Falls Risk Among Community-Dwelling Adults Aging in Place

Background and Purpose: Falls can create significant barriers to safe aging in place, as they are the leading cause of injuries and nursing home admissions among older adults. Falls prevention programs reduce the likelihood of incident and recurrent falls in community settings by approximately 30-40%. As funds for community programs targeting older adults are fairly scarce, it is prudent to identify individuals at heightened risk. While substantial research has targeted biomedical risks of falls, far less is known about socio-demographic correlates of falls. For example, more research is needed to identify racial differences in terms of the risk and protective factors for falls.

Methods: Data were used from the Health and Retirement Study from 2000-2010. We examined socioeconomic differences in the probability and frequency of falls over a 10-year period among a nationally-representative sample of 10,484 community-dwelling older adults (aged 65+). We examined whether or not older adults’ sex (male or female), race/ethnicity (non-Hispanic white, African American and Latino) or education level (less than high school, high school or equivalent, some college, college or more) predicted different risk or frequency of falls as one ages. We controlled for biomedical risk factors, including functional limitations and chronic illness comorbidities. We conducted random-intercept logistic regression to examine differences in falls risk and Poisson regression analyses to examine differences in falls frequency as one ages.

Results: Participant risk of falls increased by 3% each year, controlling for functional status and comorbidities. Although women were more likely (18%) to have an initial fall, among those who fell, men fell more frequently (28%). African Americans were significantly less likely (35%) to fall than non-Hispanic whites, particularly as they aged. Among fallers, African Americans also experienced less frequent falls (24%) relative to non-Hispanic whites. Latinos and non-Hispanic whites were equally likely to fall—and fell with similar frequency—as they aged. There were no pronounced difference in falls risk and frequency by educational status. In subsequent analyses, we found that social and environmental circumstances, including household composition, support, type of housing, and social support, appeared to protect against falls for African American older adults residing in community settings.

Conclusions and Implications: Although African Americans are considered “higher risk” according to falls risk profiles than non-Hispanic whites, African Americans were less likely than non-Hispanic whites to fall and fell less often. Falls prevention programs are already mediated by informal social/structural characteristics preventing opportunities and risks of falls. Programs should consider protective roles of supportive relationships and social policies should incentivize informal structures to promote aging in place.