Presence of home fall risk factors, fall perception, and fear of falling in older adults: a cross-sectional study

Lyra, Caroline Rodrigues; Silva, Eduardo Quadros da; Lima, Leidiane Aparecida; Santos, Eduarda Patrono dos; Nascimento Júnior, José Roberto Andrade do; Oliveira, Daniel Vicentini de

doi:10.1590/fm.2025.38105

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ORIGINAL ARTICLE • Fisioter. Mov. 38 • 2025 • https://doi.org/10.1590/fm.2025.38105 linkcopy

Presence of home fall risk factors, fall perception, and fear of falling in older adults: a cross-sectional study

Presença de fatores de risco de queda domiciliar, percepção de queda e medo de cair em idosos: um estudo transversal

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Introduction: Concerns regarding home falls, perceptions of falling, and associated fear are essential to understanding the challenges faced by older adults and to inform prevention and intervention strategies.

Objective: To investigate the association of home fall risk factors with sociodemographic, health-related, perception of falls, and fear of falling variables in older adults.

Methods: A cross-sectional study was conducted with 201 older adults of both sexes residing in South and Southeast of Brazil. A sociodemographic and health profile questionnaire, the Falls Risk Awareness Questionnaire (FRAQ-Brazil), a questionnaire on perception of home fall risk, and the Falls Efficacy Scale-International (FES-I-Brazil) were utilized. Data were analyzed using the chi-square test, binary logistic regression, and Hosmer-Lemeshow test (p < 0.05).

Results: A higher proportion of older adults with lower levels of education, lower monthly income, and from the southern region of the country were noted to have more home fall risk factors (p < 0.05). A higher proportion of older adults with good perceived health engaged in physical exercise, and without reported osteoarthritis were highlighted to have fewer home fall risk factors (p < 0.05). A higher proportion of older adults with less fear of falling were evidenced to have fewer home fall risk factors (p < 0.05). Illiterate older adults, those with incomplete primary education, nonusers or light users of medication, and those with higher income were found to have higher odds of having more than eight home fall risk factors.

Conclusion: The results of this study emphasize the importance of education, income, and geographical location in identifying home fall risk factors among older adults.

Keywords:
Accidental falls; Aging; Homebound patients

Variables	f (%)
Gender
Male	73 (36.3)
Female	128 (63.7)
Age range
60 to 69 years	126 (62.7)
70 to 79 anos	66 (32.8)
80 years or older	9 (4.5)
Marital status
With a partner	120 (59.7)
Without a partner	81 (40.3)
Education level
Illiterate	19 (9.5)
Incomplete primary education	51 (25.4)
Complete primary education	17 (8.5)
Complete secondary education	36 (17.9)
Higher education	78 (38.7)
Color skin
White	169 (84.1)
Black/Brown	21 (10.4)
Yellow	11 (5.5)
Monthly income (minimum wage)
1 to 2	94 (46.8)
2,1 to 3	36 (17.9)
More than 3	71 (35.3)
Retirement
Yes	162 (80.6)
No	39 (19.4)
Region of the country
South	137 (68.2)
Southeast	64 (31.8)
Housing
Urban	193 (96.0)
Rural	8 (4.0)

Variables	f (%)
Dimmed lights at night	152 (75.6)
Getting up at night	164 (81.6)
Slippery or unprotected bathroom	51 (25.4)
Absence of handrail on stairs	59 (29.4)
Objects out of reach	26 (12.9)
Dimmed lights in dark areas	102 (50.7)
Living alone or with another older adult	92 (45.8)
Seats without armrests or backrests	85 (42.3)
Uneven floors	98 (48.8)
Pets in the household	108 (53.7)
Obstacles along the pathway inside the house	55 (27.4)
Slippery floors	114 (56.7)
Unprotected hallway	67 (33.3)
Wearing excessively long clothing at home	3 (1.5)
Consuming alcohol	44 (21.9)
Room without a lamp	14 (7.0)
Children in the household during part of the day	44 (21.9)
Wearing inappropriate footwear	59 (29.4)
High mattress or bed	104 (51.7)
Inadequate toilet height	70 (34.8)

Variables	Risk factors - f (%)		X²	p
Variables	Up to 8	> 8	X²	p
Gender
Male	45 (61.6)	28 (38.4)	0.629	0.428
Female	86 (67.2)	42 (32.8)	0.629	0.428
Age group
60 to 69 years	82 (65.1)	44 (34.9)	0.004	0.948
70 to 79 years	43 (65.2)	23 (34.8)
≥ 80 years	6 (66.7)	3 (33.3)
Marital status
With partner	77 (64.2)	43 (35.8)	0.133	0.715
Without partner	54 (66.7)	27 (33.3)	0.133	0.715
Education
Illiterate	7 (36.8)	12 (63.2)	21.847	< 0.001*
IPE	23 (45.1)	28 (54.9)
CPE	12 (70.6)	5 (29.4)
CSE	28 (77.8)	8 (22.2)
HE	61 (78.2)	17 (21.8)
Race/Ethnicity
White	110 (65.1)	59 (34.9)	0.001	0.994
Black/Brown	14 (66.7)	7 (33.3)
Yellow	7 (63.6)	4 (36.4)
Monthly income
1 to 2 MW	48 (51.1)	46 (48.9)	11.896	0.001*
2.1 to 3 MW	29 (80.6)	7 (19.4)
> 3 MW	54 (76.1)	17 (23.9)
Retirement
Yes	104 (64.2)	58 (35.8)	0.351	0.554
No	27 (69.2)	12 (30.8)	0.351	0.554
Region
South	81 (59.1)	56 (40.9)	6.939	0.008*
Southeast	50 (78.1)	14 (21.9)	6.939	0.008*
Housing
Urban	126 (65.3)	67 (34.7)	0.026	0.571
Rural	5 (62.5)	3 (37.5)	0.026	0.571

Variables		Presence of risk factors - f (%)		X²	p
Variables		Up to 8	> 8	X²	p
Health perception	Good	77 (72.0)	30 (28.0)	6.067	0.014*
	Fair	48 (60.0)	32 (40.0)
	Poor	6 (42.9)	8 (57.1)
Medication	Does not use	18 (51.4)	17 (48.6)	3.412	0.065
	1 to 2	55 (65.5)	29 (34.5)
	3 to 4	31 (68.9)	14 (31.1)
	More than 4	27 (73.0)	10 (27.0)
Physical exercise practice	Yes	87 (77.0)	26 (23.0)	15.879	< 0.001*
Physical exercise practice	No	44 (50.0)	44 (50.0)	15.879	< 0.001*
Has or had heart disease	Yes	15 (60.0)	10 (40.0)	0.337	0.562
Has or had heart disease	No	116 (65.9)	60 (34.1)	0.337	0.562
Hypertension	Yes	70 (61.9)	43 (38.1)	1.184	0.276
Hypertension	No	61 (69.3)	27 (30.7)	1.184	0.276
Cerebrovascular accident	Yes	5 (83.3)	1 (16.7)	0.899	0.667
Cerebrovascular accident	No	126 (64.6)	69 (35.4)	0.899	0.667
Diabetes	Yes	36 (62.1)	22 (37.9)	0.346	0.556
Diabetes	No	95 (66.4)	48 (33.6)	0.346	0.556
Cancer	Yes	5 (62.5)	3 (37.5)	0.026	0.871
Cancer	No	126 (65.3)	67 (34.7)	0.026	0.871
Osteoarthritis	Yes	28 (53.8)	24 (46.2)	3.966	0.046*
Osteoarthritis	No	103 (69.1)	46 (30.9)	3.966	0.046*
Pulmonary disease	Yes	11 (64.7)	6 (35.3)	0.002	0.966
Pulmonary disease	No	120 (65.2)	64 (34.8)	0.002	0.966
Depression	Yes	23 (56.1)	18 (43.9)	1.870	0.172
Depression	No	108 (67.5)	52 (32.5)	1.870	0.172
Osteoporosis	Yes	28 (54.9)	23 (45.1)	3.177	0.075
Osteoporosis	No	103 (68.7)	47 (31.3)	3.177	0.075

Variables	Risk factors - f (%)		X²	p
Variables	Up to 8	> 8	X²	p
Perception of falls
Up to 25 points	57 (64.0)	32 (36.0)	0.090	0.765
> 25 points	74 (66.1)	38 (33.9)	0.090	0.765
Fear of falling
Less fear	37 (77.1)	11 (22.9)	3.940	0.047*
More fear	94 (61.4)	59 (38.6)	3.940	0.047*

Variables		OR crude	OR adjusted [CI 95%]
Education	Illiterate	6,151 [2,097 - 18,042]*	4,742 [1,086 - 20,695]*
	Incomplete elementary school	4,368 [2,022 - 9,436]*	4,079 [1,246 - 13,352]*
	Complete elementary school	1,495 [0,462 - 4,835]	1,047 [0,256 - 4,292]
	Complete high school	1	1
Monthly income (minimum wage)	1 to 2	3,044 [1,544 - 6,001]*	0,983 [0,362 - 2,664]
	2.1 to 3	0,767 [0,285 - 2,062]	0,267 [0,075-0,951]*
	More than 3	1	1
Region of the country	South	2,469 [1,246 - 4,891]*	1,173 [0,499 - 2,758]
Region of the country	Southeast	1	1
Health perception	Good	0,292 [0,094 - 0,913]*	0,825 [0,161 - 4,239]
	Fair	0,500 [0,158 - 1,578]	0,618 [0,145 - 2,635]
	Poor	1	1
Medication	Does not use	2,550 [0,954 - 6,813]	14,968 [3,491 - 64,171]*
	1 to 2	1,424 [0,606 - 3,343]	3,506 [1,014 - 12,124]*
	3 to 4	1,219 [0,466 - 3,190]	2,684 [0,770 - 9,357]
	More than 4	1	1
Physical exercise practice	Yes	0,299 [0,163-0,547]*	0,544 [0,232 - 1,275]
Physical exercise practice	No	1	1
Osteoarthritis	Yes	1,919 [1,005 - 3,664]*	1,263 [0,545 - 2,927]
Osteoarthritis	No	1	1
Depression	Yes	1,625 [0,807 - 3,273]	3,081 [1,162 - 8,165]*
Depression	No	1	1
Osteoporosis	Yes	1,800 [0,939 - 3,450]	1,307 [0,555 - 3,078]
Osteoporosis	No	1	1
Fear of falling	Less fear	0,474 [0,224 - 1,001]	0,525 [0,213 - 1,293]
Fear of falling	More fear	1	1

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[TFN1] Note: up to 8 risk factors (n = 131); more than 8 risk factors (n = 70). IPE = incomplete primary education; CPE = complete primary education; CSE = complete secondary education; HE = higher education; MW = minimum wage. *Significant association - p < 0.05: chi-square test.