Perceived Neighborhood Fall Risks and Strategies Used to Prevent Outdoor Falls: Does Age Matter?

To the Editor: Although outdoor falls are just as common as indoor falls, the focus of falls prevention has been on intrinsic factors and the home environment. Risk factors for outdoor falls differ from those for indoor falls and include being younger, male, and white; participating in more leisure-time physical activity; and having a fast gait speed.1, 2 Outdoor falls are more likely to be precipitated by environmental causes than indoor falls and often occur on sidewalks, streets, and curbs. Common causes include uneven or wet surfaces and slipping or tripping over an object.2 Although many older adults recognize falls as a preventable health concern, they do not often see the personal relevance.3, 4 The current study explored perceived fall risks and strategies used for outdoor fall prevention in older adults aged 75 and older and those younger than 75. Fourteen individuals aged 65 and older were recruited from three senior centers. Data collection included a background questionnaire and in-depth semistructured interviews. Collaizzi's5 phenomenological method was used for qualitative analysis. Two coders were employed to increase reliability of the findings. Descriptive quantitative analysis was conducted using SPSS version 21 (SPSS, Inc., Chicago, IL). A mixed-methods matrix was used to analyze quantitative and qualitative results concurrently (Table 1).6 Data for this study were drawn from a broader qualitative study on the neighborhood environment.7 Weather and related conditions Street and sidewalk conditions Built environment Bicycles Social environment Use caution Change route Use built environment Modify gait Footwear Avoid going out Limit amount carried Use of social environment Daily, 75% 2 or 3 times/wk, 25% Weather and related conditions Street/sidewalk conditions Built environment Bicycles Use caution Change route Use built environment Modify gait Footwear Avoid going out Use of social environment Themes related to perceived fall risks common to both age groups were weather and related conditions (e.g., wind, snow-covered streets), street and sidewalk conditions (e.g., bumps and cracks), built environment (e.g., open grates, cobblestones), and bicycles. One divergent theme emerged from the group younger than 75, namely, the social environment. One participant stated, “There is also a tempo in NYC where they don't want to be slowed down by the snow, and so everyone is trying to go at the same pace, and you can't go at the same pace.” Another participant described how pedestrians were inattentive, “talking on the phone” and “not looking.” Common themes for both groups regarding fall prevention include using caution (e.g., wait for light, avoid cellular telephone use), changing their route (e.g., to avoid potholes), using the built environment (e.g., use of rails on stairs or fences for support), modifying gait (e.g., slowing down, lifting feet), use of appropriate footwear, and avoiding going out (e.g., if not feeling well), but when significant statements were counted, use of caution and an alternate route were much more common in the group aged 75 and older. A divergent theme with regard to strategy use was limiting the amount carried by the group younger than 75. One woman described her shopping routine: “It seems I just limit myself and make more trips.” Although use of the social environment was common to both groups, there were differences in the way the social environment was employed as a prevention strategy. Participants in the group aged 75 and older were more likely to use brief communication strategies with drivers (e.g., waving them across and making eye contact). The younger group used a variety of strategies that actively engaged other pedestrians, including asking to hold the arm of a stranger to cross during snowy weather or expressing pain to procure a seat at the bus stop. On average, participants in the group aged 75 and older identified fewer perceived fall risks but implemented more prevention strategies. Mobility disability and reduced physical activity in the older (but not younger) age group are consistent with previous studies.8-10 Themes regarding perceived neighborhood fall risks are consistent with previous studies that examined common causes of outdoor falls, but additional perceived fall risks identified include the built environment, the social environment, and bicycle use by others in the neighborhood. Several participants younger than 75 reported that they were employed. This may be why the social environment is more problematic (e.g., traveling during rush hour). It may also explain why time spent outdoors was, on average, shorter for this age group. The younger participants' willingness to ask for help when walking outdoors suggests a form of self-advocacy that warrants further investigation. Results suggest subtle differences in perceived fall risks and number and type of strategies used for prevention in older and younger individuals. Implications include targeted fall prevention programs and promoting awareness regarding outdoor fall risks. Limitations of this study include the use of self-report and retrospective data collection and a small sample size for quantitative analysis. A larger study with expanded measures is warranted. Conflict of Interest: The authors have no financial or personal conflicts of interest to disclose. Author Contributions: The corresponding author has listed everyone who contributed significantly to the work. Tracy Chippendale was responsible for designing and conducting the study. Tracy Chippendale and Marie Boltz analyzed the data and contributed to writing the manuscript. Sponsor's Role: Not applicable.