The reflection of the fear of falls and risk of falling in walking activity spaces of older adults in various urban environments

Abstract

Abstract Participation of older adults in daily activities has a major positive impact on health and contributes to a sense of accomplishment, satisfaction, self-efficacy, and well-being. Walking is considered to be one of the most influential activities promoting health and active living. Older adults are particularly vulnerable to their immediate local environment where age- related declined capabilities combined with barriers in the home neighborhood pose a risk of falling and fear of falls. Most research focusing on the built environment role in incidents of older adults outdoor falls and fear of falls is focused on identifying the environmental features risk factors. Effort is made to develop audit checklist tools to assess out-door falls risk. In contrast, this study focuses on the manifestation of fear of falls in older adults walking activity spaces. We identify spatial walking patterns of outdoor daily activities in public urban spaces and examine the relations between fear of falls, risk of falling status, previous occurrence of fall incidents and number of medical diagnoses and walking activity spaces among older adults in different urban environments. The analysis included 271 older adults (age 60+ with 70% females and 30% males), and 483 walking routes in three cities. A psychological measure related to mobility self-efficacy was evaluated by the Falls Efficacy Scale examining the fear of falling through a functional perspective. Motor evaluation was conducted by functional mobility evaluation through the Timed Up and Go (TUG) screening test which assesses the level of risk of falling. GIS analysis was conducted for mapping and identifying walking activity spaces. The analysis shows different walking activity spaces of people with high risk of falling and fear of falls in comparison to those with no risk and no fear of falling across gender and age groups (60–65, 66–74, and 75+). In this approach we show the outcome reflection of barriers and enablers and their revealed cumulative effect through walking activity spaces among older adults.