Abstract
BACKGROUND: Older adults who experience falls are at a high risk of injury and death and require long-term care. Notably, the risk of falls varies among different neighborhood environments. No prior longitudinal studies have examined the association between falls and neighborhood environment at the community level. Identifying such associations will help prevent people falling by improving their neighborhood environment. Herein, we aimed to identify neighborhood environmental factors associated with falls among older adults in Japan. METHODS: We analyzed the data of 27,346 older adults living in 416 communities who participated in the 2010, 2013, and 2016 Japan Gerontological Evaluation Study surveys. The dependent variable was the occurrence of falls in 2016, and the explanatory variables were the mean scores of each of eight community-level neighborhood environment variables, categorized into tertiles (high, middle, and low groups) in 2013. Our model was adjusted for covariates (e.g., sex, age, and socioeconomic status) using the variables from 2010. A multilevel Poisson regression analysis was performed to obtain the relative risk (RR) and 95% confidence interval (CI) between the neighborhood environment and falls. Missing variable values were supplemented by multiple imputations. RESULTS: Older adults living in neighborhood environments with more parks or foot paths suitable for exercise or walking had a lower risk of falling after 3 years compared to those living in neighborhood environments with fewer parks or foot paths (RR: 0.89; CI: 0.80-0.99). For the variable ‘locations difficult for walking, such as hills or steps’, older adults in the middle group had a lower risk of falling than those in the low group (RR: 0.94; CI: 0.88-0.99). CONCLUSIONS: Parks or foot paths are important environmental improvements that may prevent falls. Having hills or steps in the neighborhood could be beneficial when properly integrated into the environment. KEY MESSAGES: • Older adults with access to parks, footpaths, and challenging terrains suitable for exercise and walking, had a lower risk of falling. • These findings could be applied in urban designs to prevent falls among older adults.