Multidimensional assessment of home safety and fall risk in older adults: the role of environmental and functional factors

In this study, it is aimed to determine the level of home safety among individuals aged 65 and over living in the Central district of Kırklareli, to examine whether the sub-dimensions of home safety differ according to socio-demographic and residence characteristics, and to evaluate the relationship between spatial safety areas and reports of indoor, outdoor, and total falls/accidents. Three hundred eighty-five older adults were included in this cross-sectional and quantitative study. Data were collected using a structured questionnaire, which was developed according to home safety checklists. The questionnaire was made up of 103 items (including sub-items: total 106) assessing home safety through questions about socio-demographic and residence characteristics. Descriptive findings were summarized using frequency and percentage values. Independent samples t-test, one-way ANOVA, and, where appropriate, Tukey HSD and Games–Howell multiple comparison tests were used to examine the variation of home safety sub-dimensions across different groups. All statistical analyses were performed using SPSS version 25.0. 13.0% of the participants reported having an accident inside their residences, and 8.8% reported having an accident in the immediate vicinity of their residences. The percentage of individuals with a history of falls was 19.1%. Logistic regression analyses showed a significant and inverse relationship between the probability of having an accident indoors and wet area safety (OR = 0.11; %95 CI: 0.01–0.93; p = 0.042). Individual factors, particularly the use of orthosis, were found to be significantly associated with accidents outdoors (OR = 10.72; %95 CI: 2.67–43.07; p = 0.001). In the overall accident model, it was determined that building and immediate vicinity safety was associated with lower odds of accidents (OR = 0.24; %95 CI: 0.08–0.69; p = 0.009), while a history of fall-related fractures and prostheses was associated with higher odds of accidents (OR = 3.02–4.05; %95 CI: 1.53–10.18; p ≤ 0.003). The findings indicate that the risk of falls and accidents in elderly individuals should be assessed not only in terms of health status but also in relation to the architectural and environmental characteristics of the residence. In particular, making wet areas safe and reducing risks at building entrances and in the immediate vicinity are critically important in preventing falls. Accordingly, age-friendly housing and environmental arrangements should be addressed within the framework of the aging in place approach, with the holistic contribution of architecture, interior design, and public health disciplines.