Neighborhood environmental characteristics and the risk of falls among older adults: A 3-year longitudinal follow-up of the Japan gerontological evaluation study

OBJECTIVE: Falls are a significant global public health concern as they are a leading cause of fall-related deaths and long-term care needs, particularly among older adults. Using longitudinal data, this study aimed to examine the association between neighborhood environmental characteristics and fall risk. METHODS: We analyzed data from the Japan Gerontological Evaluation Study. This study included 27,346 functionally independent adults aged ≥ 65 years nested within 416 school districts. The outcome variable, falls, was assessed in 2016, whereas the explanatory variable, eight neighborhood environmental characteristics, was evaluated in 2013. Covariates were measured in 2010. Multilevel modified Poisson regression was conducted to account for individuals nested within school districts, providing a more granular understanding of neighborhood effects. RESULTS: In total, 25% of the participants reported that they had experienced a fall. Compared with living in an area with a low presence of each environmental factor, living in a high presence of "parks or foot paths suitable for exercise or walking" was associated with an 11% lower fall risk (risk ratio, 0.89). The moderate presence of "locations difficult for walking, such as hills or steps" was associated with a 6% reduced risk (risk ratio, 0.94). No significant associations were observed with other neighborhood environmental characteristics. CONCLUSION: Walkable, activity-supportive environments, such as accessible parks and foot paths, may reduce the risk of falls among older adults. Moderately challenging terrain can be protective against fall risk. These findings provide insights for designing community-based fall prevention strategies in the context of global population aging.