Association of neighborhood physical environment with falls and fear of falling in older adults: A prospective cohort study.

Abstract

Objectives: To explore the prospective association between physical environment characteristics of the neighborhood and risk of falls/fear of falling among community-dwelling older adults. Study design: Prospective cohort analysis using data from the Seniors-ENRICA-2 cohort (metropolitan Madrid, Spain). Methods: At baseline (2015-17), a neighborhood physical characteristics score was developed using the Physical Activity Neighborhood Environment Scale and an additional indicator of distance to green areas. In the second wave of follow-up (2019-20) we collected self-reported incident falls and fear of falling, assessed with the Short Falls Efficacy Scale International. Adjusted odds ratios (OR) and 95 % confidence intervals (CI) for the association between neighborhood environment perception and incidence of falls/fear of falling were calculated using logistic regression. Results: Among 1823 participants, 27.7 % reported a fall during the previous year and 32.1 % were concerned about having a fall. Better neighborhood environment was associated with lower risk of falls (OR: 0.75; 95 %CI: 0.57-0.99) and fear of falling (0.73; 0.55-0.96). Specifically, low traffic intensity (0.68; 0.52-0.90) and sidewalks in good condition (0.75; 0.59-0.95) were associated with lower risk of falling. Moreover, available facilities for biking (0.77; 0.61-0.96), sidewalks in good condition (0.67; 0.52-0.86), night security (0.80; 0.60-0.99) and day security (0.62; 0.44-0.98) were independently associated with lower fear of falling. Conclusions: Better neighborhood physical environments could play a key role in the prevention of falls and fear of falling among older adults. Policies aiming to improve residential environments can have broad implications for achieving healthy aging.