Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Oct 20;7(9):igad121.
doi: 10.1093/geroni/igad121. eCollection 2023.

Housing Environmental Factors Driving Falls Among Middle-Aged and Older Adults: A National Cohort Study

Shaojie Li  1   2 , Guanghui Cui  3 , Yuliang Er  4 , Pengpeng Ye  4 , Tao Xue  1   5 , Junfeng Jim Zhang  6 , Xiaoyun Liu  2 , Leilei Duan  4 , Faqin Lv  7 , Yao Yao  2   8
Affiliations

Housing Environmental Factors Driving Falls Among Middle-Aged and Older Adults: A National Cohort Study

Shaojie Li et al. Innov Aging. .

Abstract

Background and objectives: Housing is one of the main places where falls occur; however, few studies have examined housing environmental factors driving fall risk. This study aimed to explore the associations between housing environmental factors and falls in China.

Research design and methods: The study included data of middle-aged and older adults aged ≥45 years from 4 waves of the China Health and Retirement Longitudinal Study. We assessed 7 housing environmental factors: building materials, toilet types, household tidiness, household cooking fuels, and access to electricity, running water, and bathing facilities. Based on these, we divided housing environments into 3 types: good (0-2 poor factors), moderate (3-5 poor factors), and poor (6-7 poor factors). Falls incidence (yes or no) was self-reported during the survey period. We applied the Cox proportional hazard model to estimate the associations, adjusting for a set of covariates such as sociodemographic characteristics, lifestyles, and disease status.

Results: A total of 12,382 participants were analyzed, and the incidence of falls was 31.7%. According to the fully adjusted model, having a squatting toilet (hazard ratio [HR] = 1.14, 95% confidence interval [CI] = 1.03-1.26), household untidiness (HR = 1.09, 95% CI = 1.01-1.18), and solid fuel use for cooking (HR = 1.10, 95% CI = 1.02-1.18) were associated with a higher risk of falls (ps < .05), compared to their counterparts. We found a linear relationship between housing environments and falls (p for trend = .001). Specifically, moderate (HR = 1.16, 95% CI = 1.06-1.27) and poor housing environments (HR = 1.21, 95% CI = 1.08-1.34) were associated with a higher risk of falls compared to a good housing environment.

Discussion and implications: Among middle-aged and older Chinese adults, a better household environment, including sitting toilets, tidy living conditions, and clean fuel use for cooking, may reduce the risk of falls. The evidence from our study suggests the need to implement age-friendly housing environments to prevent falls and disability in an aging society.

Keywords: Cohort study; Falls; Housing environments; Middle-aged and older adults.

PubMed Disclaimer

Conflict of interest statement

Y. Yao is an editorial board member of Innovation in Aging and had no role in the editor review and peer review process of this manuscript.

Figures

Figure 1.
Figure 1.
The sample selection process. CHARLS = China Health and Retirement Longitudinal Study.
Figure 2.
Figure 2.
Sensitivity analyses. Building material (permanent vs temporary), toilet type (sitting vs squatting), electricity (yes vs no), tap water (yes vs no), bath facility (yes vs no), household tidiness (tidy vs untidy), and household cooking fuels (clean fuel vs solid fuel). CI = confidence interval; HR = hazard ratio.
See this image and copyright information in PMC

References

    1. Akter, J., Islam, M. R., Akter, S., Rahman, M. M., Hossain, F., Anam, M. R., Alam, M. A., Sultana, P., & Rashid, S. (2022). Equity in access to safely managed sanitation and prevalence of diarrheal diseases in Bangladesh: A national and sub-national analysis. BMC Infectious Diseases, 22(1), 871. 10.1186/s12879-022-07884-4 - DOI - PMC - PubMed
    1. Cao, L., Gao, J., & Xia, Y. (2021). The effects of household solid fuel use on self-reported and performance-based physical functioning in middle-aged and older Chinese populations: A cross-sectional study. Ecotoxicology and Environmental Safety, 213, 112053. 10.1016/j.ecoenv.2021.112053 - DOI - PubMed
    1. Cao, L., Zhai, D., Kuang, M., & Xia, Y. (2022). Indoor air pollution and frailty: A cross-sectional and follow-up study among older Chinese adults. Environmental Research, 204(Pt A), 112006. 10.1016/j.envres.2021.112006 - DOI - PubMed
    1. Chen, X., He, L., Shi, K., Wu, Y., Lin, S., & Fang, Y. (2023). Interpretable machine learning for fall prediction among older adults in China. American Journal of Preventive Medicine, 65(4), 579–586. 10.1016/j.amepre.2023.04.006 - DOI - PubMed
    1. Chen, X., Lin, Z., Gao, R., Yang, Y., & Li, L. (2021). Prevalence and associated factors of falls among older adults between urban and rural areas of Shantou city, China. International Journal of Environmental Research and Public Health, 18(13), 7050. 10.3390/ijerph18137050 - DOI - PMC - PubMed