Lee Haena, Lim Justin H
Department of Sociology, Sungkyunkwan University, Seoul, South Korea.
Graduate School of Environmental Studies, Seoul National University, Seoul, South Korea.
Innov Aging. 2023 Jun 16;7(6):igad055. doi: 10.1093/geroni/igad055. eCollection 2023.
Physical conditions of living environments can affect the incidence of falls; however, prior work has focused typically on 1 domain at a time-either neighborhood or home, capturing limited environmental boundaries of older adults. We examined how neighborhood together with the home environment affect the incidence of falls over time and whether living arrangement modifies the influence of the environmental risks on falls.
Using the 2012-2020 waves of the Health and Retirement Study (HRS; = 1,893), we fitted logistic regression to estimate the incidence of falls over an 8-year study period. We used the neighborhood and housing data that are collected systematically by trained observers in the HRS to assess environmental hazards. Sidewalk quality, neighborhood disorder, and the presence of green space were measured to capture outdoor environmental hazards. Indoor environmental hazards included the presence of housing decay and poorly maintained stairways. All models were stratified by living arrangement.
Neighborhood and housing environment were independently associated with the odds of falls net of demographic characteristics and preexisting health conditions, and effects were significant for people living alone only. The presence of green space and poorly maintained stairways were associated with greater odds of falling, net of covariates during 8 years of follow-up (odds ratios = 2.10 and 2.65, < .05, respectively). None of the environmental risk factors were significant for those living with others.
Falls in old age may be determined in part by a combination of outdoor and indoor risk factors. More research is needed to understand pathways that lead to greater vulnerability among older adults living alone to environmental hazards.
生活环境的物理条件会影响跌倒的发生率；然而，先前的研究通常一次只关注一个领域——要么是社区环境，要么是家庭环境，所涵盖的老年人的环境范围有限。我们研究了社区环境与家庭环境如何随时间影响跌倒发生率，以及居住安排是否会改变环境风险对跌倒的影响。
利用健康与退休研究（HRS；n = 1893）2012 - 2020年各轮的数据，我们采用逻辑回归来估计8年研究期内的跌倒发生率。我们使用了HRS中由经过培训的观察员系统收集的社区和住房数据来评估环境危害。测量人行道质量、社区混乱程度和绿地的存在情况以捕捉户外环境危害。室内环境危害包括房屋破败和楼梯维护不善的情况。所有模型均按居住安排进行分层。
在排除人口统计学特征和既往健康状况的影响后，社区和住房环境与跌倒几率独立相关，且仅对独居者有显著影响。在8年的随访中，排除协变量后，绿地的存在和楼梯维护不善与跌倒几率增加相关（优势比分别为2.10和2.65，P <.05）。对于与他人同住者，没有任何环境风险因素具有显著性。
老年人跌倒可能部分由室外和室内风险因素共同决定。需要更多研究来了解导致独居老年人更容易受到环境危害的途径。
