Although several studies have conducted on general fear of falling in relation to personal risk factors, little is known about the relationship between fear of outdoor falling and outdoor environments. This study identified factors associated with the fear of outdoor falling among assisted living residents aged ≥65 by different time of outdoor use. This study used survey data collected from a multiregional study conducted in 2007 that surveyed residents of 68 assisted living facilities in Houston, Texas; Chicago, Illinois; and Seattle, Washington. This study incorporated data from 907 out of 1,043 participants, who used the outdoor areas. Multivariate logistic regression was used to identify significant outdoor environmental risk factors associated with fear of outdoor falling, controlling for covariates. Less frequent outdoor users were 16% more likely to have fear of outdoor falling, compared to those who frequently used outdoor in the assisted living facilities. However, frequent outdoor users tended to be more influenced by the outdoor characteristics than less frequent outdoor users. Multivariate analyses showed that overall design qualities of outdoor areas (OR=0.61, p=0.036 for <50% outdoor users and OR=0.46, p=0.006 for ≥ 50% outdoor users) and comfortable outdoor areas (OR=0.61, p=0.039 for <50% outdoor users and OR=0.40, p=0.001 for ≥ 50% outdoor users) were associated with decreased fear of outdoor falling after adjusting for the individual factors. Improved walkways and comfort levels in outdoor areas are associated with reduced fear of outdoor falling, which can further contribute to promoting healthy outdoor physical activity among assisted living residents.
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