SAFER Karachi: Strengthening an Adapted Fall Prevention Intervention for Resilience in Older Adults - A Pilot Study in Karachi

Falls are a major public health concern among older adults and are a leading cause of injury, disability, and loss of independence worldwide. The burden is particularly high in low- and middle-income countries (LMICs), where over 80% of fall-related deaths occur. In Pakistan, and especially in urban settings like Karachi, older adults face compounded risks due to limited access to geriatric care, inadequate home safety infrastructure, financial constraints, and reliance on informal caregiving systems. Despite this growing burden, fall prevention remains underexplored and under-implemented in the local context.

Most evidence-based fall prevention interventions have been developed and tested in high-income countries, raising concerns about their applicability in LMIC settings due to differences in environmental conditions, health system structures, cultural norms, and resource availability. There is a critical need to adapt and evaluate such interventions to ensure they are feasible, acceptable, and effective within the local context.

The SAFER Karachi study (Strengthening an Adapted Fall Prevention Intervention for Resilience in Older Adults) is a pilot quasi-experimental study designed to address this gap. The study aims to adapt, strengthen, and evaluate a culturally relevant fall prevention intervention for community-dwelling older adults aged 60 years and above in urban Karachi.

The intervention is based on the evidence-based Stepping On program, a multi-component fall prevention strategy that integrates strength and balance training, environmental safety education, medication awareness, and behavioural change approaches to improve self-efficacy and reduce fall risk. While the core structure of the program will be retained, context-specific adaptations and strengthening measures will be incorporated to enhance feasibility, safety, and relevance in a low-resource urban setting. These include standardized facilitator training, physiotherapist-informed delivery of exercise components, integration of supportive tools to improve adherence, and minor refinements informed by formative research and local implementation considerations.

The study will use a pre-test and post-test quasi-experimental design and will enroll approximately 50 older adults from selected urban communities in Karachi. The intervention will be delivered over a 7-week period through structured group sessions led by trained facilitators. Each session will focus on key components of fall prevention, including physical exercises, home hazard identification, medication-related risk awareness, vision and footwear considerations, and behavioural strategies to support long-term adherence. Peer interaction and social support will be emphasized to enhance engagement and sustainability.