Association between a hilly neighborhood environment and falls among rural older adults: a cross-sectional study

Influence of social networks and environmental factors on older adults' regular walking

Introduction

Few studies have confirmed the influence of social networks and environmental factors on the regular walking of older adults in the community. This study aimed to identify factors influencing regular walking, focusing on social networks and the walkability of the neighborhood environment.

Methods

This study is a secondary analysis of a cross-sectional survey conducted with 840 community-dwelling older adults. Multiple logistic regressions were performed to determine the factors influencing regular walking.

Results

Older women are 1.58 times more likely to walk regularly than men. For older men, the likelihood of regular walking increased 1.56 times as their frequency of contact with friends and neighbors increased. For older women, the probability of regular walking increased by 1.39 times when street connectivity improved. Habitual walking probabilities were lowered by 1.45 times for older women when the terrain was hilly.

Discussion

Health care providers should consider their social networks and environmental factors while developing strategies to promote regular walking in older adults.

Outdoor Environmental Risk Factors for Falls and Fear of Falling: A Systematic Review

BACKGROUND AND OBJECTIVES

The objective of this systematic review was to determine the outdoor environmental factors that are associated with increased risk of falls and fear of falling in middle-aged and older adults.

RESEARCH DESIGN AND METHODS

PubMed, Medline, EMBASE, APA Psych INFO, and CINAHL electronic databases were searched through August 2024 for studies that included participants 45 years or older, falls or fear of falling as an outcome, and measured the outdoor environment (i.e., uneven sidewalks, neighborhood disorder). Title and abstract screenings, full-text screenings, and critical appraisal assessments were independently reviewed.

RESULTS

The search retrieved 7,474 records, 627 full texts were reviewed, and 51 unique studies met the inclusion/exclusion criteria. The number of participants ranged from 12 to 6,720,937. There were 41 studies that included fall outcomes, 5 studies that included fear of falling outcomes, and 5 studies that included both outcomes. Micro-walkability (e.g., sidewalk quality) was the most frequently studied outdoor environmental characteristics and many studies found associations with falls and fear of falling. Macro-walkability (e.g., land use), crime and safety, socioeconomic, greenspace, terrain, physical disorder, and social features were studied to a lesser extent and had mixed findings.

DISCUSSION AND IMPLICATIONS

The most consistent associations were found between micro-walkability features of the outdoor environment with falls whereas other environmental domains and fear of falling were studied to a lesser extent. Environmental contributors to falls should be considered in future research, policy implementation, and clinical interventions to reduce falls and their negative outcomes for older adults.

Association Between Depressive Symptoms in Spousal Caregivers and Falls in Care Recipients With Disability: A Nationwide Population-Based Cohort Study

OBJECTIVE

To investigate the association between depressive symptoms in spousal caregivers and both fall risk and the frequency of falls requiring medical treatment in care recipients with disabilities.

DESIGN

A retrospective cohort study.

SETTING

Data from the China Health and Retirement Longitudinal Study.

PARTICIPANTS

1357 patient-caregiver dyads.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

The incidence of falls and the frequency of falls requiring medical treatment among care recipients.

RESULTS

The mean (standard deviation) age of care recipients was 61.6 (9.1) years, and 62.1% of them were women. After adjusting for covariates, it was found that caregiver depressive symptoms were associated with a 32% higher risk of falls (relative risk [RR], 1.32; 95% confidence interval [CI], 1.08-1.61). Moreover, caregivers who exhibited depressive symptoms only at follow-up had a RR of falls requiring medical treatment of 2.74 (95% CI, 1.28-5.88), whereas those who had depressive symptoms at both the baseline and follow-up had a RR of 2.13 (95% CI, 1.19-3.80). The likelihood ratio test showed that grouping depressive symptoms significantly improved the model fit for both fall risk (likelihood ratio [LR] χ²(3)=8.89, P=.031) and falls requiring medical treatment (LR χ²(3)=14.50, P=.002).

CONCLUSION

Caregiver depressive symptoms are significantly associated with an increased risk of falls and a higher frequency of falls requiring medical treatment among care recipients with disabilities. Addressing the mental health of caregivers may help reduce fall-related risks in this population.

Regional differences in the Association of Healthy Aging with the incidence of falls: an analysis based on the China Health and Retirement Longitudinal Study from 2011 to 2020

Background

Falls frequently occur among the older adult population. In this study, we examined the variations in fall incidence across different regions over time, focusing on the disparities between urban and rural areas among older adult Chinese individuals, Healthy aging is comprised of five dimensions: (1) absence of chronic diseases, (2) good physical functioning, (3) normal cognitive function, (4) active social participation, and (5) absence of depression. Additionally, we explored the relationship between healthy aging and the occurrence of falls in middle-aged and older adults. Falls are defined as events that occurred within the past two years.

Results

Among 9,918 participants, 33.8% lived in urban areas and 23.0% achieved healthy aging. In contrast, 66.2% resided in rural areas with 16.5% achieving healthy aging. In 2011, rural residents had a higher fall incidence rate (17% in rural vs. 13.5% in urban); by 2020, the fall rate remained higher in rural areas (19.5% in rural vs. 17.3% in urban). Unhealthy aging (HR = 1.08, 95%CI: 1.00-1.16) were risk factors for falls. Subgroup analysis revealed that in rural areas, unhealthy aging increased the risk of falls. In urban areas, the increased risk of falls associated with unhealthy aging was not significant (Rural HR = 1.11, 95%CI:1.01-1.22; Urban HR = 1.05, 95%CI: 0.93-1.18).

Conclusion

Healthy aging may be more strongly associated with a lower risk of falls in rural areas, while this association might be less pronounced in urban areas due to different environmental and social factors. This highlights the need for environment-specific fall prevention strategies and targeted measures for the older adult.

Association between changes in depressive symptoms and falls: The China health and retirement longitudinal study (CHARLS)

PURPOSE

This study aimed to investigate the impact of depressive symptoms and changes in depressive status on falls among middle-aged and older population in China.

METHODS

We used two waves of interview data (time 1 [T1] and time 2 [T2], 2 years from T1) from a nationally representative sample of the China Health and Retirement Longitudinal Study (CHARLS), which included a total of 14,356 participants (male 6859; mean age: 59.5 ± 9.3 years). Depressive symptoms were assessed using the 10-item short form of the Center for Epidemiologic Studies Depression Scale (CES-D-10). Participants were categorized into four groups based on changes in their CES-D-10 scores over a 2-year follow-up period. Self-reported falls were evaluated, and logistic regression models and restricted cubic splines (RCS) were employed to examine the relationship between depressive symptoms and fallen.

RESULTS

Participants who had experienced falls had higher CES-D-10 scores and were more likely to have depressive symptoms. Depressive symptoms at T1 were significantly associated with falls during the follow-up period. After adjusting for covariables, increasing CES-D-10 scores were associated with higher adjusted odds ratios (ORs) for falling prevalence: 1.230 (95 % CI, 1.041-1.453), 1.579 (95 % CI, 1.331-1.873), 1.745 (95 % CI, 1.472-2.070), and 2.366 (95 % CI, 1.972-2.838). Participants who experienced depressive symptoms at either T1 or T2, as well as those with persistent depressive symptoms from T1 to T2, were both at higher risk for future falls. The worsening of depressive symptoms significantly increased the likelihood of falls.

CONCLUSION

This study revealed a significant association between depressive symptoms and changes in depressive status with subsequent falls in older adults. The heightened fall risk among individuals with depressive symptoms underscores the importance of addressing mental health as an integral part of comprehensive fall prevention strategies.

The risk of falls among the aging population: A systematic review and meta-analysis

Aim

This study aims to clarify the risk factors for falls to prevent severe consequences in older adults.

Methods

We searched the PubMed, Web of Science, Embase, and Google Scholar databases using the terms "risk factors" OR "predicting factors" OR "predictor" AND "fall" OR "drop" to identify all relevant studies and compare their results. The study participants were divided into two groups, the "fall group" and the "control group", and differences in demographic characteristics, lifestyles, and comorbidities were compared.

Results

We included 34 articles in the analysis and analyzed 22 factors. Older age, lower education level, polypharmacy, malnutrition, living alone, living in an urban area, smoking, and alcohol consumption increased the risk of falls in the aging population. Additionally, comorbidities such as cardiac disease, hypertension, diabetes, stroke, frailty, previous history of falls, depression, Parkinson's disease, and pain increased the risk of falls.

Conclusion

Demographic characteristics, comorbidities, and lifestyle factors can influence the risk of falls and should be taken into consideration.