Outdoor Footwear Characteristics Among Older Adults with Concern About Falling: A Secondary Analysis of the FEARFALL_CARE Nurse-Led Cluster-Randomised Trial

Background/Objectives: This exploratory secondary analysis described outdoor footwear among older adults with concern about falling (CaF), examined baseline associations, evaluated a nurse-led intervention, and explored associations with CaF and falls. Methods: Data came from 163 community-dwelling adults aged ≥ 65 years in the FEARFALL_CARE cluster-randomised trial across ten primary care centres. Footwear was observed at baseline and six months using an unvalidated four-criterion composite. Mixed-effects models were complemented by inverse probability weighting (IPW) and cluster-level sensitivity analyses. Results: At baseline, 37/163 randomised participants (22.7%; composite available for 158) wore footwear meeting all criteria. Female sex and dwelling type were associated with baseline classification in an exploratory model. The ground-level house category contained only six participants. At six months, 18/59 intervention participants (30.5%) and 12/69 controls (17.4%) met all criteria. The adjusted intervention estimate was imprecise (aOR = 1.92; 95% CI: 0.78–4.69; p = 0.151), as were the IPW estimate (aOR = 2.18; 95% CI: 0.91–5.24; p = 0.081) and the adjusted cluster-level difference (9.3 percentage points; 95% CI: −9.6–28.2; p = 0.290). Baseline classification was associated with follow-up classification (aOR = 4.24; 95% CI: 1.65–10.92; p = 0.002). No statistically significant association was detected between footwear classification trajectory and six-month Short FES-I scores (p = 0.808) or experiencing at least one fall (p = 0.884). Conclusions: Failure to meet predefined footwear criteria was common. Sensitivity analyses did not establish an intervention effect, and imprecision precludes concluding absence of benefit or of associations with CaF and falls. The prevalence of potentially modifiable characteristics supports considering footwear assessment within multifactorial fall-risk evaluation.