Abstract
We investigated the association between perceived neighbourhood characteristics and falls in community-dwelling adults, using data from Wave 5 and 6 of the Survey of Health, Ageing and Retirement in Europe (SHARE). We included 25,467 participants aged 50 to 103 years (mean age 66.2 ± 9.6, 58.5% women), from fourteen European countries (Austria, Belgium, Czech Republic, Denmark, Estonia, France, Germany, Israel, Italy, Luxembourg, Slovenia, Spain, Sweden, Switzerland). At baseline, we recorded individual-level factors (socio-demographic, socio-economic and clinical factors), contextual-level factors (country, urban versus rural area, European region) and perceived neighbourhood characteristics (vandalism or crime, cleanliness, feeling part of neighbourhood, helpful neighbours, accessibility to services) for each participant. We recorded falls in the six months prior to the baseline and 2-year follow-up interviews. The associations between neighbourhood characteristics and falls were analysed by binary logistic regression models; odds ratios (95% confidence intervals) were calculated. Participants reporting-versus not reporting-vandalism or crime had an increased falls risk of 1.16 (1.02–1.31) at follow-up, after full adjustment; lack of cleanliness, feeling part of the neighbourhood, perceiving neighbours as helpful and difficult accessibility to services were not associated with falls. Vandalism or crime was consistently associated with increased falls risks in women, adults without functional impairment and urban areas residents. In conclusion, adverse neighbourhood environments may account for inequality in falls risk among middle-aged and older adults and could be added to fall risk stratification tools.
Similar content being viewed by others
Data availability
Data are available upon request from the SHARE website (see http://www.share-project.org/data-access/user-registration.html).
Code availability
Not applicable.
References
Auchincloss AH, Mujahid MS, Shen M, Michos ED, Whitt-Glover MC, Diez Roux AV (2013) Neighborhood health-promoting resources and obesity risk (the multi-ethnic study of atherosclerosis). Obesity (silver Spring) 21(3):621–628. https://doi.org/10.1002/oby.20255
Avendano M, Glymour MM, Banks J, Mackenbach JP (2009) Health disadvantage in US adults aged 50 to 74 years: a comparison of the health of rich and poor Americans with that of Europeans. Am J Public Health 99(3):540–548. https://doi.org/10.2105/AJPH.2008.139469
Balfour JL, Kaplan GA (2002) Neighborhood environment and loss of physical function in older adults: evidence from the Alameda County Study. Am J Epidemiol 155(6):507–515. https://doi.org/10.1093/aje/155.6.507
Börsch-Supan A, Brandt M, Hunkler C et al (2013) Data resource profile: the survey of health, ageing and retirement in Europe (SHARE). Int J Epidemiol 42(4):992–1001. https://doi.org/10.1093/ije/dyt088
Börsch-Supan A (2020a) Survey of health, ageing and retirement in Europe (SHARE) Wave 5. Release version: 7.1.0. SHARE-ERIC. Data Set. https://doi.org/10.6103/SHARE.w5.710
Börsch-Supan A (2020b) Survey of health, ageing and retirement in Europe (SHARE) Wave 6. Release version: 7.1.0. SHARE-ERIC. Data set. https://doi.org/10.6103/SHARE.w6.710
Bu F, Abell J, Zaninotto P, Fancourt D (2020) A longitudinal analysis of loneliness, social isolation and falls amongst older people in England. Sci Rep 10(1):20064. https://doi.org/10.1038/s41598-020-77104-z
Chippendale T, Boltz M (2015) The neighborhood environment: perceived fall risk, resources, and strategies for fall prevention. Gerontologist 55(4):575–583. https://doi.org/10.1093/geront/gnu019
Christine PJ, Auchincloss AH, Bertoni AG et al (2015) Longitudinal associations between neighborhood physical and social environments and incident type 2 diabetes mellitus: the multi-ethnic study of atherosclerosis (MESA). JAMA Intern Med 175(8):1311–1320. https://doi.org/10.1001/jamainternmed.2015.2691
Deandrea S, Lucenteforte E, Bravi F, Foschi R, La Vecchia C, Negri E (2010) Risk factors for falls in community-dwelling older people: a systematic review and meta-analysis. Epidemiology 21(5):658–668. https://doi.org/10.1097/EDE.0b013e3181e89905
Diez Roux AV (2002) Invited commentary: places, people, and health. Am J Epidemiol 155(6):516–519. https://doi.org/10.1093/aje/155.6.516
Diez Roux AV, Mair C (2010) Neighborhoods and health. Ann N Y Acad Sci 1186:125–145. https://doi.org/10.1111/j.1749-6632.2009.05333.x
Do Nascimento CF, Duarte YA, Lebrão ML, Chiavegatto Filho AD (2017) Individual and contextual characteristics of indoor and outdoor falls in older residents of São Paulo Brazil. Arch Gerontol Geriatr. 68:119–125. https://doi.org/10.1016/j.archger.2016.10.004
Duchowny KA, Glymour MM, Cawthon PM (2020) Is perceived neighbourhood physical disorder associated with muscle strength in middle aged and older men and women? Findings from the US health and retirement study. J Epidemiol Community Health 74(3):240–247. https://doi.org/10.1136/jech-2019-213192
Evenson KR, Block R, Diez Roux AV, McGinn AP, Wen F, Rodríguez DA (2012) Associations of adult physical activity with perceived safety and police-recorded crime: the Multi-ethnic Study of Atherosclerosis. Int J Behav Nutr Phys Act. 9:146. https://doi.org/10.1186/1479-5868-9-146
Hoffman GJ, Ha J, Alexander NB, Langa KM, Tinetti M, Min LC (2018) Underreporting of fall injuries of older adults: implications for wellness visit fall risk screening. J Am Geriatr Soc 66(6):1195–1200. https://doi.org/10.1111/jgs.15360
Kaiser P, Diez Roux AV, Mujahid M et al (2016) Neighborhood environments and incident hypertension in the multi-ethnic study of atherosclerosis. Am J Epidemiol 183(11):988–997. https://doi.org/10.1093/aje/kwv296
Katz S, Ford AB, Moskowitz RW, Jackson BA, Jaffe MW (1963) Studies of illness in the aged. The index of ADL: a standardized measure of biological and psychological function. JAMA 185:914–919. https://doi.org/10.1001/jama.1963.03060120024016
Kelsey JL, Procter-Gray E, Hannan MT, Li W (2012) Heterogeneity of falls among older adults: implications for public health prevention. Am J Public Health 102(11):2149–2156. https://doi.org/10.2105/AJPH.2012.300677
Lawton MP, Brody EM (1969) Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist 9(3):179–186
Lee S, Lee C, Ory MG (2019) Association between recent falls and changes in outdoor environments near community-dwelling older adults’ homes over time: findings from the NHATS study. Int J Environ Res Public Health. 16(18):3230. https://doi.org/10.3390/ijerph16183230
Li W, Keegan TH, Sternfeld B, Sidney S, Quesenberry CP Jr, Kelsey JL (2006) Outdoor falls among middle-aged and older adults: a neglected public health problem. Am J Public Health 96(7):1192–1200. https://doi.org/10.2105/AJPH.2005.083055
Li W, Procter-Gray E, Lipsitz LA et al (2014) Utilitarian walking, neighborhood environment, and risk of outdoor falls among older adults. Am J Public Health 104(9):e30–e37. https://doi.org/10.2105/AJPH.2014.302104
Lo AX, Rundle AG, Buys D et al (2016) Neighborhood disadvantage and life-space mobility are associated with incident falls in community-dwelling older adults. J Am Geriatr Soc 64(11):2218–2225. https://doi.org/10.1111/jgs.14353
Lorenc T, Petticrew M, Whitehead M et al (2013) Fear of crime and the environment: systematic review of UK qualitative evidence. BMC Public Health 13:496. https://doi.org/10.1186/1471-2458-13-496
Lovasi GS, Goh CE, Pearson AL, Breetzke G (2014) The independent associations of recorded crime and perceived safety with physical health in a nationally representative cross-sectional survey of men and women in New Zealand. BMJ Open 4(3):e004058. https://doi.org/10.1136/bmjopen-2013-004058
McClure R, Turner C, Peel N, Spinks A, Eakin E, Hughes K (2005) Population-based interventions for the prevention of fall-related injuries in older people. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD004441.pub2
Mohd Hairi F, Mackenbach JP, Andersen-Ranberg K, Avendano M (2010) Does socio-economic status predict grip strength in older Europeans? Results from the SHARE study in non-institutionalised men and women aged 50+. J Epidemiol Community Health 64(9):829–837. https://doi.org/10.1136/jech.2009.088476
Nevitt MC, Cummings SR, Kidd S, Black D (1989) Risk factors for recurrent nonsyncopal falls. A prospective study. JAMA 261(18):2663–2668
Nicklett EJ, Lohman MC, Smith ML (2017) Neighborhood environment and falls among community-dwelling older adults. Int J Environ Res Public Health 14(2):175. https://doi.org/10.3390/ijerph14020175
Organisation for Economic Co-operation and Development. Classifying educational programmes: manual for ISCED-97 implementation in OECD countries. Paris: OECD, (1999)
Pickett KE, Pearl M (2001) Multilevel analyses of neighbourhood socioeconomic context and health outcomes: a critical review. J Epidemiol Community Health 55(2):111–122. https://doi.org/10.1136/jech.55.2.111
Piro FN, Noss O, Claussen B (2006) Physical activity among elderly people in a city population: the influence of neighbourhood level violence and self perceived safety. J Epidemiol Community Health 60(7):626–632. https://doi.org/10.1136/jech.2005.042697
Rubenstein LZ (2006) Falls in older people: epidemiology, risk factors and strategies for prevention. Age Ageing. 35(2 Suppl):37ii-ii41. https://doi.org/10.1093/ageing/afl084
Shenassa ED, Liebhaber A, Ezeamama A (2006) Perceived safety of area of residence and exercise: a pan-European study. Am J Epidemiol 163(11):1012–1017. https://doi.org/10.1093/aje/kwj142
Stafford M, Chandola T, Marmot M (2007) Association between fear of crime and mental health and physical functioning. Am J Public Health 97(11):2076–2081. https://doi.org/10.2105/AJPH.2006.097154
Stafford M, Cummins S, Macintyre S, Ellaway A, Marmot M (2005) Gender differences in the associations between health and neighbourhood environment. Soc Sci Med 60(8):1681–1692. https://doi.org/10.1016/j.socscimed.2004.08.028
Stevens JA, Corso PS, Finkelstein EA, Miller TR (2006) The costs of fatal and non-fatal falls among older adults. Inj Prev 12(5):290–295. https://doi.org/10.1136/ip.2005.011015
Tinetti ME, Speechley M, Ginter SF (1988) Risk factors for falls among elderly persons living in the community. N Engl J Med 319(26):1701–1707. https://doi.org/10.1056/NEJM198812293192604
Tinetti ME, Williams CS (1997) Falls, injuries due to falls, and the risk of admission to a nursing home. N Engl J Med 337(18):1279–1284. https://doi.org/10.1056/NEJM199710303371806
Vaz C, Andrade AC, Silva U et al (2020) Physical disorders and poor self-rated health in adults living in four latin american cities: a multilevel approach. Int J Environ Res Public Health. 17(23):8956. https://doi.org/10.3390/ijerph17238956
World Health Organization (2016) Global report on urban health: Equitable healthier cities for sustainable development, vol 1. WHO, Geneva
Acknowledgements
This paper uses data from SHARE Waves 5 and 6 for methodological details (Börsch-Supan A, Brandt M, Hunkler C, Kneip T, Korbmacher J, Malter F, Schaan B, Stuck S, Zuber S; SHARE Central Coordination Team. Data Resource Profile: the Survey of Health, Ageing and Retirement in Europe (SHARE). Int J Epidemiol. 2013 Aug;42(4):992-1001.. Epub 2013 Jun 18. PMID: 23778574; PMCID: PMC3780997). The SHARE data collection has been funded by the European Commission through FP5 (QLK6-CT-2001-00360), FP6 (SHARE-I3: RII-CT-2006-062193, COMPARE: CIT5-CT-2005-028857, SHARELIFE: CIT4-CT-2006-028812), FP7 (SHARE-PREP: GA N°211909, SHARE-LEAP: GA N°227822, SHARE M4: GA N°261982, DASISH: GA N°283646) and Horizon 2020 (SHARE-DEV3: GA N°676536, SHARE-COHESION: GA N°870628, SERISS: GA N°654221, SSHOC: GA N°823782) and by DG Employment, Social Affairs & Inclusion. Additional funding from the German Ministry of Education and Research, the Max Planck Society for the Advancement of Science, the U.S. National Institute on Aging (U01_AG09740-13S2, P01_AG005842, P01_AG08291, P30_AG12815, R21_AG025169, Y1-AG-4553-01, IAG_BSR06-11, OGHA_04-064, HHSN271201300071C) and from various national funding sources is gratefully acknowledged (see www.share-project.org).
Funding
Dr Giulia Ogliari was supported by Nottingham Hospitals Charity, Nottingham, UK (grant APP2380/N7359 (N7359 Osteoporosis & Falls Research for “Improving Quality of Life In Older Patients”).
Author information
Authors and Affiliations
Contributions
GO contributed to conceptualization, methodology, formal analysis, writing—original draft. JR contributed to conceptualization, supervision, writing—review & editing. KA-R contributed to conceptualization, supervision, writing—review & editing. LLS-H contributed to conceptualization, methodology, writing—review & editing. TM contributed to conceptualization, supervision, writing—review & editing.
Corresponding author
Ethics declarations
Conflict of interest
On behalf of all authors, the corresponding author states that there is no conflict of interest.
Ethics approval
SHARE obtained ethical approval by the University of Mannheim and the Ethics Council of the Max Planck Society.
Consent to participate
This article uses anonymised data.
Consent for publication
Not applicable. Personal data were not identifiable during the analysis.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Responsible Editor: Morten Wahrendorf
Supplementary Information
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Ogliari, G., Ryg, J., Andersen-Ranberg, K. et al. Perceived neighbourhood environment and falls among community-dwelling adults: cross-sectional and prospective findings from the Survey of Health, Ageing and Retirement in Europe (SHARE). Eur J Ageing 19, 1121–1134 (2022). https://doi.org/10.1007/s10433-022-00685-3
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10433-022-00685-3