Exploring the Current Tools for Fall Risk Assessment in Older Adults Across Southeast Asia and the Need for Culturally Adapted Models: A Scoping Review.

Background: Falls are a leading cause of unintentional injury, functional disability, and premature mortality among older adults worldwide, ranking second among causes of unintentional injury-related death globally according to the World Health Organization (WHO), with the burden disproportionately concentrated in low- and middle-income countries, including those across Southeast Asia (SEA). Assessing fall risk is central to primary prevention; however, it remains unclear which tools are recommended or validated for clinical practice across the 11 nations of the Association of Southeast Asian Nations (ASEAN) and whether existing Western-developed instruments adequately account for culturally specific risk determinants in this region. Aim: This scoping review aimed to identify, review, and map the available literature on fall risk assessment tools used in older adults across SEA countries and to explore the extent to which cultural practices and local wisdom influence their applicability and the need for culturally adapted models. Methods: This scoping review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) and the Joanna Briggs Institute (JBI) methodology. Searches were conducted in March 2026 in the Scopus, PubMed/MEDLINE, and Web of Science (WoS) databases. English-language, full-text articles published between 2015 and 2025 from the 11 ASEAN countries were eligible; open-access status was preferred but non-open-access records were also obtained via institutional subscription and author contact. The protocol was pre-registered on the Open Science Framework (OSF; https://doi.org/10.17605/OSF.IO/5DHXK). Results: Thirty-two primary-data studies from Thailand (n=12), Malaysia (n=10), Indonesia (n=5), Vietnam (n=3), and Singapore (n=2) met the inclusion criteria; three additional regional secondary reviews informed cut-off triangulation. Twelve fall risk tool categories were identified. Western tools dominated (84.4% of primary-data studies) with minimal cultural adaptation. The Timed Up and Go (TUG) test was the most frequently used instrument (25/32 studies), but it showed variable cut-off values (8-14.3 s). Six ASEAN countries had no eligible primary studies. The weighted mean proportion of female participants was 63.4%; community-dwelling samples predominated (65.6%). Conclusion: Current fall risk assessment research in SEA is geographically concentrated and dominated by unadapted Western tools. Cultural practices central to SEA - floor-level mobility, barefoot ambulation, and domestic environmental hazards - are systematically unaddressed. Urgent investment in culturally adapted tool development, multicentre validation, and digital scaling is required across ASEAN. We propose an integrative framework, Southeast Asian Fall Assessment for Living and Locality (SEA-FALL), to guide future validation and policy translation.