Person-environment fit predicts falls in older adults better than the consideration of environmental hazards only

Objective: To test the hypotheses that the empirical consideration of objective person-environment fit in the home environment is a stronger predictor of indoor falls among older adults than the assessment of environmental barriers only, and that perceived aspects of home play a role as predictors for falls. Design: Survey study with data collection at home visits, followed up by self-reports about falls at home visits one year later. Setting: Urban districts in Sweden, Germany, Latvia. Participants: Eight hundred and thirty-four single-living, older adults (75-89 years), in ordinary housing. Measurements: An assessment of objective person-environment fit in the home environment (housing enabler), a self-rating of the perceived home environment (usability in my home) and retrospective self-reports on indoor falls. Results: The participants reporting falls tended to be frailer than the non-fallers. The number of environmental barriers in the home was similar for the fallers and non-fallers; the magnitude of person-environment fit problems was higher among the fallers. The person-environment fit problem variable was a stronger fall predictor (odds ratio (OR) = 1.025; P = 0.037) than number of environmental barriers (n. s.), even after controlling for confounders. Fallers also experienced lower usability of their home. Conclusion: The results suggest that much of the inconclusiveness of the data in the relationship between environmental hazards and falls in the previous falls literature could be due to the neglect of person-environment fit assessment. The effectiveness of environmental interventions based on the notion of person-environment fit compared with traditional home hazard checklists remains to be tested.