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AIMS Public Health

2025, Volume 12, Issue 1: 185-201. doi: 10.3934/publichealth.2025012
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Research article

Gender differences in the associations of recreational walking with indoor and outdoor falls among older adults-the Healthy Aging and Neighborhood Study (HANS)

  • 1.
    Department of Public Health and Center for Health Statistics, University of Massachusetts Lowell, 61 Wilder St, Lowell, MA 01854, USA
  • 2.
    Marcus Institute for Aging Research, Hebrew SeniorLife, 1200 Centre Street, Boston, MA 02131, USA
  • Received: 22 August 2024 Revised: 21 November 2024 Accepted: 06 January 2025 Published: 08 February 2025

  • Objective 

    This study examined gender differences in the association between recreational walking and indoor and outdoor fall rates among older adults.

    Methods 

    The Healthy Aging and Neighborhood Study is a prospective cohort that included 716 community-dwelling adults aged 65–95 years in central and northeastern Massachusetts, USA (2018–2023). Recreational walking at baseline was measured by the frequency of walking for exercise for at least 10 min in the participants' neighborhood. Falls were reported on monthly falls calendars, and the circumstances for reported falls were collected via subsequent telephone interviews. Mixed effects negative binomial models were used to estimate gender differences in the associations of recreational walking with rates of indoor and outdoor falls, separately. Models were adjusted for sociodemographic variables, physical health, functional status, lifestyle behaviors, mental health, and fear of falling.

    Results 

    There were 394 (55%) female and 322 (45%) male participants enrolled in the study, and the mean (SD) age was 74.08 (6.29). About 61% of participants engaged in recreational walking at least once weekly. Women had lower outdoor fall rates than men (32 vs. 40 per 100 person-years), while indoor fall rates did not significantly differ by gender (31 vs. 34 per 100 person-years). Women engaging in recreational walking at least once weekly had a 62% lower indoor fall rate [IRR (95% CI): 0.38 (0.21, 0.71)] than those who did not. No significant associations were observed between recreational walking and outdoor falls for both women and men.

    Discussion 

    Among community-dwelling older women, but not men, a higher frequency of recreational walking was associated with lower rates of indoor falls, while no changes were seen with outdoor falls. Increasing recreational walking may be a viable focus for fall prevention programs in the community, especially for older women.

    Citation: Lingming Chen, Elizabeth Procter-Gray, Qun Le, Danielle LoPilato, Marianella Ferretto, Kevin Kane, Marian T. Hannan, Sarah Berry, Wenjun Li. Gender differences in the associations of recreational walking with indoor and outdoor falls among older adults-the Healthy Aging and Neighborhood Study (HANS)[J]. AIMS Public Health, 2025, 12(1): 185-201. doi: 10.3934/publichealth.2025012

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  • Objective 

    This study examined gender differences in the association between recreational walking and indoor and outdoor fall rates among older adults.

    Methods 

    The Healthy Aging and Neighborhood Study is a prospective cohort that included 716 community-dwelling adults aged 65–95 years in central and northeastern Massachusetts, USA (2018–2023). Recreational walking at baseline was measured by the frequency of walking for exercise for at least 10 min in the participants' neighborhood. Falls were reported on monthly falls calendars, and the circumstances for reported falls were collected via subsequent telephone interviews. Mixed effects negative binomial models were used to estimate gender differences in the associations of recreational walking with rates of indoor and outdoor falls, separately. Models were adjusted for sociodemographic variables, physical health, functional status, lifestyle behaviors, mental health, and fear of falling.

    Results 

    There were 394 (55%) female and 322 (45%) male participants enrolled in the study, and the mean (SD) age was 74.08 (6.29). About 61% of participants engaged in recreational walking at least once weekly. Women had lower outdoor fall rates than men (32 vs. 40 per 100 person-years), while indoor fall rates did not significantly differ by gender (31 vs. 34 per 100 person-years). Women engaging in recreational walking at least once weekly had a 62% lower indoor fall rate [IRR (95% CI): 0.38 (0.21, 0.71)] than those who did not. No significant associations were observed between recreational walking and outdoor falls for both women and men.

    Discussion 

    Among community-dwelling older women, but not men, a higher frequency of recreational walking was associated with lower rates of indoor falls, while no changes were seen with outdoor falls. Increasing recreational walking may be a viable focus for fall prevention programs in the community, especially for older women.


    Abbreviations

    BMI

    body mass index

         ADL

    activities of daily living

         IADL

    instrumental activities of daily living

         PASE

    Physical Activity Scale for the Elderly

         PSS-4

    Perceived Stress Scale

         CES-D

    Center for Epidemiologic Studies Depression Scale

         BAI

    Beck Anxiety Inventory

         FES-I

    Falls Efficacy Scale International

         AIC

    Akaike information criterion

         BIC

    Bayesian information.
    加载中

    Acknowledgments


    This work was supported by the National Institute on Aging (NIA), USA (Grant Number: R01AG066492; PI: Wenjun Li). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
    We would like to thank the community organizations we have collaborated with in Massachusetts for their support. These community organizations include Active Life Adult Day Center in Fitchburg; Amrit Sabha Adult Day Care Center in Northborough; Anew Adult Day Care Center in Billerica; Arca Adult Day Health in Worcester; City of Lawrence Veterans' Services in Lawrence; Fitchburg Green in Fitchburg; Golden Way Adult Day Care Center in Waltham; Green Hill Towers in Worcester; Groton Herald in Groton; Harvard Joyful Adult Health, LLC in Harvard; Learning in Retirement Association in Lowell; Millennium Home Adult Day Healthcare in Westford; Shirley Council on Aging in Shirley; Shrewsbury Council on Aging in Shrewsbury; Shrewsbury Senior Center in Shrewsbury; Spanish American Center in Leominster; Sterling Senior Center in Sterling; Worcester Housing Authority in Worcester; Worcester Senior Center in Worcester; Xiangfu Adult Day Care Center in Chelmsford.

    Authors' contribution


    Dr. Wenjun Li conceived the study, obtained the funding, and guided the analysis. Qun Le was responsible for project management and IRB submissions. Danielle LoPilato, Marianella Ferretto, Qun Le, and Lingming Chen recruited and followed participants. Dr. Elizabeth Procter-Gray and Kevin Kane did the data management. Lingming Chen conducted the statistical analysis and drafted the manuscript. Dr. Wenjun Li, Dr. Elizabeth Procter-Gray, Kevin Kane, Dr. Marian T. Hannan and Dr. Sarah Berry contributed to the revision of the manuscript. All authors read and approved the manuscript.

    Conflict of interest


    Wenjun Li is an associate editor in chief for AIMS Public Health and was not involved in the editorial review or the decision to publish this article. All authors declare that there are no competing interests.

    [1] Vaishya R, Vaish A (2020) Falls in older adults are serious. Indian J Orthop 54: 69-74. https://doi.org/10.1007/s43465-019-00037-x
    [2] Moreland B, Kakara R, Henry A (2020) Trends in nonfatal falls and fall-related injuries among adults aged ≥65 years—United States, 2012–2018. Morb Mortal Wkly Rep 69: 875-881. https://doi.org/10.15585/mmwr.mm6927a5
    [3] Houry D, Florence C, Baldwin G, et al. (2015) The CDC injury center's response to the growing public health problem of falls among older adults. Am J Lifestyle Med 10: 74-77. https://doi.org/10.1177/1559827615600137
    [4] Freiberger E, Sieber CC, Kob R (2020) Mobility in older community-dwelling persons: A narrative review. Front Physiol 11. https://www.frontiersin.org/articles/10.3389/fphys.2020.00881
    [5] Pitchai P, Dedhia HB, Bhandari N, et al. (2019) Prevalence, risk factors, circumstances for falls and level of functional independence among geriatric population-A descriptive study. Indian J Public Health 63: 21. https://doi.org/10.4103/ijph.IJPH_332_17
    [6] Cross SH, Anderson DM, Cox CE, et al. (2022) Trends in location of death among older adult Americans after falls. Gerontol Geriatr Med 8: 23337214221098897. https://doi.org/10.1177/23337214221098897
    [7] Kakara R (2023) Nonfatal and fatal falls among adults aged ≥65 years—United States, 2020–2021. MMWR Morb Mortal Wkly Rep 72. https://doi.org/10.15585/mmwr.mm7235a1
    [8] Li W, Keegan THM, Sternfeld B, et al. (2006) Outdoor falls among middle-aged and older adults: A neglected public health problem. Am J Public Health 96: 1192-1200. https://doi.org/10.2105/AJPH.2005.083055
    [9] Kelsey JL, Procter-Gray E, Hannan MT, et al. (2012) Heterogeneity of falls among older adults: Implications for public health prevention. Am J Public Health 102: 2149-2156. https://doi.org/10.2105/AJPH.2012.300677
    [10] Duckham RL, Procter-Gray E, Hannan MT, et al. (2013) Sex differences in circumstances and consequences of outdoor and indoor falls in older adults in the MOBILIZE Boston cohort study. BMC Geriatr 13: 133. https://doi.org/10.1186/1471-2318-13-133
    [11] Procter-Gray E, Leveille SG, Hannan MT, et al. (2015) Variations in community prevalence and determinants of recreational and utilitarian walking in older age. J Aging Res 2015: 382703. https://doi.org/10.1155/2015/382703
    [12] Ghani F, Rachele JN, Washington S, et al. (2016) Gender and age differences in walking for transport and recreation: Are the relationships the same in all neighborhoods?. Prev Med Rep 4: 75-80. https://doi.org/10.1016/j.pmedr.2016.05.001
    [13] Pollard TM, Wagnild JM (2017) Gender differences in walking (for leisure, transport and in total)across adult life: A systematic review. BMC Public Health 17: 341. https://doi.org/10.1186/s12889-017-4253-4
    [14] Li W, Procter-Gray E, Churchill L, et al. (2017) Gender and age differences in levels, types and locations of physical activity among older adults living in car-dependent neighborhoods. J Frailty Aging 6: 129-135. https://doi.org/10.14283/jfa.2017.15
    [15] Chan E, Procter-Gray E, Churchill L, et al. (2020) Associations among living alone, social support and social activity in older adults. AIMS Public Health 7: 521-534. https://doi.org/10.3934/publichealth.2020042
    [16] Katz S (1983) Assessing self-maintenance: Activities of daily living, mobility, and instrumental activities of daily living. J Am Geriatr Soc 31: 721-727. https://doi.org/10.1111/j.1532-5415.1983.tb03391.x
    [17] Lawton MP, Brody EM (1969) Assessment of older people: Self-maintaining and instrumental activities of daily living. Gerontologist 9: 179-186.
    [18] Lewinsohn PM, Seeley JR, Roberts RE, et al. (1997) Center for Epidemiologic Studies Depression scale (CES-D) as a screening instrument for depression among community-residing older adults. Psychol Aging 12: 277-287. https://doi.org/10.1037//0882-7974.12.2.277
    [19] Beck AT, Epstein N, Brown G, et al. (1988) An inventory for measuring clinical anxiety: psychometric properties. J Consult Clin Psychol 56: 893-897. https://doi.org/10.1037//0022-006x.56.6.893
    [20] Cohen S, Kamarck T, Mermelstein R (1983) A global measure of perceived stress. J Health Soc Behav 24: 385-396. https://doi.org/10.2307/2136404
    [21] Felix AS, Lehman A, Nolan TS, et al. (2019) Stress, resilience, and cardiovascular disease risk among black women. Circ Cardiovasc Qual Outcomes 12: e005284. https://doi.org/10.1161/CIRCOUTCOMES.118.005284
    [22] Washburn RA, Smith KW, Jette AM, et al. (1993) The physical activity scale for the elderly (PASE): Development and evaluation. J Clin Epidemiol 46: 153-162. https://doi.org/10.1016/0895-4356(93)90053-4
    [23] Women's health initiative questionnaires. Available from: https://www.whi.org/formList
    [24] Yardley L, Beyer N, Hauer K, et al. (2005) Development and initial validation of the Falls Efficacy Scale-International (FES-I). Age Ageing 34: 614-619. https://doi.org/10.1093/ageing/afi196
    [25] Kelsey JL, Berry SD, Procter-Gray E, et al. (2010) Indoor and outdoor falls in older adults are different: The maintenance of balance, independent living, intellect, and zest in the elderly of boston study. J Am Geriatr Soc 58: 2135-2141. https://doi.org/10.1111/j.1532-5415.2010.03062.x
    [26] Yu J, Chiu YL, Guu SM, et al. (2024) The association between leisure activity and mental health in the older adults in China: Amazing Guangchangwu. Front Public Health 11. https://doi.org/10.3389/fpubh.2023.1291809
    [27] Piva G, Caruso L, Gómez AC, et al. (2024) Effects of forest walking on physical and mental health in elderly populations: A systematic review. Rev Environ Health 39: 121-136. https://doi.org/10.1515/reveh-2022-0093
    [28] Ruiz-Comellas A, Valmaña GS, Catalina QM, et al. (2022) Effects of physical activity interventions in the elderly with anxiety, depression, and low social support: A clinical multicentre randomised trial. Healthcare (Basel) 10: 2203. https://doi.org/10.3390/healthcare10112203
    [29] Han A, Kim J, Kim J (2021) A study of leisure walking intensity levels on mental health and health perception of older adults. Gerontol Geriatr Med 7: 2333721421999316. https://doi.org/10.1177/2333721421999316
    [30] Kessler R, Schmitt S, Sauder T, et al. (2020) Long-term neuroanatomical consequences of childhood maltreatment: Reduced amygdala inhibition by medial prefrontal cortex. Front Syst Neurosci 14: 28. https://doi.org/10.3389/fnsys.2020.00028
    [31] Liu WZ, Zhang WH, Zheng ZH, et al. (2020) Identification of a prefrontal cortex-to-amygdala pathway for chronic stress-induced anxiety. Nat Commun 11: 2221. https://doi.org/10.1038/s41467-020-15920-7
    [32] Ramasubbu R, Konduru N, Cortese F, et al. (2014) Reduced intrinsic connectivity of amygdala in adults with major depressive disorder. Front Psychiatry 5. https://doi.org/10.3389/fpsyt.2014.00017
    [33] Zhang X, Ge TT, Yin G, et al. (2018) Stress-induced functional alterations in amygdala: Implications for neuropsychiatric diseases. Front Neurosci 12. https://doi.org/10.3389/fnins.2018.00367
    [34] Sudimac S, Sale V, Kühn S (2022) How nature nurtures: Amygdala activity decreases as the result of a one-hour walk in nature. Mol Psychiatry 27: 4446-4452. https://doi.org/10.1038/s41380-022-01720-6
    [35] Murtagh EM, Nichols L, Mohammed MA, et al. (2015) The effect of walking on risk factors for cardiovascular disease: An updated systematic review and meta-analysis of randomised control trials. Prev Med 72: 34-43. https://doi.org/10.1016/j.ypmed.2014.12.041
    [36] Sithichoksakulchai S, Chen MC, Chen KM (2022) Walking promotes physical fitness of community-dwelling older adults: A systematic review and meta-analysis. Top Geriatr Rehabil 38: 101. https://doi.org/10.1097/TGR.0000000000000351
    [37] Roh KH, Park HA (2013) A meta-analysis of the effect of walking exercise on lower limb muscle endurance, whole body endurance and upper body flexibility in elders. J Korean Acad Nurs 43: 536-546. https://doi.org/10.4040/jkan.2013.43.4.536
    [38] Li W, Procter-Gray E, Lipsitz LA, et al. (2014) Utilitarian walking, neighborhood environment, and risk of outdoor falls among older adults. Am J Public Health 104: e30-e37. https://doi.org/10.2105/AJPH.2014.302104
    [39] Rigby BP, Dodd-Reynolds CJ, Oliver EJ (2020) Inequities and inequalities in outdoor walking groups: A scoping review. Public Health Rev 41: 4. https://doi.org/10.1186/s40985-020-00119-4
    [40] Smith GSE, Moyle W, Burton NW (2023) Frequency of physical activity done with a companion: Changes over seven years in adults aged 60+ living in an Australian capital city. J Aging Health 35: 736-748. https://doi.org/10.1177/08982643231158424
    [41] Liu Y, Lachman ME (2021) A group-based walking study to enhance physical activity among older adults: The role of social engagement. Res Aging 43: 368-377. https://doi.org/10.1177/0164027520963613
    [42] Marselle MR, Irvine KN, Warber SL (2013) Walking for well-being: Are group walks in certain types of natural environments better for well-being than group walks in urban environments?. Int J Environ Res Public Health 10: 5603-5628. https://doi.org/10.3390/ijerph10115603
    [43] Meads C, Exley J (2018) A systematic review of group walking in physically healthy people to promote physical activity. Int J Technol Assess Health Care 34: 27-37. https://doi.org/10.1017/S0266462317001088
    [44] Young SN (2007) How to increase serotonin in the human brain without drugs. J Psychiatry Neurosci JPN 32: 394-399.
    [45] Anderson E, Shivakumar G (2013) Effects of exercise and physical activity on anxiety. Front Psychiatry 4: 27. https://doi.org/10.3389/fpsyt.2013.00027
    [46] Mikkelsen K, Stojanovska L, Polenakovic M, et al. (2017) Exercise and mental health. Maturitas 106: 48-56. https://doi.org/10.1016/j.maturitas.2017.09.003
    [47] Smoski MJ, LaBar KS, Steffens DC (2014) Relative effectiveness of reappraisal and distraction in regulating emotion in late-life depression. Am J Geriatr Psychiatry 22: 898-907. https://doi.org/10.1016/j.jagp.2013.01.070
    [48] Xu L, Gu H, Cai X, et al. (2023) The effects of exercise for cognitive function in older adults: A Systematic review and meta-analysis of randomized controlled trials. Int J Environ Res Public Health 20: 1088. https://doi.org/10.3390/ijerph20021088
    [49] Savvakis I, Adamakidou T, Kleisiaris C (2024) Physical-activity interventions to reduce fear of falling in frail and pre-frail older adults: A systematic review of randomized controlled trials. Eur Geriatr Med 15: 333-344. https://doi.org/10.1007/s41999-024-00944-9
    [50] Yin J, John A, Cadar D (2024) Bidirectional associations of depressive symptoms and cognitive function over time. JAMA Netw Open 7: e2416305. https://doi.org/10.1001/jamanetworkopen.2024.16305
    [51] Zhou R, Li J, Chen M (2022) The association between cognitive impairment and subsequent falls among older adults: Evidence from the China health and retirement longitudinal study. Front Public Health 10: 900315. https://doi.org/10.3389/fpubh.2022.900315
    [52] Hallford DJ, Nicholson G, Sanders K, et al. (2017) The association between anxiety and falls: A Meta-analysis. J Gerontol Ser B 72: 729-741. https://doi.org/10.1093/geronb/gbv160
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