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Purpose <p>Falls have a multifactorial etiology reflecting interactions between intrinsic vulnerabilities and environmental hazards, yet the shared residential built environment remains understudied. This study estimated fall prevalence, quantified within-household clustering, and examined associations of personal factors and dwelling hazards with any fall in the past 12&#xa0;months among older adults in Türkiye.</p> Methods <p>This cross-sectional secondary analysis utilized the nationally representative 2023 Türkiye Older Persons Profile Survey. The sample comprised 11,657 community-dwelling adults aged ≥ 65&#xa0;years nested within 8754 households. The outcome was self-reported any fall in the past 12&#xa0;months. We employed a dual-estimand framework, utilizing design-based survey-weighted logistic regression for population-averaged (design-based) estimates and mixed-effects logistic regression with a household-level random intercept for household-conditional (random-intercept) associations.</p> Results <p>The survey-weighted 12-month fall prevalence was 24.0% (confidence interval [95% CI] 23.2–24.9). In the fully adjusted household-conditional (random-intercept) model, intrinsic vulnerabilities, including regular medication use (odds ratio [OR] 1.50, 95% CI 1.25–1.81), short sleep duration (OR 1.30, 95% CI 1.17–1.44), and functional difficulties, were independently associated with higher fall odds. Independent of these individual factors, indoor structural hazards, inadequate staircase (OR 1.32, 95% CI 1.15–1.52), and inadequate indoor lighting (OR 1.36, 95% CI 1.18–1.56), remained significantly associated with falls. Substantial within-household clustering of fall odds was identified (intraclass correlation coefficient = 0.19; median odds ratio = 2.3).</p> Conclusions <p>Indoor architectural hazards are modifiable correlates of falls embedded within clustered household risk environments. Findings support integrating structured home-hazard screening and structural modifications into routine primary care as part of multifactorial fall-prevention pathways.</p>

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Home hazards and household clustering of falls among older adults in Türkiye: a multilevel analysis

  • 期刊论文

  • 发表日期：

    2026年6月21日

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  • Dursun Yasemin Yayla Keskin,
  • Salih Keskin,
  • Ali Ceylan

摘要

Purpose

Falls have a multifactorial etiology reflecting interactions between intrinsic vulnerabilities and environmental hazards, yet the shared residential built environment remains understudied. This study estimated fall prevalence, quantified within-household clustering, and examined associations of personal factors and dwelling hazards with any fall in the past 12 months among older adults in Türkiye.

Methods

This cross-sectional secondary analysis utilized the nationally representative 2023 Türkiye Older Persons Profile Survey. The sample comprised 11,657 community-dwelling adults aged ≥ 65 years nested within 8754 households. The outcome was self-reported any fall in the past 12 months. We employed a dual-estimand framework, utilizing design-based survey-weighted logistic regression for population-averaged (design-based) estimates and mixed-effects logistic regression with a household-level random intercept for household-conditional (random-intercept) associations.

Results

The survey-weighted 12-month fall prevalence was 24.0% (confidence interval [95% CI] 23.2–24.9). In the fully adjusted household-conditional (random-intercept) model, intrinsic vulnerabilities, including regular medication use (odds ratio [OR] 1.50, 95% CI 1.25–1.81), short sleep duration (OR 1.30, 95% CI 1.17–1.44), and functional difficulties, were independently associated with higher fall odds. Independent of these individual factors, indoor structural hazards, inadequate staircase (OR 1.32, 95% CI 1.15–1.52), and inadequate indoor lighting (OR 1.36, 95% CI 1.18–1.56), remained significantly associated with falls. Substantial within-household clustering of fall odds was identified (intraclass correlation coefficient = 0.19; median odds ratio = 2.3).

Conclusions

Indoor architectural hazards are modifiable correlates of falls embedded within clustered household risk environments. Findings support integrating structured home-hazard screening and structural modifications into routine primary care as part of multifactorial fall-prevention pathways.