Presentation description

Introduction:
Fall injuries are a public concern, and as individuals age falls become both more common and more injurious. Our study assesses outdoor fall injuries among older adults and uses quantitative methods to understand how the built environment impacts fall risk and identify specific environmental fall risk factors.

Methods:
Our study uses National Emergency Medical Services Information System (NEMSIS) incident data to identify fall-related injuries, linking fall incidents to environmental data by ZIP code. Statistical methods masked and anonymized value codes to protect privacy. We use zero-inflated negative binomial regression to evaluate environmental risk factors associated with fall-related injuries among older adults in the United States.

Results:
We employed a zero-inflated negative binomial (ZINB) model to predict the number of falls by nine environmental variables. The model revealed six significant predictors, including the percentage of senior population (seniorpercADJ), pedestrian intersection density (PedIntDenADJ), weather conditions (weatherADJ), urbanization status (urbanized), population density(popdenADJ), and area deprivation index (adiADJ). SeniorpercADJ and urbanized had the highest impact. Holding other variables constant, a one-unit increase in the senior population percentage results in about a 3.55 times higher expected count of falls, and falls are about 6.63 times higher in urbanized areas.

Conclusion:
The built environment significantly influences pedestrian fall risk among older adults. These findings underscore the critical need for targeted interventions and policies to modify the built environment, especially in urbanized areas, regions with high pedestrian intersection density, and communities with a high proportion of seniors. The significance of the pedestrian intersection variable highlights the necessity of understanding behavioral risk factors. Improved urban planning and design strategies are essential to mitigate conflicts between pedestrians and between pedestrians and vehicles at street intersections.