Fall-Risk Screening Tool for Older Adults with Diabetes Mellitus in Primary Health Care

Background: Falls are a major concern among older adults with diabetes mellitus (DM), yet systematic screening and prevention remain limited in Indonesian primary health care (PHC). This study aimed to identify key determinants of fall risk and explore contextual needs to inform the development of a multidomain fall-risk screening tool for Indonesian primary care. Methods: A mixed methods design was employed at five PHCs. Quantitative data were collected using standardized assessments of fall risk, including the TUG, the mCTSIB, and the short version of FES-International in 412 patients with DM. Semi-structured interviews were undertaken with healthcare personnel and purposively selected patients reflecting a range of fall-risk characteristics. Results: Vestibular disorders were identified as the most influential predictor of fall risk across mobility (TUG) and sensory balance (mCTSIB), while fear of falling (FES-I) was primarily associated with gender and age. The optimal cut-offs for TUG (13.5 sec), FES-I (score 13), and mCTSIB (81 sec) demonstrated excellent diagnostic performance, with sensitivity and specificity values reaching 100% and 90–99.4%, respectively, underscoring their robustness for fall-risk screening. Qualitative findings revealed functional decline, sensory challenges, low awareness, and the absence of routine screening in PHC. Integrated results highlight the urgent need for a simple, multidomain, and feasible fall-risk screening tool for primary care. Conclusion: Beyond age and gender, vestibular disorders emerged as the strongest determinant of fall risk, and the excellent diagnostic accuracy of TUG, FES-I, and mCTSIB underscores the need for a simple, feasible, and multidomain fall-risk screening tool in primary care.