Fear of Outdoor Falling, Frequency of Going Outside, and Outdoor Environments among Assisted Living Residents

BACKGROUND: As fear of falling with poor confidence in mobility particularly restrict frail elderly engage in physical activity, fear of falling is a major issue in assisted living facilities (ALF). ALF is a senior housing option for people who needs minimal cares with daily living to en-courage residents’ independence, privacy, and self-identity in a safe environment. There has been also a growing interest in the role of oudoor environment and access to nature on health outcomes among older adults in long-term care facilities.

METHODS:

CONCLUSION: Enhanced outdoor environments and using well-designed outdoor environments would be helpful not only for promoting physical activity and social acitivity in residents but also for reducing fear of outdoor falling. Those who stay indoor and not frequently go outside have a substantially higher rate of fear of outdoor falling due to the inteactions of functional impairments and environmental concerns , it is important to provide well-designed and maintained outdoor areas to enrouage outdoor activities as well as to reduce such concerns among assisted living residents.

ACKNOWLEDGEMENT: Funding for this study was provided by the National Institute on Aging, SBIR #R44 AG024786, and by the Ronald L. Skaggs Endowed Professorship in Health Facilities Design, College of Architecture, Texas A&M University

Sungmin Lee, Chanam Lee, and Susan RodiekCollege of Agriculture, Health and Nautral Resources, University of Connecticut, CT College of Architecture, Texas A&M University, TX

HOUSTON

SEATTLE

CHICAGO

68 assisted living facilities located in three major cities: Houston, Texas; Chicago, Illinois; and Seattle, Washington. This cross-sectional stduy stems from the resident surveys between May and July, 2007. A total sample is 907 participants, who used the outdoor areas. Multivariate logistic regression was used to identify significant prosepctice factors for preventing fear of outdoor falling

OutdoorUse

Outdoor design has protective effects against fear of outdoor falling.

Outdoor design is more effective among those who actively use oudoor spaces although fear of outdoor falling is lower among those frequent outdoor users.

Fear of outdoor falling is not necessarily a marker of walking time spent for exercise itself. Rather, spent time in outdoor space would be more effective in helping to reduce the fear of outdoor falling

12

3

Male

Female

RESULTS

DISCUSSIONS

“The odds of having a fear of outdoor falling are”

35.1% lower for those who had better health conditions than those who did not.

Health Conditions

46.2% lower for those who went outdoor frequently more than 105 min per a week than those who did not.

Frequency of outdoor use

38.6% lower for those who reported that the walkways in outdoor areas were very well-designed than those who did not.

Design of walkways

34.3% lower for those who reported that the comfort in outdoor areas were very well-designed than those who did not.

Comfort in outdoor areas

2.14 times larger for those who had history of falling than those who did not.

History of falling

2.14 times larger for those who needs help to use wheelchair and power scooter those who did not.

Mobility Aid

Total <50% Outdoor Users ≥50% Outdoor Users (n=452)Variables OR OR OR95% CI P-value 95% CI P-value 95% CI P-value

(n=455)

Perceived outdoor environment

Design of outdoor areas 0.549** 0.389 - 0.776 0.001 0.602* 0.379 - 0.956 0.032 0.490** 0.286 - 0.842 0.010

Design of walkways 0.438** 0.31 - 0.62 <0.001 0.405** 0.252 - 0.650 <0.001 0.527* 0.303 - 0.918 0.024 Enough different seats in outdoor areas 0.513** 0.359 - 0.734 <0.001 0.606* 0.374 - 0.982 0.042 0.414 ** 0.237 - 0.725 0.002

Accessibility to the outdoor areas 0.494** 0.311 - 0.785 0.003 0.480* 0.266 - 0.864 0.014 0.570 0.255 - 1.275 0.171 Interaction outdoor use with accessibility to the outdoor areas 1.249 0.476 - 3.278 0.652

Comfort in outdoor areas 0.458** 0.325 - 0.645 0.000 0.567* 0.358 - 0.899 0.016 0.410** 0.241 - 0.7 0.001

Preference in outdoor areas

Note: **p<0.01, *0.01≤p<0.05 †0.05≤p<0.1a Adjusted for age, sex, health condition, history of falling, vision problems, mobility aid, ADLs, walking for exercise, city, independence of outdoor use, and frequency of outdoor use

0.916 0.637 - 1.316 0.635 1.202 0.754 - 1.916 0.440 0.718 0.377 - 1.365 0.312

Confounding variable Age (continuous) 1.014 0.988 - 1.042 0.286 Sex (0:Male, 1: Female) 0.888 0.571 - 1.382 0.599

Health and behavioral variable Health condition 0.649 * 0.443 - 0.95 0 0.026 History of falling 2.139 ** 1.368 - 3.344 0.001 Vision problems 1.579 0.962 - 2.591 0.071 Mobility Aid (reference: None/cane)

Walker (w/ seat) 1.704* 1.050 - 2.767 0.031 Wheelchair and power scooter 2.141** 1.351 - 3.391 0.001

ADLs (reference: None) Bath 1.055 0.641 - 1.735 0.834 Dress 1.273 0.725 - 2.235 0.4

Walking for exercise (min per a week) 1.000 1.000 - 1.001 0.305 City (reference: Houston)

Chicago 1.241 0.789 - 1.951 0.351 Seattle 1.445 0.906 - 2.305 0.123

Outdoor usage Frequency of outd oor use 0.538** 0.368 - 0.787 0.001 Independence of outdoor use 0.941 0.651 - 1.361 0.748

Perceived outdoor environment Design of outdoor areas 0.876 0.565 - 1.358 0.555 Design of walkways 0.614 * 0.405 - 0.931 0.022 Enough different seats in outd oor areas 0.763 0.498 - 1.167 0.212 Accessibility to the outdoor areas 0.779 0.469 - 1.294 0.335 Comfort in outdoor areas 0.657 * 0.437 - 0.989 0.044

Q. Have you ever worried about falling while using the outdoor areas at this senior community?

Participants’ Characteristics

Average age of the participants: 8250% percentile of outdoor users: 105 min per a week

Sex Health Condition History of falling Vision Program Mobility AidADLs

Seldom or neverSometimes and often

Fear of out-door falling

Not very good

Very good

No

Yes

No

Yes

None

One

Two or more

No need/ caneWalker and walker with seatWheelchair, power scooter,and others

1 2 3

Very well designed Partly well or not well designed

1 2 3

Very well designed Partly well or not well designed

1 2 3

Very or somewhat easy Somewhat or very hard

1 2 3

Very well designed Partly well or not well designedDesign of outdoor areas Design of walkways Accessibility to the outdoor areas Comfort in otudoor areas

Total <50% outdoor users

>50% outdoor users Total <50%

outdoor users>50%

outdoor users Total <50% outdoor users

>50% outdoor users Total <50%

outdoor users>50%

outdoor users

a

a b

b b

Decreased mobility disabilityPreventing

Fear of OutdoorFalling Increased

physical activity

?

22%

78%

Total

Variables Odds Ratio 95% CI P-value

69%

31%

13%

87% 87%

13%

81%

19%

68%

18%

14%36%

32%

32%

56.6 52.8 60.3

43.4 47.2 39.7

57.7 54.6 60.6

42.3 45.4 39.4

86 .5 83.1 90

13.5 16.9 10

57.4 48.566.5

42.6 51.533.5

“Outdoor visits are found to have significant

impacts on preventing fear of outdoor falling. ”

“Among the less frequent outdoor users, accessibility to the outdoor areas would be

more important to reduce the fear of outdoor falling than

others. ”