Document Type


Journal/Book Title/Conference

The Gerontologist


Oxford University Press

Publication Date


Journal Article Version

Accepted Manuscript

First Page


Last Page



Background and Objectives: Fall incidents from unsafe home environment are frequent in older-adult homes but the literature is ambiguous whether it is the presence/absence, or the interplay of such conditions and physical functioning that is of salience. We therefore estimated whether unsafe home environment adversely associated with subsequent falls among older adults and what proportion of this association was mediated through limitations in daily and instrumental activities of daily living (ADL/IADL).

Research Design and Methods: Using a nationally representative sample of community-dwelling Medicare beneficiaries (≥65 years) in the 2018-2019 National Health and Aging Trends Study (NHATS; n=2,599), we conducted bivariate and multivariable analyses. We examined baseline conditions of home disorders, unsafe bathroom settings, unsafe house/building features, and house disrepairs in 2018 and their relation with subsequent falls in 2019, after controlling for covariates. To assess whether ADL/IADL limitations mediated this relationship, we employed the Karlson–Holm–Breen (KHB) methodology.

Results: In 2019, the self-reported prevalence of falls among older adults was estimated at 34.68%. While baseline home disorders had both a direct (adjusted Odds Ratio [aOR]: 1.14, 95% Confidence Interval [CI]:1.03,1.26) and an indirect effect through limitations in ADL and IADL (aOR: 1.01; 95%CI: 1.00,1.03), the relation between unsafe bathroom settings and subsequent falls was unclear. Unsafe house/building features and house disrepairs were not statistically significantly related either directly or indirectly with subsequent falls.

Discussion and Implications: Addressing home disorders through policy and housing assessments to highlight home environmental safety would be essential to address falls among older adults.


This is a pre-copyedited, author-produced version of an article accepted for publication in The Gerontologist following peer review. The version of record "Debasree Das Gupta, Uma Kelekar, Sidney C Turner, Older Adult Falls in the Community: Does Unsafe Home Environment Have a Risk Role Through the Mediating Effect of Functional Limitations?, The Gerontologist, 2023;, gnad139" is available online at:

Available for download on Wednesday, October 23, 2024

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