title: Neighborhood Disadvantage and Life-Space Mobility Are Associated with Incident Falls in Community-Dwelling Older Adults.
abstract: To determine the relationship between neighborhood-level socioeconomic characteristics, life-space mobility, and incident falls in community-dwelling older adults.
  
  
  
  Prospective, observational cohort study with a baseline in-home assessment and 6-month telephone follow-up.
  
  
  
  Central Alabama.
  
  
  
  Community-dwelling adults aged 65 and older recruited from a random sample of Medicare beneficiaries (N = 1,000).
  
  
  
  Neighborhood disadvantage was measured using a composite index derived from baseline neighborhood-level residential census tract socioeconomic variables. Data on individual-level socioeconomic characteristics, clinical variables, and life-space collected at baseline were included as covariates in a multivariate model using generalized estimating equations to assess the association with incident falls in the 6 months after baseline.
  
  
  
  Of the 940 participants who completed baseline and follow-up assessments, 126 (13%) reported one or more new falls in the 6 months after baseline. There was an independent nonlinear association between neighborhood disadvantage (according to increasing quartiles of disadvantage) and incident falls after adjusting for confounders: The lowest quartile served as reference; 2nd quartile odds ratio (OR) = 2.4, 95% confidence interval (CI) = 1.2-4.6; 3rd quartile OR = 1.9, 95% CI = 1.0-3.7; 4th quartile OR = 3.2, 95% CI = 1.7-6.0. Each 10-point decrement in life-space (OR = 1.2, 95% CI = 1.0-1.3) was associated with a higher risk of falls.
  
  
  
  Greater neighborhood disadvantage was associated with greater risk of falls. Life-space also contributes separately to fall risk. Community-dwelling older adults in disadvantaged neighborhoods, particularly those with limited mobility, may benefit from a more-rigorous assessment of their fall risk by healthcare providers. Neighborhood level socioeconomic characteristics should also be an important consideration when identifying vulnerable populations that may benefit the most from fall prevention programs.
authors.affiliation: Department of Emergency Medicine, University of Alabama at Birmingham, Birmingham, Alabama.|Comprehensive Center for Healthy Aging, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Alexander X
authors.initials: AX
authors.lastname: Lo
authors.affiliation: Department of Epidemiology, Columbia University, New York, New York.
authors.forename: Andrew G
authors.initials: AG
authors.lastname: Rundle
authors.affiliation: Department of Food Science, Nutrition, and Health Promotion, Mississippi State University, Mississippi State, Mississippi.|Mississippi Agricultural and Forestry Experiment Station, Mississippi State, Mississippi.
authors.forename: David
authors.initials: D
authors.lastname: Buys
authors.affiliation: Comprehensive Center for Healthy Aging, University of Alabama at Birmingham, Birmingham, Alabama.|Division of Gerontology, Geriatrics and Palliative Care, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Richard E
authors.initials: RE
authors.lastname: Kennedy
authors.affiliation: Comprehensive Center for Healthy Aging, University of Alabama at Birmingham, Birmingham, Alabama.|Division of Gerontology, Geriatrics and Palliative Care, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Patricia
authors.initials: P
authors.lastname: Sawyer
authors.affiliation: Geriatrics and Extended Care Services, Office of Patient Care Services, Veterans Health Administration, Washington, District of Columbia.
authors.forename: Richard M
authors.initials: RM
authors.lastname: Allman
authors.affiliation: Comprehensive Center for Healthy Aging, University of Alabama at Birmingham, Birmingham, Alabama.|Division of Gerontology, Geriatrics and Palliative Care, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama.|Geriatric Research, Education, and Clinical Center, Birmingham/Atlanta Veterans Affairs, Birmingham, Alabama.
authors.forename: Cynthia J
authors.initials: CJ
authors.lastname: Brown
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control / Q000706:statistics & numerical data; D000368:Aged; D000407:Alabama; D001107:Architectural Accessibility / Q000379:methods / Q000592:standards; D005260:Female; D015577:Geriatric Assessment / Q000379:methods; D006801:Humans; D057187:Independent Living / Q000706:statistics & numerical data*; D007407:Interviews as Topic / Q000379:methods; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data; D051346:Mobility Limitation; D011314:Preventive Health Services / Q000379:methods / Q000458:organization & administration; D011446:Prospective Studies; D012111:Residence Characteristics; D018570:Risk Assessment; D012307:Risk Factors; D012959:Socioeconomic Factors; D014481:United States
keywords: falls; life-space; neighborhood disadvantage; socioeconomic status