Abstract Mobility-related injury remains a major cause of morbidity, disability, and loss of independence in older adults. Conventional prevention frameworks predominantly emphasise environmental exposure while underrepresenting biological heterogeneity. In later life, injury risk is not simply a function of exposure but emerges from a dynamic mismatch between environmental demand and neurobiological capacity. White matter hyperintensities (WMH) and brain atrophy (BA), reflecting cumulative neurovascular burden, may reduce the neural reserve required for safe mobility. We propose an exposure–resilience interaction framework in which injury vulnerability arises when environmental demands exceed compensatory capacity (Figure 1). Evidence from neuroimaging and functional studies indicates that structural brain burden is associated with impaired hazard perception and reduced real-world performance, even among cognitively normal individuals. Japan provides a natural translational setting, where advanced population ageing and existing brain health screening systems intersect. Integrating neurovascular resilience into injury epidemiology reframes prevention from external hazard control toward preservation of intrinsic capacity.
Kaechang Park (Thu,) studied this question.