Neighborhood Risk Factors for Falls in the Elderly

描述(由申请人提供)： 跌倒是老年人最常见和最严重的健康问题之一。目前预防跌倒的方法侧重于个人适应现有条件，或改变家庭环境以降低跌倒的可能性。虽然许多研究报道了老年人跌倒的个人水平的风险因素或家庭环境危害，但很少考虑邻里环境因素。这项拟议的辅助研究的目的是确定社区老年人中社区环境属性对跌倒发生率的影响，这是NIH资助的项目(AG04390-21A1)的一部分，正在进行研究。我们建议在队列成员居住的人口普查区组中收集邻里环境数据。随着时间的推移变化不大的环境数据，例如老年人在日常活动中参观的人行道、公园或其他户外场所的可用性和可达性特征，将在研究开始时收集，并在计划项目期间进行监测。在跟进期间，将每三个月收集一次更有可能随时间变化的环境数据，如人行道和街道的状况和维护。社区数据将与方案项目收集的个人级别的数据相结合，使用参与者的人口普查区组的联邦信息处理标准代码(FIPS55)。这项研究的主要目标是确定在对总体体力活动水平进行调整后，较低的户外跌跌率是否与潜在的可改变的环境危害有关(如可获得性、人行道、可步行街道和户外公园和娱乐区域的良好功能和状况，以及户外停车场和车库的良好维护)，并评估参与者的健康状况是否改变了这种联系。这项拟议的研究将有助于我们更好地了解城市社区的建成环境是否满足老年居民的需求。它将提供与潜在的基于社区的环境干预措施的设计直接相关的信息，这些干预措施可以改变或改善老龄化社会的生活环境，并可能提出降低与跌倒相关的医疗成本的方法。在一个广泛向老年人推荐适度体力活动以保持他们的身体机能和独立性并减少慢性病和残疾风险的时代，这种方法至关重要。与公众健康相关这项拟议的研究将探讨户外社区环境特征(例如，可获得性有限、人行道功能和状况不佳；缺乏可步行的街道；户外公园和游乐区维护不善)对社区居住的老年人户外跌倒风险的影响。这项研究的结果应该提出以社区为基础的具体环境干预策略，以改善我们老龄化社会的生活环境。在一个广泛向老年人推荐适度体力活动以保持他们的身体机能和独立性并减少慢性病和残疾风险的时代，这种方法至关重要。

DESCRIPTION (provided by applicant): Falls are among the most common and serious health problems of the elderly. The current approaches to fall prevention focus on individual adaptation to existing conditions, or making changes in the home environment to decrease the likelihood of falling. While numerous studies have reported individual-level risk factors or home environmental hazards for falls of the elderly, neighborhood environmental factors have rarely been considered. The purpose of this proposed ancillary study is to determine the effect of neighborhood environmental attributes on rate of falls in a large population- based cohort of community-dwelling older persons being studied as part of an NIH- funded Program Project (AG04390-21A1). We propose to collect neighborhood environmental data in the census block groups where the cohort members reside. Environmental data that vary little over time, such as availability and accessibility features of sidewalks, parks or other outdoor places that elders visit during their daily activities, will be collected at the beginning of the study and monitored over the period of the Program Project. Environmental data that are more likely to vary over time, such as condition and maintenance of sidewalks and streets, will be collected every three months for the duration of follow-up. The neighborhood data will be integrated with the individual-level data collected by the Program Project using the Federal Information Processing Standards Codes (FIPS55) of census block groups of the participant. The primary goal of the study is to determine whether lower rates of outdoor falls, after adjusting for overall physical activity level, are associated with potentially modifiable environmental hazards (such as availability, good features and condition of sidewalks, walkable streets and outdoor parks and recreational areas, and good maintenance of outdoor parking lots and garages), and assess whether such associations are modified by the health status of the participant. This proposed study will help us better understand whether the built environments of urban neighborhoods meet the needs of their elderly residents. It will provide information that is directly relevant to design of potential community-based environmental interventions that modify or improve the living environment for an aging society, and may suggest ways to reduce medical costs related to falls. Such approaches are of paramount importance in an era when moderate physical activity is widely recommended to the elderly to maintain their physical function and independence and to reduce the risk for chronic diseases and disabilities. PUBLIC HEALTH RELEVANCE This proposed study will examine the effects of outdoor neighborhood environmental characteristics (e.g., limited availability and poor features and condition of sidewalks; lack of walkable streets; poor maintenance of outdoor parks and recreation areas) on risk of outdoor falls among community-dwelling older persons. The results of this study should suggest specific community-based environmental intervention strategies that could improve the living environment for our aging society. Such approaches are of paramount importance in an era when moderate physical activity is widely recommended to the elderly to maintain their physical function and independence and to reduce the risk for chronic diseases and disabilities.