Falls in Older People Across Viet Nam’s Care Continuum: From Risk Identification to Prevention, Post-Fall Review and Safer Mobility
AGE-FRIENDLY CARE QUALITYINTEGRATED CARE & CARE TRANSITIONS
Falls in Older People Across Viet Nam’s Care Continuum: From Risk Identification to Prevention, Post-Fall Review and Safer Mobility
AGE-FRIENDLY CARE QUALITY & INTEGRATED CARE
Last reviewed: October 2026
A fall can look like a single event: an older person slips beside the bed, loses balance on the way to the bathroom, misses a step at home or becomes dizzy while standing. But the fall itself is often only the visible part of a much larger story.
Perhaps mobility has been declining for months. A new medicine may have lowered blood pressure. Vision may have worsened. The person may be rushing to the toilet at night, becoming acutely confused during a hospital admission, using a walking aid incorrectly or becoming weaker after several days in bed. The home may no longer fit the person's functional ability. Several of these factors may be present at the same time.
That is why falls in older people should not be treated simply as accidents to be prevented with warning signs, blanket restrictions or instructions to “be careful.” High-quality falls care requires a continuum: identify risk, understand why it has increased, support safe mobility, address modifiable contributors, respond appropriately when a fall occurs, learn from the event and make sure important information follows the person between hospital, transitional care, home, community services and long-term care.
For Viet Nam, this approach is becoming increasingly relevant as the population ages and national policy places greater emphasis on older-person care, rehabilitation and support closer to home and community. The opportunity is not simply to introduce more fall-risk forms. It is to build falls prevention and safer mobility into the quality and safety architecture of older-person care.
Falls are common and serious, but risk can be reduced
WHO defines a fall as an event that results in a person coming to rest inadvertently on the ground, floor or another lower level. Globally, falls are the second leading cause of unintentional injury deaths. WHO estimates that approximately 684,000 people die from falls each year, more than 80% of them in low- and middle-income countries, and adults over 60 account for the greatest number of fatal falls. The Western Pacific and South-East Asia together account for around 60% of fall-related deaths globally.
For an older person, the consequences can extend far beyond the immediate injury. A fall may result in fracture, head injury, pain, hospitalization or loss of confidence. Even without major physical injury, fear of falling can lead someone to walk less, avoid going outside or stop activities that previously mattered to them. Reduced activity can then contribute to loss of strength and balance, greater dependency and potentially higher future risk.
Falls therefore sit at the intersection of injury prevention and functional ability. Higher age is associated with greater vulnerability, but many contributors to fall risk can be identified and modified. Preventing falls should not mean preventing older people from moving. It should mean helping them move more safely while addressing the health, functional, behavioral and environmental factors that make a fall more likely.
Viet Nam has evidence from both community and hospital settings, but important data gaps remain
Nationally representative contemporary Vietnamese data remain limited, so individual studies need careful interpretation. One analysis published in 2024 used nationally representative baseline data collected in 2018 from the Longitudinal Study of Ageing and Health in Viet Nam. Among 4,378 community-dwelling older Vietnamese adults, 7.3% reported at least one fall during the previous year. More chronic conditions, greater functional impairment and pain at multiple locations were associated with higher odds of falling. Because the underlying data were collected in 2018, the 7.3% estimate should not be presented as the national prevalence of falls in Viet Nam in 2026.
Hospital research provides another perspective. A multicenter nested case-control study conducted across nine public hospitals in Ho Chi Minh City examined 101 inpatient fall cases and 404 matched controls. Reduced strength and mobility, nocturia, having more than two diseases, walking-aid use, medical-device use and antiepileptic medication were among the factors associated with being in the fall group. Of the reported falls, 19.8% occurred within the first 24 hours of admission, 44.6% occurred between midnight and 5:59 a.m., and the patient bed and bathroom were the most frequent locations. More than 40% occurred while a personal caregiver was present. Because this was a case-control study based on reported incidents, it cannot be used to estimate hospital fall incidence or establish that the associated factors caused the falls.
Together, these studies support a practical conclusion rather than one national prevalence figure: falls in Viet Nam occur across settings and are unlikely to have a single cause. They emerge from interactions between health conditions, function, medicines, behavior, care processes and the physical environment.
Viet Nam now has important building blocks for falls prevention and safer mobility
The National Strategy on Older Persons to 2035, with a vision to 2045, approved through Decision No. 383/QĐ-TTg in February 2025, places substantial emphasis on healthcare, rehabilitation and functional support. For the 2025–2030 period, it sets a target that 70% of older people with disabilities are screened, have disabilities identified and receive intervention or rehabilitation. It also addresses rehabilitation services and training for families caring for older people with significant disability, memory impairment or other major difficulties.
Decision No. 1116/QĐ-TTg of 22 June 2026 further updated the Older People Health Care Program to 2030. From 2026, it provides for free periodic health examinations or screening at least once a year and health-monitoring records for older people, while also strengthening community-based models of care. It does not establish a national falls pathway or mandate a specific falls assessment, but it provides a broader policy context in which mobility, function and fall history can be incorporated into routine older-person assessment.
Most directly, Decision No. 1976/QĐ-BYT of 1 July 2026 issued professional guidance for caring for older people at home and in the community. It includes a dedicated section on supporting mobility and avoiding falls, with practical instructions for assisted walking, walking with a cane or crutches, negotiating stairs and slopes, wheelchair transfers and wheelchair mobility. It also incorporates WHO's ICOPE approach to identifying declines in intrinsic capacity.
Decision 1976 is therefore an important practical foundation, but it should not be described as a comprehensive national falls-prevention guideline. Its principal scope is professional guidance for home- and community-based older-person care. It does not by itself create one setting-spanning pathway covering risk identification, multifactorial assessment, hospital prevention, post-fall review, transition management and quality measurement. That broader system remains an important area for development.
Risk identification should begin by asking what has already happened
Falls prevention can become unnecessarily complicated if the starting point is always a long scoring tool. The World Guidelines for Falls Prevention and Management recommend opportunistic case finding among community-dwelling older adults and comprehensive multifactorial assessment for people identified as being at high risk. A history of falls, recurrent falls, injury, gait or balance problems and the circumstances surrounding an event can be more useful than relying on one numerical score in isolation.
Simple questions can therefore be powerful. Has the person fallen during the past year? How many times? Was there an injury? Was there dizziness or loss of consciousness? What was the person trying to do immediately beforehand? Have they become afraid of falling? Have they stopped activities because of that fear?
These questions are not simply attempts to predict another event. They can reveal that a person's functional trajectory is changing. A fall may be the first visible sign that an older person is no longer managing medicines safely, cannot reach the toilet in time, has developed orthostatic hypotension, is losing strength, has worsening vision or has become acutely unwell.
For hospitalized older adults, international guidance goes further and recommends against using a scored fall-risk screening tool as a substitute for multifactorial assessment. The practical point is not that structured tools have no value, but that a score should never replace understanding why this particular person may fall.
A fall-risk score is not a substitute for understanding the person
Older people rarely fall because of one isolated factor. International guidance therefore recommends a comprehensive multifactorial assessment for those at high risk, followed by personalized multidomain intervention rather than applying exactly the same bundle to everyone.
Mobility, balance and muscle strength matter because reduced physical capacity makes it harder to recover from a loss of balance. Someone may walk adequately across a clinic room yet struggle with stairs, uneven ground, turning quickly or getting to the toilet at night.
Medicines matter because sedating drugs, psychotropic medicines, some cardiovascular medicines and other fall-risk-increasing drugs can contribute to impaired alertness, dizziness or hypotension. Medication review should therefore be linked to the person's wider treatment goals and clinical condition rather than treated as an isolated pharmacy exercise.
Blood pressure and cardiovascular factors matter because dizziness or unexplained collapse may represent orthostatic hypotension, syncope, arrhythmia or another medical condition. An unexplained fall should not automatically be labeled a mechanical accident.
Cognition and delirium matter because confusion can impair judgment, orientation and safe use of mobility aids. A sudden increase in falls during an illness should raise concern about acute deterioration rather than simply being attributed to aging or dementia.
Vision, feet and footwear influence how safely a person interprets and responds to the environment. Continence and nocturia also matter because urgent or repeated trips to the bathroom, particularly at night, can interact with poor lighting, medicines and reduced mobility. In the Vietnamese multicenter inpatient study, nocturia was strongly associated with being in the fall group, but the magnitude of that observational association should not be treated as a universal causal effect.
Finally, the environment matters. Stairs, loose rugs, poor lighting, low furniture, clutter, slippery bathrooms and poorly positioned mobility aids can turn a manageable functional limitation into a fall.
The purpose of a multifactorial assessment is therefore not to create the longest checklist possible. It is to identify which combination of factors matters for this particular person now.
Safer mobility should be the goal, not immobility
Falls prevention can cause unintended harm if the response to risk is simply to reduce movement. An older person repeatedly told not to walk may become weaker. Someone kept in bed “for safety” can lose strength and functional ability. Families may become so frightened after one fall that they discourage activities the person could still perform safely.
A low fall count achieved by unnecessary immobility is not necessarily evidence of good care.
The World Falls Guidelines emphasize personalized multidomain intervention and physical activity. For community-dwelling older adults at risk, the strongest exercise approaches emphasize balance-challenging and functional exercises, with progressive resistance strength training added where appropriate. WHO's Step Safely package similarly identifies strength and balance training as an important falls-prevention strategy for older people.
Exercise and mobility support should reflect the person's health and capabilities. For one individual, this may mean progressive balance and strength training. For another, it may mean practicing sit-to-stand transfers, walking short distances with an appropriate device or maintaining enough physical capacity to transfer safely between bed and chair.
The better question is therefore not only “How can we stop this person from falling?” It is also “How can we help this person continue moving as safely and independently as possible?”
Assistive devices help only when they fit the person and the situation
Canes, crutches, walkers and wheelchairs can support safer mobility, but the presence of an assistive device does not mean risk has automatically been controlled. A walking aid may be the wrong height, poorly maintained or used incorrectly. The person may leave it out of reach when getting up at night. Cognitive impairment may make a new device difficult to learn. A wheelchair can introduce new transfer risks if its brakes, footrests, positioning or caregiver technique are inappropriate.
In the Ho Chi Minh City multicenter study, walking-aid use was strongly associated with being in the fall group. That finding should not be interpreted as evidence that walking aids cause falls. The association may reflect, at least in part, greater underlying mobility impairment and/or problems with device selection, fitting or use; the study design cannot determine causality.
Decision 1976 is useful in this area because it provides detailed Vietnamese instructions on assisted mobility and wheelchair use. The implementation challenge is to ensure that older people, family caregivers and frontline staff are not merely given equipment but receive appropriate assessment, fitting, instruction and follow-up.
Medication review belongs inside falls prevention
Medication-related risk deserves specific attention because it connects falls with polypharmacy, multimorbidity and transitions of care.
The World Falls Guidelines recommend reviewing fall-risk-increasing drugs as part of multifactorial assessment and considering appropriate medication modification or deprescribing when the balance of benefits and harms supports it. Medication changes should remain individualized and clinically supervised rather than being made automatically because a person has experienced a fall.
For an older person, the issue may not simply be the total number of medicines. Dose, timing, recent changes, combinations of sedating medicines, blood-pressure effects and medicines taken at night can all influence risk.
This makes medication reconciliation particularly important after hospitalization. A person may return home with a different antihypertensive regimen, new analgesics or sedating medicines while also being substantially less mobile than before admission. Their fall risk after discharge may therefore be different from the risk that existed before hospitalization.
Medication safety and falls prevention should not operate as separate quality programs.
Hospitals require a different prevention strategy
Fall prevention in hospital is not identical to fall prevention at home. A hospitalized older person may be acutely ill, unfamiliar with the environment, sleeping poorly and connected to medical equipment. Medicines can change rapidly. Mobility may decline within days. Delirium can develop. Someone who ordinarily walks independently may suddenly require assistance, while a person accustomed to a familiar home must negotiate a different bed, bathroom and call-bell system.
The 2026 Cochrane review of interventions for preventing falls in older hospital patients included 55 studies and 104,474 participants. Education interventions probably reduce both fall rates and the risk of falling. Changes in models of care in acute hospitals probably reduce fall rates. Multifactorial interventions probably also reduce falls, although uncertainty remains and the evidence allows the possibility of little or no benefit for some outcomes. Across intervention types, approaches integrated into local care processes, tailored to patient needs and abilities, and involving patients and/or families may be more effective than approaches without those features.
This is highly relevant to Viet Nam. In the multicenter Ho Chi Minh City study, 19.8% of reported falls occurred during the first 24 hours after admission, nighttime falls were common, and the bed and bathroom were frequent locations. More than 40% occurred while a personal caregiver was present.
The implication is not that caregivers failed. It is that caregiver presence alone is not a complete fall-prevention strategy. Caregivers need appropriate information and support, while hospitals need systems designed around actual patterns of risk.
A post-fall review should ask “why?” before simply adding more restrictions
When an older person falls, the immediate priority is clinical safety. Depending on the event, the person may need assessment for fracture, head injury, pain, neurological change or other acute complications. Clinicians may also need to consider loss of consciousness, syncope, acute illness, orthostatic hypotension, bleeding risk or delirium.
High-quality care should then go further. A post-fall review should reconstruct what happened: Where was the person? What were they trying to do? Had mobility changed recently? Were they rushing to the bathroom? Was a walking aid available and being used correctly? Had medicines changed? Was there dizziness? Was the person confused? Was the environment adequately lit? Was the appropriate level of assistance available? Had something similar happened before?
The purpose is not to find someone to blame. It is to determine whether care needs to change. The medicine regimen may need review; the route to the bathroom may need modification; toileting support may need to change; a mobility assessment may be required; delirium or infection may need investigation; or the family may need additional training. A care plan that looks exactly the same after a significant fall as it did before the fall deserves scrutiny.
Incident reporting should create organizational learning
Falls occurring during healthcare should be considered within the broader patient-safety system. Circular No. 19/2013/TT-BYT, which remains in force, establishes the framework for hospital quality management, including patient-centeredness, organizational responsibility and continuous improvement. Circular No. 43/2018/TT-BYT, which is currently partly in force, regulates the reporting, analysis, feedback, management and prevention of medical incidents and near misses in healthcare facilities.
Circular 43 is not a falls-specific regulation, and not every fall should automatically be classified as a medical adverse event simply because it occurred in a healthcare facility. Whether a fall or related near miss falls within the medical-incident framework depends on the circumstances and on whether it meets the applicable definition of a medical incident during diagnosis, care or treatment.
From a quality-management perspective, however, the principle is clear: completing an incident form is not the same as learning from an incident. If three people fall while going to the same bathroom at night and each event is recorded independently without anyone recognizing the pattern, an organization may have reporting without effective organizational learning.
Falls data should therefore be aggregated and examined for recurring locations, times, patient characteristics, medicines, equipment, care processes and other system factors.
Home is a care setting too
Many falls occur where older people spend most of their time: at home. Home is familiar and can support independence, but familiarity can also hide changing risk. A person may have climbed the same stairs for thirty years, yet declining vision, slower reactions or weaker legs can make those same stairs very different now.
Environmental assessment should therefore be individualized. The objective is not to remove every object or make the home look like a hospital. It is to identify hazards that interact with the person's current abilities.
Poor lighting may matter greatly to someone with visual impairment. A bathroom without secure support may become difficult for a person with lower-limb weakness. A loose rug may be unimportant for one person and hazardous for another. Furniture height, stair rails, floor surfaces, toilet access and the placement of commonly used objects can all influence mobility.
International guidance supports home-hazard assessment and modification for people at increased risk as part of a broader individualized approach. Decision 1976 provides a practical Vietnamese foundation for caregiver education and safer mobility at home, but implementation requires skills, assessment and referral pathways rather than simply distributing written instructions.
Family caregivers need practical fall-prevention skills
Families play a major role in older-person care in Viet Nam, but willingness to help does not automatically mean that mobility assistance is safe.
Caregivers need to understand when an older person can move independently, when supervision is appropriate and when hands-on assistance is required. They need practical skills in transfers, walking assistance, use of mobility devices and recognition of sudden deterioration. They also need to know when an event should trigger medical assessment rather than simply encouraging the person to stand up and continue.
Unsafe assistance can create additional harm. Pulling someone abruptly by the arms, using unstable furniture as support or improvising an inappropriate mobility aid can increase risk rather than reduce it.
Decision 1976 begins to address this implementation gap through detailed instructions on assisted mobility and fall avoidance. The larger challenge is ensuring that these skills reach the families, paid caregivers and community workers actually providing day-to-day support.
Care transitions can create new fall risk within days
An older person's fall risk is not fixed. A hospital admission can change mobility, cognition and medicines rapidly. Surgery may temporarily affect strength and balance. Infection may trigger delirium. Several days of low activity can reduce physical capacity. A new mobility aid may be introduced before discharge.
The person who returns home may therefore be functionally different from the person who entered hospital.
A safe transition should communicate more than diagnoses and medication lists. Relevant information may include current walking and transfer ability, whether supervision or physical assistance is required, recent falls, new mobility devices, weight-bearing restrictions, cognitive changes, toileting needs, medication changes and the rehabilitation or follow-up plan.
Families also need realistic information about what the person can safely do now, rather than assuming they can immediately resume what they were doing before hospitalization. The same principle applies when someone moves between hospital, transitional or rehabilitation care, home care, community services and residential or long-term care. Falls prevention should travel with the person.
Long-term care should protect mobility and dignity as well as prevent injury
People using long-term care services may have many overlapping contributors to fall risk: frailty, dementia, impaired mobility, multiple medicines, continence needs, sensory impairment and dependence on others. That makes falls prevention important, but it also makes it ethically complex.
International falls guidance recommends that care-home residents generally be regarded as a high-risk population rather than using screening scores to decide which residents merit attention. Multifactorial assessment should identify the contributors that matter for each person, and a post-fall assessment should be used after a fall to reconsider risk factors and adapt the care approach. These recommendations are international clinical guidance rather than Vietnamese legal requirements, but the principles are highly relevant as Viet Nam's long-term care sector develops.
A highly restrictive environment can sometimes reduce opportunities to fall by reducing opportunities to move. Yet mobility, autonomy and social participation are themselves important outcomes of high-quality care. A person with dementia who repeatedly stands up may be uncomfortable, need the bathroom or simply be following a long-established pattern of movement. Responding only by restricting movement does not address the underlying need.
Long-term care therefore requires proportionate risk management: understand the person's usual behavior and preferences, provide suitable mobility support, review medicines, adapt the environment, anticipate toileting needs, involve rehabilitation professionals when appropriate and use the least restrictive approach compatible with reasonable safety.
A fall should not automatically result in permanent loss of independence.
Bone health and fall prevention are connected but not interchangeable
Preventing falls and reducing the likelihood of serious injury when a fall occurs are related but different goals.
Osteoporosis increases the probability that a fall results in fracture, while impaired balance, weakness and mobility limitations increase the probability of falling. Decision 1976 includes guidance relevant to osteoporosis, physical activity and mobility, while the National Strategy on Older Persons places substantial emphasis on rehabilitation and functional support.
Treating osteoporosis alone does not prevent every fall, just as balance training alone does not eliminate fracture risk. High-quality older-person care therefore needs to ask both: Why might this person fall? And if a fall occurs, how vulnerable are they to serious injury?
This becomes particularly important after recurrent falls or a low-trauma fracture, when both fall risk and bone health deserve reconsideration rather than being managed as unrelated problems.
Fear of falling should be taken seriously without reinforcing fear
After a fall, an older person may understandably become more cautious. But fear can become disabling when it leads them to stop walking, avoid social activities or depend unnecessarily on family members.
Caregivers can unintentionally reinforce that process by repeatedly saying, “Don't walk, you'll fall again.” A more constructive response is: “Let's understand what made you fall and work out how you can move more safely.”
Rehabilitation, graded activity, appropriate mobility aids, environmental changes and rebuilding confidence can all support recovery. This is one reason falls prevention and rehabilitation should be closely connected.
The outcome that matters is not simply fewer falls. It is safer participation in life.
Falls should be measured as a quality outcome, but carefully
Organizations need data to improve, but fall rates can be misleading if interpreted without context. Useful measures may include total falls, the number of people who fall, recurrent falls, falls with injury, fractures, falls per patient-days or resident-days, location and timing, completion of post-fall review and whether identified improvement actions were implemented.
A lower fall rate is not automatically evidence of better care. A service supporting people with greater dependency may experience more falls than one serving relatively independent people. Underreporting can artificially make performance look good. Conversely, a stronger reporting culture may initially increase recorded incidents because staff are documenting events more consistently.
Measures therefore need clear definitions, denominators and context. Falls with harm deserve particular attention, but non-injury falls and near misses can also contain important information. Waiting for a major fracture before examining a recurring hazard is poor quality management.
Quality teams should therefore ask not only “How many falls occurred?” but also “What patterns are we seeing, what have we learned, and did our interventions reduce harm without unnecessarily restricting mobility?”
A practical falls-quality framework for Viet Nam is possible now
Viet Nam does not need to wait for one comprehensive national falls guideline before healthcare and long-term care organizations strengthen their own quality systems.
A practical framework can connect seven functions. Risk identification means routinely asking about recent falls and changes in mobility rather than depending only on a score. Multifactorial assessment for people at higher risk examines mobility, medicines, cardiovascular factors, cognition, vision, continence, footwear, environment, mobility devices, bone health and other relevant contributors.
Personalized prevention can include exercise or rehabilitation, medication review, environmental modification, appropriate assistive devices, toileting support, caregiver education and treatment of relevant medical conditions. Safe mobility keeps preservation of function and participation as an explicit goal rather than allowing fall prevention to become unnecessary restriction.
Post-fall response and review means assessing injury and acute causes, understanding what happened and modifying the plan when necessary. Transition management makes current mobility, fall history, assistance requirements, devices and follow-up needs part of handover between settings. Measurement and learning then brings the system together by identifying patterns and testing whether interventions reduce harm while maintaining functional ability.
These functions already connect priorities that Viet Nam is developing separately: hospital patient safety, rehabilitation, medication safety, ICOPE-based assessment, home and community care, caregiver capability and long-term care quality. The value comes from treating them as one system.
From preventing falls to supporting safer lives
An older person who falls needs more than a label saying “high risk.” They need someone to ask why the fall occurred and what can realistically change. The answer may involve reviewing a medicine, identifying a blood-pressure problem, rebuilding strength, addressing vision, modifying a bathroom, fitting a mobility aid, recognizing delirium or teaching a caregiver how to assist more safely. Sometimes the person also needs reassurance that one fall does not mean they should stop moving.
For hospitals, high-quality falls care means more than completing a risk assessment on admission. It means designing care around the person's changing risk and learning systematically when falls occur. For families and community services, it means making daily life safer without unnecessarily taking away independence. For long-term care, it means balancing safety with mobility, dignity and autonomy.
As Viet Nam develops a more integrated system of care for older people, the question should therefore not simply be: “Did we identify this person as being at risk of falling?” A more meaningful question is: “Did we understand why this person was at risk, help them move as safely as possible, learn when a fall occurred and make sure that safer care continued across every setting?”
That is the difference between fall-risk screening and a genuine system for safer mobility.
References
World Health Organization. Falls. Fact sheet. Geneva: World Health Organization; 2021.
World Health Organization. Step Safely: Strategies for preventing and managing falls across the life-course. Geneva: World Health Organization; 2021.
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Montero-Odasso M, van der Velde N, Martin FC, et al. World guidelines for falls prevention and management for older adults: a global initiative. Age and Ageing. 2022;51(9):afac205.
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Prime Minister of Viet Nam. Decision No. 383/QĐ-TTg approving the National Strategy on Older Persons to 2035, with a vision to 2045. 21 February 2025.
Prime Minister of Viet Nam. Decision No. 1116/QĐ-TTg amending Decision No. 1579/QĐ-TTg approving the Older People Health Care Program to 2030. 22 June 2026.
Ministry of Health of Viet Nam. Decision No. 1976/QĐ-BYT issuing professional guidance on care for older people at home and in the community. 1 July 2026.
Ministry of Health of Viet Nam. Circular No. 19/2013/TT-BYT guiding healthcare service quality management in hospitals. 12 July 2013. Currently in force.
Ministry of Health of Viet Nam. Circular No. 43/2018/TT-BYT guiding prevention of medical incidents in medical examination and treatment establishments. 26 December 2018. Currently partly in force.