Neighborhood disadvantage and life-space mobility are associated with incident falls in community-dwelling older adults
Model System:
TBIReference Type:
JournalAccession No.:
J75317Journal:
Journal of the American Geriatrics Society
Year, Volume, Issue, Page(s):
, 64, 11, 2218-2225Publication Website:
Abstract:
Study examined the relationship between neighborhood-level socioeconomic characteristics, life-space mobility, and incident falls in community-dwelling older adults. Baseline in-home assessments were conducted with 1,000 community-dwelling Medicare beneficiaries aged 65 and older. Telephone follow-up interviews were conducted at 6-month intervals for up to 8.5 years. Neighborhood disadvantage was measured using a composite index derived from baseline neighborhood-level residential census tract socioeconomic variables. Data on individual-level socioeconomic characteristics, clinical variables, and life-space collected at baseline were included as covariates in a multivariate model using generalized estimating equations to assess the association with incident falls in the 6 months after baseline. Of the 940 participants who completed baseline and follow-up assessments, 126 (13 percent) reported one or more new falls in the 6 months after baseline. There was an independent nonlinear association between neighborhood disadvantage (according to increasing quartiles of disadvantage) and incident falls after adjusting for confounders. Individuals residing in a neighborhood in the highest quartile of neighborhood disadvantage were more than three times as likely to sustain a fall as those residing in neighborhoods in the least disadvantaged quartile. Each 10-point decrement in life-space was associated with a higher risk of falls. Greater neighborhood disadvantage was associated with greater risk of falls. Life-space also contributes separately to fall risk. Community-dwelling older adults in disadvantaged neighborhoods, particularly those with limited mobility, may benefit from a more-rigorous assessment of their fall risk by healthcare providers. Neighborhood level socioeconomic characteristics should also be an important consideration when identifying vulnerable populations that may benefit the most from fall prevention programs.
Author(s):
Lo, Alexander X., Rundle, Andrew G., Buys, David, Kennedy, Richard E., Sawyer, Patricia, Allman, Richard M., Brown, Cynthia J.