title: Individual and contextual characteristics of indoor and outdoor falls in older residents of São Paulo, Brazil.
abstract: OBJECTIVE
  To analyze a representative sample of older individuals of São Paulo, Brazil, according to outdoor fallers, indoor fallers and non-fallers, and to identify biological and socioeconomic (individual and contextual) factors associated with the occurrence and place of falls.
  
  
  METHODS
  A cross-sectional study was conducted using data (n = 1345) from the 2010 wave of the Health, Wellbeing and Aging (SABE) Study, a representative sample of older residents (60 years and older) of São Paulo, Brazil. Multinomial logistic analysis was performed to identify individual factors associated with the occurrence and place of falls, and multilevel multinomial analysis to identify contextual effects (green areas, violence, presence of slums and income inequality).
  
  
  RESULTS
  29% had a fall in the last 12 months, with 59% occurring in indoor spaces. Individuals who had outdoor falls were overall not statistically different from non-fallers; on the other hand, those who had the last fall indoor had worse health status. Moderate homicide rate was a factor associated with increased presence of indoor falls, compared with non-fallers.
  
  
  CONCLUSIONS
  Our results describe the importance of falls, a common problem in active and community-dwelling older adults of São Paulo, Brazil. Transforming outdoor spaces into walk-friendly areas is essential to allow socialization and autonomy with safety. Creating strategies that take into account the most vulnerable populations, as those who live in violent areas and the oldest older adults, will be a growing challenge among developing countries.
authors: School of Public Health, University of São Paulo, Av. Dr. Arnaldo, 715, CEP: 01246-904, São Paulo - SP, Brazil, Brazil. Electronic address: carla_fn@hotmail.com.
authors: Carla Ferreira
authors: CF
authors: do Nascimento
authors: School of Nursing, University of São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 419, CEP: 05403-000, São Paulo - SP, Brazil, Brazil.
authors: Yeda Aparecida Oliveira
authors: YA
authors: Duarte
authors: School of Public Health, University of São Paulo, Av. Dr. Arnaldo, 715, CEP: 01246-904, São Paulo - SP, Brazil, Brazil.
authors: Maria Lúcia
authors: ML
authors: Lebrão
authors: School of Public Health, University of São Paulo, Av. Dr. Arnaldo, 715, CEP: 01246-904, São Paulo - SP, Brazil, Brazil.
authors: Alexandre Dias Porto
authors: AD
authors: Chiavegatto Filho
mesh_terms: D000058:Accidental Falls / Q000706:statistics & numerical data*; D000368:Aged; D000369:Aged, 80 and over; D001938:Brazil / Q000453:epidemiology; D003430:Cross-Sectional Studies; D005260:Female; D006306:Health Surveys; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012111:Residence Characteristics; D012307:Risk Factors; D012959:Socioeconomic Factors
keywords: Indoor falls; Multilevel analysis; Neighborhoods; Outdoor falls