Abstract
BACKGROUND: This study aims to develop a advanced machine learning model to predict the fall risk among community-dwelling elders. This study could present actionable advices for early prevention of fall risk. METHODS: Between October and December 2022, 977 older adults from the Hannan District of Wuhan were recruited. Data was collected using structured questionnaires. The sample was randomly split into training (732 participants) and testing (245 participants) sets at a 3:1 ratio. The primary outcome was the occurrence of fall. Five machine learning models-Random Forest (RF), Gradient Boosted Decision Tree (GBDT), Light Gradient Boosting Machine (LGBM), Extreme Gradient Boosting (XGBoost), and Categorical Features Gradient Boosting (CatBoost)-were evaluated against a Logistic Regression (LR) model. Model performance was assessed using AUC, accuracy, precision, sensitivity, specificity, and F1 score. RESULTS: Among the 977 older adults, 195 experienced falls (20.0%). ROC curve analysis showed AUC values of LR, RF, LGBM, GBDT, XGBoost, and CatBoost were, respectively, 0.8390, 0.8632, 0.8614, 0.8544, 0.8705, and 0.8719. CatBoost had the highest AUC, indicating the best predictive performance. SHapley Additive exPlanations (SHAP) analysis identified key features influencing the CatBoost model: history of falls, comorbidities, polypharmacy, sleep disorders, ADL, TUG results, frailty status, and use of assistive devices. CONCLUSION: The fall risk prediction model for community-dwelling older adults, developed with CatBoost, showed excellent performance and can aid in early clinical assessment and fall prevention.