Longitudinal Associations Between Disaster Damage and Falls/Fear of Falling in Older Adults: 9-Year Follow-Up of Survivors of the 2011 Great East Japan Earthquake and Tsunami

Abstract

Background and Objectives Fear of falling and falls are common in older adults. However, their associations with natural disaster exposures remain poorly understood. This study aims to examine longitudinal associations between disaster damage with fear of falling/falls among older disaster survivors. Research Design and Methods In this natural experiment study, the baseline survey (4,957 valid responses) took place 7 months before the 2011 Great East Japan Earthquake and Tsunami, and three follow-ups were conducted in 2013, 2016, 2020. Exposures were different types of disaster damage and community social capital. Outcomes were fear of falling and falls (including incident and recurrent falls). We used lagged outcomes in logistic models adjusting for covariates and further examined instrumental activities of daily living (IADL) as a mediator. Results The baseline sample had a mean (SD) age of 74.8 (7.1) years; 56.4% were female. Financial hardship was associated with fear of falling (OR, 1.75; 95% CI [1.33,2.28]) and falls (OR, 1.29; 95% CI [1.05,1.58]), especially recurrent falls (OR, 3.53; 95% CI [1.90,6.57]). Relocation was inversely linked with fear of falling (OR, 0.57; 95% CI [0.34,0.94]). Social cohesion was protectively associated with fear of falling (OR, 0.82; 95% CI [0.71,0.95]) and falls (OR, 0.88; 95% CI [0.78,0.98]) while social participation increased the risk of these issues. IADL partially mediated observed associations between disaster damage and fear of falling/falls. Discussion and Implications Experiences of material damage rather than psychological trauma were associated with falls and fear of falling, and the increased risk of recurrent falls revealed a process of cumulative disadvantage. Findings could inform targeted strategies for protecting older disaster survivors.

The characteristics and risk factors of fatal falls among adults aged 60 and above in Southwest China

“…Secondly, proactive measures should be implemented for the management of fall-related injury, with a focus on reducing their severity and minimizing disability, along with preventing infections following an injury 29 . Finally, at the community level, enhancing social cohesion could serve as a strategy to mitigate persistent fall-related issues 46 , and integrating palliative care components into public health services may help alleviate the suffering of older adults who have experienced severe falls, particularly those with limited access to specialized treatment.…”