title: Utilitarian walking, neighborhood environment, and risk of outdoor falls among older adults.
abstract: OBJECTIVE
  We examined the roles of utilitarian and recreational walking in relation to occurrence of outdoor falls in older adults.
  
  
  METHODS
  We analyzed data on walking habits, falls, and fall injuries among participants of MOBILIZE Boston, a prospective cohort study of 765 community-dwelling women and men, mainly aged 70 years or older, in Boston, Massachusetts. Neighborhood socioeconomic status (SES) indicators were assessed at census block group level. Falls were recorded during a total of 2066.5 person-years of follow-up (September 2005-December 2009), and the median length of follow-up was 2.9 years (range = 0.04-4.3).
  
  
  RESULTS
  . Lower neighborhood SES indicators were associated with more utilitarian walking and higher rates of falls on sidewalks, streets, and curbs. Falls on sidewalks and streets were more likely to result in an injury than were falls in recreational areas. Utilitarian-only walkers tended to live in neighborhoods with the lowest neighborhood SES and had the highest rate of outdoor falls despite walking 14 and 25 fewer blocks per week than the recreational-only and dual walkers, respectively.
  
  
  CONCLUSIONS
  . Improving the safety of walking environments in areas where older adults shop and do other errands of necessity is an important component of fall prevention.
authors.affiliation: Wenjun Li and Elizabeth Procter-Gray are with the Health Statistics and Geography Lab, Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, Worcester. Lewis A. Lipsitz and Marian T. Hannan are with the Institute for Aging Research, Hebrew SeniorLife/Harvard Medical School, and Beth Israel Deaconess Medical Center, Boston, MA. Suzanne G. Leveille is with the College of Nursing and Health Sciences, University of Massachusetts, Boston. Holly Hackman and Madeleine Biondolillo are with the Massachusetts Department of Public Health, Boston.
authors.forename: Wenjun
authors.initials: W
authors.lastname: Li
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Procter-Gray
authors.forename: Lewis A
authors.initials: LA
authors.lastname: Lipsitz
authors.forename: Suzanne G
authors.initials: SG
authors.lastname: Leveille
authors.forename: Holly
authors.initials: H
authors.lastname: Hackman
authors.forename: Madeleine
authors.initials: M
authors.lastname: Biondolillo
authors.forename: Marian T
authors.initials: MT
authors.lastname: Hannan
mesh_terms: D000058:Accidental Falls / Q000706:statistics & numerical data*; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D001900:Boston / Q000453:epidemiology; D004777:Environment; D005260:Female; D015438:Health Behavior; D006801:Humans; D008297:Male; D011446:Prospective Studies; D011998:Recreation; D012111:Residence Characteristics / Q000706:statistics & numerical data*; D012307:Risk Factors; D012923:Social Class; D016138:Walking / Q000706:statistics & numerical data*; D014947:Wounds and Injuries / Q000209:etiology*