Objective To investigate the transition intensity and transition probabilities of fall states among middle-aged and older adults in China, and to assess the impact of potential risk factors on falls.

Methods We utilized in the study data from the China Health and Retirement Longitudinal Study (CHARLS) and employed a multi-state Markov model (MSM) to analyze the transition intensity and probabilities between states of no falls or falls without treatment, falls requiring treatment, and death.

Results A total of 14722 participants were enrolled, with a mean age of (59.4 years ± 9.7 years), and 47.9% were male. The median follow-up period was 9 years (interquartile range IQR, 7-9 years). At baseline, 12381 participants (84.1%) reported no falls or falls without treatment, while 2341 (15.9%) reported falls requiring treatment. Participants who experienced falls requiring treatment within one follow-up cycle had a 55.2% probability of not falling again or only falling without treatment in the subsequent two years, a 37.6% probability of continuing to experience falls requiring treatment, and a 7.2% probability of death. The risk of transitioning from a state of no falls or falls without treatment to falls requiring treatment increased by 8.6% for every 5-year increase in age. The risk was 35.1% higher for females compared to males. Rural residents had a 10.1% higher risk. Those who were divorced, separated, widowed, or never married had a 20.7% higher risk. Higher degrees of physical function impairment were associated with an increased risk. Depressive symptoms increased the risk by 31.6%. Having one chronic disease raised the risk by 9.6%, while multimorbidity led to a 28.8% increase in risk.

Conclusion  According to the findings of the study, falls are a dynamic process and emphasis should be given to fall prevention for older adults, individuals with a history of fall-related medical visits, those living alone, those with impaired physical function, and those with depressive symptoms.