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Neighborhood Disadvantage and Life‐Space Mobility Are Associated with Incident Falls in Community‐Dwelling Older Adults
Author(s) -
Lo Alexander X.,
Rundle Andrew G.,
Buys David,
Kennedy Richard E.,
Sawyer Patricia,
Allman Richard M.,
Brown Cynthia J.
Publication year - 2016
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/jgs.14353
Subject(s) - medicine , quartile , socioeconomic status , demography , confidence interval , odds ratio , confounding , poison control , gerontology , odds , cohort study , generalized estimating equation , injury prevention , logistic regression , population , environmental health , statistics , sociology , mathematics
Objectives To determine the relationship between neighborhood‐level socioeconomic characteristics, life‐space mobility, and incident falls in community‐dwelling older adults. Design Prospective, observational cohort study with a baseline in‐home assessment and 6‐month telephone follow‐up. Setting Central Alabama. Participants Community‐dwelling adults aged 65 and older recruited from a random sample of Medicare beneficiaries (N = 1,000). Measurements 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. Results Of the 940 participants who completed baseline and follow‐up assessments, 126 (13%) 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: The lowest quartile served as reference; 2nd quartile odds ratio (OR) = 2.4, 95% confidence interval (CI) = 1.2–4.6; 3rd quartile OR = 1.9, 95% CI = 1.0–3.7; 4th quartile OR = 3.2, 95% CI = 1.7–6.0. Each 10‐point decrement in life‐space ( OR = 1.2, 95% CI = 1.0–1.3) was associated with a higher risk of falls. Conclusion 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.