摘要：Objectives. We examined the roles of utilitarian and recreational walking in relation to occurrence of outdoor falls in older adults. Methods. We analyzed data on walking habits, falls, and fall injuries among participants of MOBILIZE Boston, a prospective cohort study of 765 community-dwelling women and men, mainly aged 70 years or older, in Boston, Massachusetts. Neighborhood socioeconomic status (SES) indicators were assessed at census block group level. Falls were recorded during a total of 2066.5 person-years of follow-up (September 2005–December 2009), and the median length of follow-up was 2.9 years (range = 0.04–4.3). Results. Lower neighborhood SES indicators were associated with more utilitarian walking and higher rates of falls on sidewalks, streets, and curbs. Falls on sidewalks and streets were more likely to result in an injury than were falls in recreational areas. Utilitarian-only walkers tended to live in neighborhoods with the lowest neighborhood SES and had the highest rate of outdoor falls despite walking 14 and 25 fewer blocks per week than the recreational-only and dual walkers, respectively. Conclusions. Improving the safety of walking environments in areas where older adults shop and do other errands of necessity is an important component of fall prevention. Falls are the leading cause of unintentional fatal and nonfatal injuries in older adults aged 65 years and older. 1,2 In the United States, one third of older adults fall each year, with approximately 10% of falls resulting in injuries that need medical attention. 1,3–5 Regular walking has been associated with numerous health benefits among older adults, including lower risk of cardiovascular diseases, obesity, diabetes, disabilities, and mortality. 6–10 Utilitarian walking can be operationally defined as walking to shop and do other necessary errands or tasks of daily life. Both recreational and utilitarian walking have been widely recommended to older adults to improve balance, muscle strength, and general health 7,10,11 and thus reduce fall risk. Utilitarian walking is particularly important to older persons with physical limitations who can no longer drive routinely or to those who cannot afford to drive. Unfortunately, walking is also the most common activity leading to falls and fall injuries among older adults, 12 with 36% to 63% of outdoor falls occurring while walking. 12–17 Experiencing an outdoor fall may result in the development of a psychological barrier to physical activity in those prone to falling, thus leading to decreased independence and mobility and increased likelihood of becoming homebound. 18,19 Recent municipal and state initiatives have aimed at improving the safety of walking areas. 20 Although these efforts are laudable, investments appear to be aimed more toward recreational walking, improving areas such as trails, tracks, and parks rather than utilitarian walking environments, possibly more crucial for the socioeconomically disadvantaged. We investigated the associations between the walking habits of older adults, the socioeconomic status (SES) of their neighborhoods, and the occurrence of outdoor falls.
