Author ORCID Identifier
0000-0003-2827-4444
Date of Award
12-31-2025
Document Type
Open Access Dissertation
Degree Name
Doctor of Philosophy (PhD)
Department
Gerontology
First Advisor
Jeffrey A. Burr
Second Advisor
Jeffrey E. Stokes
Third Advisor
Evan M. Stewart
Abstract
As more people remain in their homes as they age, the risk of living at home with frailty and reduced function increases, which may also increase the risk for falls in the home. The scientific literature shows that frail people are more likely to experience falls, which leads to many negative outcomes, such as hospitalization, placement in a skilled nursing facility, and even death. The preference to age-in-place (AIP) is more likely to be met if older people live in accessible housing. Accessible homes may mitigate the risk for falls and promote AIP, especially among frail older people.
While there has been research on the association between frailty and falls, we do not yet know the potential significance of home accessibility as a moderator within longitudinal frameworks, nor do we know much about the trajectories of frailty and falls in the context of the accessibility of the home over time. Falls in the home could be due, in part, to a non-accessible home environment. Misalignment between internal competence, represented by frailty, and environmental press, as measured by home accessibility, may offer insights into in-home falls over time for community-dwelling older people.
The study sample for this dissertation included all National Health and Aging Trends Study respondents who were residing in their homes at the time of the 2011 interview. Subsequent rounds of observations from this cohort, from 2012 through 2020, were merged to create a respondent-round dataset. This allowed a trajectory analysis tracking the same individuals over time. The main analytic strategy included testing hypotheses using weighted logistic regression models in a multilevel modeling framework.
Hypothesis 1 tested the association between frailty and falling in the home, and this hypothesis was supported by the current study. There results showed that as compared to respondents with no frailty, respondents with more frailty had higher odds ratios of experiencing a fall in the next year. When this growth trajectory is graphed, we can also see that as age increases, the risk of falling increases, and it is consistently higher as levels of frailty increase. Hypothesis 2 tested the association between accessibility of the home and falling in the home and this hypothesis was not supported in the current study. The third hypothesis tested whether home accessibility moderated the relationship between frailty and experiencing a future fall. In other words, this study addressed the question of whether there was positive relationship between frailty and a future in-home fall higher for older people with higher levels of frailty living in less accessible homes as compared to those living in more accessible homes. This hypothesis was somewhat supported in that some of the interaction terms were significant.
The main practice and policy implications from the study findings are related to the first hypothesis. As age increased, the risk of frailty and falls increased. These findings supported clinical frailty assessments using the physical frailty phenotype. In clinical assessments, if an older person scores in the prefrail or frail category, they should be referred by health care providers to a falls risk reduction program, such as Medicaid’s CAPABLE or other programs that aim to reduce falls hazards.
Recommended Citation
Albright, Bonnie, "Frailty, Home Accessibility, and Falls in Later Life" (2025). Graduate Doctoral Dissertations. 1118.
https://scholarworks.umb.edu/doctoral_dissertations/1118
Comments
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