BACKGROUND:
Falls are a leading cause of injury, functional decline, and loss of independence among older adults worldwide, with disproportionate consequences in LMICs1,2. In Pakistan, rapid population ageing, limited geriatric services, unsafe home environments, and the absence of structured fall prevention initiatives heighten vulnerability among community-dwelling older adults3,4. Locally grounded evidence incorporating various perspectives remains scarce, constraining the development of contextually appropriate prevention strategies5.

OBJECTIVE:
To explore fall-related risks, prevention priorities, and health system gaps affecting community-dwelling older adults in urban Karachi among older adults, caregivers, and healthcare providers.

METHODS:
We conducted a qualitative multi-stakeholder assessment using in-depth interviews with older adults (n=5) and informal caregivers (n=5) recruited from urban community settings in Karachi and healthcare providers (n=6) purposively sampled with varying experience in geriatric care. Data were analysed using a hybrid inductive–deductive thematic analysis to identify individual-, household-, and system-level factors shaping fall risk and prevention.

RESULTS:
Older adults described age-related health conditions, including mobility limitations, balance instability, and fear of falling, leading to activity restriction and social withdrawal. Caregivers highlighted substantial supervision demands, progressive functional decline, and limited access to supportive resources, including physiotherapy and assistive devices. Healthcare providers highlighted a high burden of falls alongside the absence of standardized geriatric care protocols, limited workforce training, and infrastructural constraints. Across stakeholder groups, there was strong convergence on priority areas, including structured exercise programmes, home safety modifications, caregiver education, and improved integration between community-based and clinical services.

CONCLUSIONS:
This study identifies critical gaps in fall prevention for community-dwelling older adults in urban Karachi and highlights the need for integrated clinical, environmental, and psychosocial approaches tailored to local contexts. By incorporating household and health system perspectives, the findings provide actionable evidence to inform contextually appropriate fall prevention interventions and support service planners in strengthening healthy ageing initiatives in resource-constrained settings.