Abstract
Falls are serious health problems among older adults, and are the leading cause of fatal and nonfatal injuries treated by emergency medical services (EMS). Although considerable research has examined the risk factors of falls at the individual level, relatively few studies have addressed the risk factors at the neighborhood level. This study examines the characteristics of neighborhood environments associated with fall injuries reported to EMS providers. A total of 13,163 EMS records from 2011 to 2014 involving adults aged 65 and older in the city of San Antonio (TX, USA) were analyzed at the census tract level (n = 264). Negative binomial regression was used to identify significant census tract-based neighborhood environmental variables associated with the count of fall injuries in each census tract. Adjusting for exposure variable and the size of the census tract, neighborhoods with higher residential stability, captured as the percent of those who lived in the same house as the previous year were associated with decreased count of fall injuries. Neighborhoods with higher residential density and having a higher vacancy rate were associated with increased count of fall injuries. The study highlights the importance of stable and safe neighborhoods in reducing fall risks among older adults, which should be considered a prerequisite for promoting age-friendly environments.
Highlights
Falls are a common and serious health concern as people age
In 2014, 2.7 million older adults were treated in emergency rooms for nonfatal falls [3], which typically lead to a decrease in physical activity, quality of life, and social interaction; in the same year, 27,180 adults aged 65 and older in the United States died from serious falls
The findings indicate that low income areas have more fall injuries than high income areas, because housing in low income areas tends to have poor maintenance, lack of opportunities to participate in fall-prevention programs, and lack of home-safety devices for seniors
Summary
A fourth of people aged 65 years or older in the United States experience falls, and 20% to 30% of these falls result in nonfatal or fatal injuries [1,2]. Several risk factors are related to falls through a complex interaction of intrinsic and extrinsic pathways [5]. Extrinsic factors related to falls include medications, assistive devices, and hazardous environments (e.g., an uneven surface and poor lighting) [7]. These risk factors have been determined in previous studies using survey-based
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