Abstract
OBJECTIVE: In this study, we examined the longitudinal trajectories of falls and physical activity statuses among older adults and identified factors associated with state transitions. METHODS: A total of 1,327 community-dwelling adults aged ≥ 60 years (mean age = 68.72 ± 6.02 years; 673 females, 50.7%) who participated in the second, third, and fourth waves of data collection and had complete falls and physical activity data were analysed using a multi-state Markov model. RESULTS: Among participants with one fall, 63% remained fall-free in subsequent assessments. Those with ≥ 2 falls had a 25% probability of returning to no-fall state and a 21% probability of transitioning to a 1-fall state. Physical activity levels remained relatively stable over time, with comparable probabilities of improvement or decline. Key factors influencing transitions included age, education, skeletal muscle mass, depression, cognitive function, and physical fitness. CONCLUSION: This study highlights the dynamic nature of falls and physical activity patterns among older adults, emphasizing the crucial role of modifiable factors including cognitive function, muscle mass, and physical fitness. Our findings suggest that comprehensive, targeted interventions addressing these key determinants could effectively improve mobility, reduce fall incidence, and enhance overall quality of life in ageing populations.