-implementation evaluation. A system dynamics model was developed to assess the current falls prevention landscape, identify system bottlenecks, and project the impact of different policy scenarios over a 30-year period (2010–2040). The model incorporated demand and supply dynamics including: population dynamics, screening and intervention capacity, and uptake of interventions. Five policy scenarios were conducted which included increasing service uptake, expanding screening capacity, implementing high-quality prevention programmes, and an all-in scenario (bundled policy package). Sensitivity analyses were conducted to assess model robustness. In the business-as-usual scenario, the number of fallers in Singapore is projected to triple by 2040. Strategies, such as increasing service uptake, had minimal impact due to system bottlenecks. The most effective strategy was a bundled policy package that integrated early screening, high-risk prioritisation, and expanded programme capacity, reducing fallers by up to 12% by 2040. Findings demonstrate the need for a coordinated, system-wide approach to falls prevention. Simply expanding service uptake is insufficient as targeted screening, structured referral pathways, and evidence-based intervention programs are critical to ensuring older adults at the highest risk receive timely care. The study highlights the importance of addressing healthcare system bottlenecks—particularly in screening and intervention capacity—to optimise the impact of falls prevention strategies. ChatGPT