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This study aimed to estimate the prevalence of fallers, recurrent fallers, and individuals at high risk of falls; identify associated sociodemographic and health-related factors; and examine the relationship between functional fitness and fall outcomes among older adults in Ghana, a country representative of the broader sub-Saharan African context.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a population-based cross-sectional study among 639 community-dwelling adults aged\u2009\u2265\u200960 years in urban and rural Ghana, using multi-stage sampling. Fall history over the past 12 months was assessed through self-report, and fall risk was evaluated using the 12-item Fall Risk Questionnaire. Functional fitness was measured using eight performance tests adapted from the Senior Fitness Test and Short Physical Performance Battery. Associations between fall outcomes, sociodemographic and health factors, and fitness measures were analysed using Poisson regression with robust variance and negative binomial regression models.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The prevalence of fallers, recurrent fallers, and high fall risk was 24.6%, 10.3%, and 30.2%, respectively. Female sex was strongly associated with both fallers and recurrent fallers. Rural residence was significantly associated with recurrent fallers. Moderate pain and high sedentary behaviour, were also linked to fallers. Fall risk scores were strongly associated with reported fall events, with psychological and strength-related items contributing most to fall outcomes.<\/jats:p>\n                    <jats:p>Poor lower limb strength, assessed using the five-times sit-to-stand test, was significantly associated with recurrent fallers (PR\u202f= 1.08; 95% CI: 1.04-1.13), while declines in any fitness domain were associated with elevated fall risk.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Falls are common among older adults in Ghana, with risk influenced by sex, residence, and functional status. Functional fitness plays a central role in fall risk, underscoring the value of targeted interventions to promote safe and healthy ageing in sub-Saharan Africa.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12877-026-07577-6","type":"journal-article","created":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T08:17:21Z","timestamp":1777882641000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Falls and functional fitness among older adults in Sub-Saharan Africa: findings from the first population-based cross-sectional study in Ghana"],"prefix":"10.1186","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3534-7285","authenticated-orcid":false,"given":"Bertha","family":"Oppong-Yeboah","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6960-5751","authenticated-orcid":false,"given":"Alfred Edwin","family":"Yawson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9230-1246","authenticated-orcid":false,"given":"Koen","family":"Milisen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7253-5766","authenticated-orcid":false,"given":"Jannique","family":"van Uffelen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0265-9154","authenticated-orcid":false,"given":"Jos","family":"Tournoy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,5,4]]},"reference":[{"key":"7577_CR1","doi-asserted-by":"publisher","first-page":"693","DOI":"10.1111\/JGS.15304","volume":"66","author":"CS Florence","year":"2018","unstructured":"Florence CS, Bergen G, Atherly A, Burns E, Stevens J, Drake C. 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