摘要：Objectives. We examined risk factors for falls among older people according to indoor and outdoor activity at the time of the fall and explored risk factors for seriously injurious falls. Methods. Data came from MOBILIZE Boston, a prospective cohort study of 765 community-dwelling women and men, mainly aged 70 years or older. Over 4.3 years, 1737 falls were recorded, along with indoor or outdoor activity at the time of the fall. Results. Participants with poor baseline health characteristics had elevated rates of indoor falls while transitioning, walking, or not moving. Healthy, active people had elevated rates of outdoor falls during walking and vigorous activity. For instance, participants with fast, rather than normal, gait speed, had a rate ratio of 7.36 (95% confidence interval [CI] = 2.54, 21.28) for outdoor falls during vigorous activity. The likelihood of a seriously injurious fall also varied by personal characteristics, activity, and location. For example, the odds ratio for serious injury from an outdoor fall while walking outside compared to inside a participant’s neighborhood was 3.31 (95% CI = 1.33, 8.23). Conclusions. Fall prevention programs should be tailored to personal characteristics, activities, and locations. Falls in older people are a major public health problem. In the United States, about one third of community-dwelling people aged 65 years or older fall each year, with about 10% of falls resulting in serious injury. 1–3 These falls and injuries can lead to disability, loss of independence, and fear of falling. 1 Several fall prevention strategies have been developed, most of which emphasize strength, balance, and gait training; use of assistive devices; treatment of medical conditions; reduction in the use of certain medications; improvement in vision; and elimination of home hazards. 1–6 However, about 50% of falls in community-dwelling older people occur outdoors, mainly in healthy, active people. 7–13 Knowing which people are likely to fall under what circumstances should help prevention efforts by enabling different recommendations to be emphasized to different people, a strategy recommended in the 1990s by Northridge et al. 14,15 and Speechley and Tinetti, 16 but seldom implemented as policy. Previous studies have reported on people’s activities at the time they fall, with walking by far most frequent. 9,17–19 However, only limited data are available on whether certain personal characteristics affect the likelihood of falls during specific activities, and on which combinations of fall-related activities, personal characteristics, and location are most likely to result in serious injury among those who fall. 14,17 Our objectives were (1) to examine whether particular personal characteristics (e.g., demographic, lifestyle, and health attributes; functional and cognitive status; fall history) are associated with falls during certain indoor and outdoor activities and (2) to explore, with smaller numbers of events, risk factors for serious injury from falls according to personal characteristics, activity, and location. Such information can contribute to the development of more effective public health prevention strategies tailored to specific groups of people and activities.
