Living Alone, Environmental Hazards, and Falls among US Older Adults

Physical conditions of living environments can impact the incidence of falls; however, prior work has focused typically on one domain at a time—either neighborhood or home, capturing limited environmental boundaries of older adults. We examined how neighborhood together with home environment impact the incidence of falls over time and whether living arrangement modifies the influence of the environmental risks on falls.Using the 2012-2020 waves of the Health and Retirement Study (HRS; N=1,893), we fitted logistic regression to estimate the incidence of falls over an 8-year study period. We used the neighborhood and housing data that are collected systematically by trained observers in the HRS to assess environmental hazards. Sidewalk quality, neighborhood disorder, and presence of green space were measured to capture outdoor environmental hazards. Indoor environmental hazards included presence of housing decay and poorly maintained stairways. All models were stratified by living arrangement.Neighborhood and housing environment were independently associated with the odds of falls net of demographic characteristics and preexisting health conditions, and effects were significant for people living alone only. The presence of green space and poorly maintained stairways were associated with greater odds of falling, net of covariates during 8 years of follow-up (odds ratios [OR]=2.10 and 2.65, p\<0.05, respectively). None of the environmental risk factors were significant for those living with others.Falls in old age may be determined in part by a combination of outdoor and indoor risk factors. More research is needed to understand pathways that lead to greater vulnerability among older adults living alone to environmental hazards.