The Efficacy of “Pre-habilitation” in Primary Care for Geriatric Fall Prevention: A Narrative Review

Falls represent a major public health concern among older adults, contributing to significant morbidity, mortality, and healthcare costs. Community-dwelling geriatric populations experience falls at rates of 20-30% annually, with higher risks in those with frailty, impaired balance, or prior falls. Traditional fall prevention strategies in primary care have emphasized reactive approaches following incidents, but emerging concepts such as “pre-habilitation”—proactive interventions aimed at enhancing physiological reserve before adverse events—offer a preventive paradigm. Originally developed in surgical contexts to optimize outcomes in frail patients, pre-habilitation is increasingly explored in non-surgical settings to mitigate fall risk through targeted exercise, neuromodulation, and multifactorial risk reduction. This narrative review synthesizes recent evidence on the efficacy of pre-habilitation-inspired interventions delivered in primary care for geriatric fall prevention. Key themes include exercise-based programs, home-based self-delivered protocols combining motor imagery and neuromodulation, and multifactorial individualized approaches. High-quality systematic reviews and randomized trials demonstrate moderate benefits from exercise interventions in reducing fall rates and injurious falls, particularly among at-risk individuals. Multifactorial strategies show smaller but consistent effects on falls when tailored appropriately. Emerging pre-habilitation protocols, such as home-based neuromodulation-assisted motor imagery, show promise for feasibility and acceptability in proactive fall risk reduction, though large-scale efficacy data remain limited. Primary care delivery facilitates accessibility, but implementation barriers include resource constraints and patient adherence. This review highlights the potential of pre-habilitation to shift from reactive to proactive fall prevention in primary care, while underscoring the need for further research in community settings.

Accordingly, this narrative review aims to: (1) define pre-habilitation in the context of geriatric fall prevention; (2) summarize the epidemiological burden and multifactorial risk profile of falls among older adults; (3) review current guideline recommendations relevant to primary care practice; (4) evaluate evidence supporting exercise-based and emerging pre-habilitation strategies, including neuromodulatory and digital interventions; and (5) discuss implementation considerations, barriers, and facilitators within primary care settings. By synthesizing peer-reviewed literature published, this review seeks to clarify the role of pre-habilitation as a proactive, patient-centered paradigm for fall prevention in aging populations.

Defining pre-habilitation in geriatric fall prevention

Pre-habilitation refers to structured interventions designed to enhance functional capacity and physiological reserve prior to an anticipated stressor, with the goal of improving outcomes and mitigating adverse events (Santa Mina et al., 2021). Traditionally applied in perioperative care, pre-habilitation targets modifiable risk factors before surgical insult through multimodal programs incorporating exercise, nutritional optimization, and psychological support (Carli & Zavorsky, 2020; McAdams-DeMarco et al., 2021). In the context of geriatric fall prevention, the anticipated stressor is not a discrete procedural event but the ongoing and cumulative risk of falling itself, particularly among frail or pre-frail older adults living in the community.

This conceptual shift distinguishes pre-habilitation from conventional rehabilitation, which is inherently reactive and initiated after injury or functional loss has occurred. Pre-habilitation is anticipatory, aiming either to prevent the first fall or to reduce fall severity and recurrence by strengthening underlying physiological and neuromotor systems before failure occurs (Swanson et al., 2024). Core components typically include structured exercise programs emphasizing strength, balance, and gait; nutritional strategies to support muscle mass and energy availability; and psychological interventions to address fear of falling, self-efficacy, and engagement (Friedman et al., 2020; Carli & Zavorsky, 2020; Yardley et al., 2020). In non-surgical settings, adaptations emphasize accessibility, scalability, and self-management rather than intensive supervised delivery.

Within primary care, pre-habilitation for fall prevention may be operationalized through brief, targeted interventions embedded into routine visits, supported by telehealth platforms, or delivered via home-based protocols. Emerging models increasingly leverage digital health technologies to facilitate monitoring, adherence, and individualized progression, aligning with older adults’ preferences for autonomy and convenience (Choi et al., 2023; Pillay et al., 2024). A notable example is a recent pilot protocol combining motor imagery—mental rehearsal of functional mobility tasks—with transcranial direct current stimulation (tDCS) applied to frontal cortical regions, delivered through a self-administered, home-based program over two weeks (Swanson et al., 2024). This approach targets central mechanisms of mobility decline by enhancing motor learning and cortical plasticity, offering a low-burden adjunct to traditional exercise interventions.

Preliminary feasibility outcomes for such models are encouraging, demonstrating acceptable adherence, retention, and safety among community-dwelling older adults (Taube et al., 2023; Swanson et al., 2024). Importantly, these interventions may also positively influence fear of falling and balance confidence—key psychosocial determinants of mobility behavior and fall risk (Friedman et al., 2020; Yardley et al., 2020). While robust effectiveness data remain limited, the conceptual alignment of these approaches with pre-habilitation principles highlights their potential relevance to primary care-based fall prevention.

In summary, pre-habilitation in geriatric fall prevention represents a proactive, resilience-oriented framework that shifts the focus from post-fall recovery to anticipatory risk reduction. By targeting modifiable physiological, neuromotor, and psychological vulnerabilities before functional failure occurs, pre-habilitation offers a complementary strategy to existing guideline-recommended interventions and may enhance the effectiveness and sustainability of fall prevention efforts in primary care.

Epidemiology and risk factors for falls in older adults

Falls are highly prevalent among community-dwelling older adults and demonstrate a steep, age-associated gradient. Epidemiological data consistently indicate that approximately 25–35% of adults aged 65 years and older experience at least one fall annually, with incidence rising to nearly 50% among adults aged 80 years and above (Bergen et al., 2022; Nicholson et al., 2024; Pillay et al., 2024). Recurrent falls are common, and prior falls remain one of the strongest predictors of subsequent events (Tromp et al., 2021). Importantly, falls are not benign occurrences: approximately one-third result in physical injury, and an estimated 5–10% lead to fractures, head injury, or hospitalization (Vieira et al., 2020; Nicholson et al., 2024). Hip fractures are particularly consequential, with reported one-year mortality rates ranging from 20% to 30%, alongside sustained functional decline among survivors (Tromp et al., 2021; Hopewell et al., 2023).

Beyond individual health consequences, falls impose a substantial economic burden on healthcare systems. Costs are driven by emergency department utilization, inpatient care, rehabilitation services, long-term care placement, and indirect costs related to loss of independence and caregiver burden (Friedman et al., 2020; Davis et al., 2021; Bergen et al., 2022). In the United States, fall-related medical expenditures have risen steadily over the past decade in parallel with population aging, reinforcing falls as both a clinical and public health priority (Bergen et al., 2022). Comparable trends have been documented internationally, highlighting the global relevance of effective preventive strategies (Vieira et al., 2020).

Fall risk arises from the interaction of multiple intrinsic and extrinsic factors. Intrinsic risk factors include lower extremity muscle weakness, impaired balance and gait, slowed reaction time, visual impairment, cognitive dysfunction, orthostatic hypotension, and chronic disease burden (Tromp et al., 2021; Hopewell et al., 2023; Nicholson et al., 2024). Polypharmacy—particularly the use of psychotropic medications, sedatives, antihypertensives, and anticholinergics—has been consistently associated with increased fall risk through effects on alertness, blood pressure regulation, and motor coordination (Vieira et al., 2020; Nicholson et al., 2024). Frailty syndromes, characterized by slow gait speed, low grip strength, exhaustion, and reduced physical activity, markedly elevate fall susceptibility and worsen post-fall recovery (Fried et al., 2021). Longitudinal cohort data demonstrate that frailty and pre-frailty states independently predict both falls and fractures, even after adjustment for age and comorbidity (Fried et al., 2021; Tromp et al., 2021).

Extrinsic risk factors include environmental hazards such as inadequate lighting, uneven walking surfaces, loose rugs, and lack of handrails, as well as inappropriate footwear and assistive device misuse (Vieira et al., 2020; Nicholson et al., 2024). Risk is further shaped by the mismatch between an individual’s functional capacity and environmental or activity demands, emphasizing that falls often occur during routine daily activities rather than high-risk behaviors (Tromp et al., 2021). Psychosocial factors also play a critical role. Fear of falling—whether following an initial fall or arising independently—contributes to activity restriction, deconditioning, social isolation, and loss of confidence, thereby creating a self-reinforcing cycle that increases future fall risk (Friedman et al., 2020; Yardley et al., 2020).

Primary care settings are uniquely positioned to identify and modify many of these risk factors before injurious falls occur. Structured screening tools, such as those embedded within the CDC STEADI algorithm, facilitate systematic identification of fall history, gait and balance impairment, medication-related risk, and functional limitations (Centers for Disease Control and Prevention, 2023–2024; Eckstrom et al., 2023). Importantly, many risk factors—muscle weakness, balance deficits, medication burden, and fear of falling—are potentially modifiable through early, proactive intervention, providing a clear rationale for anticipatory approaches such as pre-habilitation.

Current guidelines and recommendations for fall prevention in primary care

Major clinical guidelines consistently endorse fall risk screening and targeted interventions for older adults in primary care. The US Preventive Services Task Force recommends exercise interventions for community-dwelling adults aged 65 years and older who are at increased risk of falls (Grade B), citing moderate-certainty evidence demonstrating reductions in fall rates and injurious falls (Bergen et al., 2022; Nicholson et al., 2024; Guirguis-Blake et al., 2024). Effective programs typically incorporate balance, strength, gait, and functional training, delivered two to three times per week for a duration of at least 12 months (Liu-Ambrose et al., 2021; Nicholson et al., 2024). These interventions have demonstrated benefit across diverse populations, including adults with frailty or prior falls.

In contrast, the USPSTF assigns a Grade C recommendation to multifactorial interventions, reflecting evidence of modest net benefit and substantial heterogeneity in outcomes (Hopewell et al., 2020; Nicholson et al., 2024). Multifactorial approaches involve individualized risk assessment followed by tailored interventions addressing exercise, medication optimization, vision correction, environmental modification, and management of postural hypotension or cardiovascular contributors (Hopewell et al., 2020; Nicholson et al., 2024). While such interventions may be beneficial for selected high-risk individuals, their effectiveness appears contingent on appropriate targeting, patient engagement, and implementation fidelity (Hopewell et al., 2020; Goodwin et al., 2022).

The Centers for Disease Control and Prevention STEADI (Stopping Elderly Accidents, Deaths, and Injuries) initiative provides a pragmatic, primary care–oriented framework for translating evidence into practice (Eckstrom et al., 2023; Centers for Disease Control and Prevention, 2023–2024). STEADI integrates brief screening (e.g., Stay Independent questionnaire), standardized assessment tools (Timed Up and Go test, 4-Stage Balance Test), and evidence-based interventions, including exercise referral, medication review, vitamin D assessment, and home safety counseling (Centers for Disease Control and Prevention, 2023–2024). Implementation studies demonstrate that embedding STEADI into annual wellness visits, nurse-led workflows, or team-based care models improves fall risk detection and intervention delivery (Eckstrom et al., 2023). Guideline recommendations, delivery considerations, and implementation barriers relevant to pre-habilitation in primary care are outlined in Table 1.

Table 1. Guideline Alignment and Implementation Considerations for Pre-habilitation in Primary Care

Despite guideline support, real-world uptake remains uneven. Reported barriers include limited visit time, competing clinical priorities, insufficient reimbursement, and uncertainty regarding patient adherence (Goodwin et al., 2022). Facilitators include interdisciplinary collaboration, patient education, and alignment with preventive care incentives (Reuben et al., 2021; Goodwin et al., 2022). These implementation challenges underscore the need for prevention strategies that are efficient, scalable, and sustainable within routine primary care—features that align closely with pre-habilitation principles.

Evidence for exercise-based interventions as pre-habilitation

Exercise-based interventions represent the cornerstone of both guideline-recommended fall prevention and pre-habilitation-inspired strategies. High-quality systematic reviews and meta-analyses published consistently demonstrate that structured exercise programs reduce fall rates by approximately 15–25% among at-risk community-dwelling older adults (Tricco et al., 2020; Liu-Ambrose et al., 2021; Bergen et al., 2022; Nicholson et al., 2024; Guirguis-Blake et al., 2024). Programs emphasizing balance and functional training—either alone or combined with resistance exercise—are more effective than single-component or low-intensity interventions (Liu-Ambrose et al., 2021; Nicholson et al., 2024). Benefits extend to reductions in injurious falls and improvements in mobility, confidence, and functional performance (Davis et al., 2021; Liu-Ambrose et al., 2021).

From a pre-habilitation perspective, exercise serves not only to restore function but to build physiological reserve before functional failure occurs. Progressive resistance and balance training enhance neuromuscular control, reaction time, and postural stability, directly targeting mechanisms implicated in age-related fall risk (Liu-Ambrose et al., 2021; Tromp et al., 2021). Cost-effectiveness analyses further support exercise-based prevention, demonstrating favorable cost–benefit profiles when delivered at scale, particularly among higher-risk populations (Davis et al., 2021).. Key characteristics and outcomes of recent exercise-based and pre-habilitation–aligned interventions for fall prevention in primary care are summarized in Table 2.

Table 2. Summary of Pre-habilitation–Aligned Interventions for Geriatric Fall Prevention

Home-based and self-managed exercise programs are especially relevant to primary care and pre-habilitation paradigms. Such models reduce reliance on supervised sessions, promote long-term adherence, and accommodate mobility or transportation limitations common among older adults (Choi et al., 2023; Swanson et al., 2024). Randomized trials and pragmatic studies demonstrate that home-based programs can improve balance confidence, gait speed, and functional capacity, even among frail individuals (Swanson et al., 2024). While longer-duration programs (12–30 months) yield the most robust effects, shorter, intensive interventions may serve as effective entry points for initiating behavioral and neuromotor adaptation (Nicholson et al., 2024).

Emerging pre-habilitation strategies

Emerging pre-habilitation strategies extend beyond conventional exercise to target central nervous system mechanisms underlying mobility decline. Motor imagery and action observation—cognitive techniques involving mental rehearsal of movement—have demonstrated potential to enhance motor learning and functional performance in older adults (Clark & Patten, 2022). When combined with non-invasive brain stimulation modalities such as transcranial direct current stimulation (tDCS), these approaches aim to prime cortical plasticity and augment training effects (Taube et al., 2023).

A recent pilot randomized controlled trial evaluated a home-based, self-delivered pre-habilitation protocol combining motor imagery with tDCS over a two-week period in community-dwelling older adults at fall risk (Swanson et al., 2024). Feasibility outcomes, including adherence, retention, and safety, were favorable, and preliminary signals suggested improvements in mobility-related outcomes. Such interventions are particularly attractive for primary care settings, where access to supervised rehabilitation may be limited and scalable, low-burden solutions are needed. While definitive effectiveness data are not yet available, these approaches exemplify the shift toward proactive neural and functional priming inherent to pre-habilitation frameworks.

Multifactorial interventions in primary care

Multifactorial fall prevention programs address multiple risk domains through individualized assessment and tailored intervention, typically encompassing exercise prescription, medication review, vision assessment, cardiovascular evaluation, and home safety modification (Hopewell et al., 2020; Nicholson et al., 2024). Evidence from meta-analyses indicates modest reductions in fall rates, with pooled incidence rate ratios approximating 0.84, though effects on fractures and individual fall risk are variable (Hopewell et al., 2020; Nicholson et al., 2024).

Large pragmatic trials have demonstrated that nurse-led, primary care–embedded multifactorial strategies can reduce serious fall-related injuries, particularly when targeted to high-risk individuals (Sherrington et al., 2020). However, effectiveness depends on accurate risk stratification, patient engagement, and sustained follow-up—conditions that are not uniformly met in routine practice (Goodwin et al., 2022). From a pre-habilitation standpoint, multifactorial interventions may be most effective when selectively applied to individuals with identifiable vulnerability (e.g., frailty, prior falls) and integrated with proactive, capacity-building strategies rather than reactive post-fall care.

rESULTS AND DISCUSSION

The synthesis of evidence published supports a substantive reframing of geriatric fall prevention toward proactive, pre-habilitation–inspired strategies embedded within primary care. Rather than conceptualizing falls as isolated adverse events requiring post hoc rehabilitation, contemporary evidence increasingly positions fall risk as a foreseeable and modifiable manifestation of declining functional reserve. Within this framework, pre-habilitation shifts the emphasis from recovery after injury to anticipatory enhancement of neuromuscular, balance, and adaptive capacity before destabilizing events occur.

Exercise-based interventions form the empirical backbone of this paradigm. Across multiple high-quality systematic reviews, meta-analyses, and guideline evaluations, exercise programs demonstrate consistent moderate reductions in fall rates, the proportion of fallers, and injurious falls among community-dwelling older adults at increased risk (Tricco et al., 2020; Liu-Ambrose et al., 2021; Bergen et al., 2022; Nicholson et al., 2024; Guirguis-Blake et al., 2024). The 2024 recommendation statement from the US Preventive Services Task Force and its accompanying evidence review provide particularly robust confirmation, reporting pooled incidence rate ratios of 0.85 for total falls and 0.84 for injurious falls in interventions emphasizing balance, gait, and strength training (Bergen et al., 2022; Nicholson et al., 2024; Guirguis-Blake et al., 2024). These findings are notable not only for their statistical consistency but also for their clinical relevance, as reductions in injurious falls directly translate into preserved independence, reduced hospitalization, and lower long-term disability burden.

From a pre-habilitation perspective, the structure and duration of exercise programs warrant particular attention. Most effective interventions involve two to three sessions per week sustained over at least 12 months, suggesting that durable neuromuscular adaptation and motor learning require prolonged exposure (Liu-Ambrose et al., 2021; Pillay et al., 2024). However, emerging evidence indicates that shorter, more intensive protocols may serve as catalytic interventions—initiating early improvements in balance confidence, gait stability, and movement efficiency that can be consolidated through longer-term maintenance strategies (Pillay et al., 2024). This distinction is especially relevant in primary care, where patient engagement may initially be fragile and early perceived benefit may be critical for adherence.

Multifactorial interventions align conceptually with pre-habilitation by addressing the multidimensional nature of fall risk, encompassing physical impairments, medication burden, sensory deficits, cardiovascular contributors, and environmental hazards (Hopewell et al., 2020; Nicholson et al., 2024). Meta-analytic evidence demonstrates modest but significant reductions in fall rates, with pooled incidence rate ratios approximating 0.84 (Hopewell et al., 2020). However, effects on injurious falls, fractures, and mortality are less consistent, and adherence frequently declines over time. These limitations underpin the cautious Grade C recommendation issued by the USPSTF, emphasizing selective rather than universal implementation and careful alignment with patient preferences, comorbidities, and prior fall history (Hopewell et al., 2020; Nicholson et al., 2024). Importantly, subgroup analyses suggest stronger effects when multifactorial interventions are targeted to individuals with clear vulnerability—such as prior falls, frailty, or polypharmacy—highlighting the importance of risk stratification rather than broad deployment (Hopewell et al., 2020; Vieira et al., 2020).

Primary care plays a pivotal role in operationalizing both exercise-based and multifactorial approaches. Routine encounters provide repeated opportunities for early identification of gait impairment, balance decline, medication-related risk, and fear of falling, often before a sentinel fall event occurs. Tools such as the STEADI algorithm from the Centers for Disease Control and Prevention facilitate systematic screening and triage, enabling timely referral to preventive interventions (Bergen et al., 2022; Eckstrom et al., 2023; Centers for Disease Control and Prevention, 2023–2024). From a systems perspective, pre-habilitation aligns closely with the preventive mandate of primary care, offering a structured response to gradual functional decline rather than episodic crisis management.

Emerging pre-habilitation strategies extend this foundation by explicitly targeting central nervous system mechanisms implicated in age-related mobility decline. The home-based protocol combining motor imagery with transcranial direct current stimulation represents a novel attempt to enhance cortical plasticity and motor learning before falls occur (Swanson et al., 2024). This approach is conceptually distinct from traditional exercise interventions in that it seeks to “prime” neural circuits underlying balance and gait, potentially amplifying the effects of physical training or compensating for limitations in exercise tolerance. The pilot randomized controlled trial protocol targets community-dwelling older adults with self-identified fall risk, delivering brief, self-administered sessions through accessible technology (Swanson et al., 2024). Feasibility outcomes—including recruitment, retention, compliance, and acceptability—are prioritized, reflecting the early developmental stage of this intervention. The mechanistic rationale is supported by evidence that motor imagery activates neural networks overlapping with physical execution, while tDCS transiently increases cortical excitability, together potentially mitigating age-related declines in sensorimotor integration (Taube et al., 2023; Swanson et al., 2024).

Although large-scale efficacy data for such neuromodulatory approaches are not yet available, their relevance to primary care is substantial. Limited access to supervised therapy, transportation barriers, and workforce constraints frequently impede delivery of conventional fall prevention programs. Self-delivered, home-based interventions may therefore address structural barriers while supporting patient autonomy and sustained engagement (Tromp et al., 2021; Swanson et al., 2024). Importantly, these approaches also directly target fear of falling and confidence—psychological determinants that strongly influence activity patterns and future fall risk (Friedman et al., 2020; Yardley et al., 2020).

Despite these promising developments, significant implementation challenges persist. Time constraints, competing clinical priorities, and variability in clinician training continue to limit routine fall risk screening and intervention delivery in primary care (Yardley et al., 2020; Goodwin et al., 2022). Studies examining STEADI integration demonstrate improved detection and referral when embedded into annual wellness visits or nurse-led workflows, yet long-term sustainability depends on interdisciplinary teamwork, patient education, and institutional support (Eckstrom et al., 2023; Centers for Disease Control and Prevention, 2023–2024). Patient values and preferences further shape uptake; recent syntheses indicate a strong preference for individualized exercise formats over group-based programs, with heterogeneous acceptability of modalities such as tai chi or cognitively oriented interventions (Pillay et al., 2024). These findings underscore the importance of flexibility and shared decision-making within pre-habilitation frameworks.

Equity considerations are also central. Access to supervised exercise programs, digital platforms, or technology-assisted pre-habilitation remains uneven, potentially exacerbating disparities among socioeconomically disadvantaged or rural populations (Choi et al., 2023; Nicholson et al., 2024). Without deliberate attention to accessibility, scalability, and cultural relevance, pre-habilitation strategies risk benefiting only a subset of older adults.

Limitations of the current evidence base must therefore temper enthusiasm for immediate widespread adoption. Most available data derive from exercise or multifactorial interventions not explicitly designed as pre-habilitation, with true anticipatory protocols largely confined to pilot studies or perioperative contexts (McAdams-DeMarco et al., 2021; Swanson et al., 2024). Heterogeneity in definitions, intervention components, outcome measures, and follow-up duration complicates synthesis and limits generalizability (Hopewell et al., 2020; Pillay et al., 2024). Few trials are conducted entirely within primary care settings, and long-term outcomes beyond 12–24 months remain insufficiently characterized (Lamb et al., 2022). While reported harms are generally minor—most commonly transient musculoskeletal discomfort—underreporting in multifactorial studies warrants continued caution (Nicholson et al., 2024).

Nonetheless, the conceptual advantages of pre-habilitation remain compelling. By enhancing physiological and neural reserve before destabilizing events occur, pre-habilitation offers a means to interrupt the vicious cycle of falls, fear of falling, activity restriction, and deconditioning (Friedman et al., 2020; Swanson et al., 2024). Primary care’s longitudinal reach and accessibility position it uniquely to identify pre-frail or at-risk individuals early and to deploy low-burden interventions that strengthen resilience before irreversible decline ensues (Fried et al., 2021). The integration of emerging technologies—such as app-supported exercise, remote monitoring, and home-based neuromodulation—may further extend reach while maintaining alignment with patient-centered care principles (Tchalla et al., 2022; Swanson et al., 2024).

CONCLUSION

In conclusion, contemporary evidence supports exercise as the cornerstone intervention for preventing falls in community-dwelling older adults at increased risk, with moderate net benefits that justify routine recommendation in primary care. Multifactorial approaches offer smaller and more variable benefits and should be selectively applied based on individual risk profiles, comorbidities, and patient preferences. Pre-habilitation–inspired strategies represent a promising evolution of fall prevention, reframing intervention from reactive recovery to proactive resilience-building. Home-based and technology-supported models, including those incorporating motor imagery and neuromodulation, may be particularly well suited to primary care environments where traditional supervised programs are difficult to sustain.

Future directions

Future research should prioritize large-scale randomized controlled trials explicitly evaluating pre-habilitation protocols for fall prevention in primary care populations. These studies should assess effects on fall incidence, injurious falls, functional outcomes, and quality of life over extended follow-up periods. Parallel implementation research is needed to address clinician training, reimbursement mechanisms, workflow integration, and equitable access, particularly for underserved or digitally marginalized populations. Comparative effectiveness studies examining delivery modes—home-based versus supervised, technology-assisted versus conventional—and subgroup analyses stratified by frailty status, cognitive impairment, and baseline mobility will refine targeting and personalization. Longitudinal evaluations of sustainability, cost-effectiveness, and integration with electronic health record–based screening and reminder systems are also essential.

Ultimately, embedding pre-habilitation principles into routine primary care offers a forward-looking strategy to mitigate the growing burden of falls in aging populations. Realizing this potential will require continued evidence generation, careful implementation, and sustained alignment with patient values and real-world practice constraints.

ACKNOWLEDGMENTS: None

CONFLICT OF INTEREST: None

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ETHICS STATEMENT: None