Older American Indian and Alaska Native adults with a fear of falling: Prevalence and correlates of falling and falls needing medical treatment

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Turner Goins, Robin Besse, Collette Adamsen This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8562738/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 5 You are reading this latest preprint version Abstract Background Older American Indian and Alaska Native (AIAN) peoples are at greatest risk for falls and fall-related injuries than any race or ethnic group. Compared to same-aged peers of other races, older AIAN peoples have the highest rate of falls. Yet, little research has been pursued that would improve our understanding of falls within this high-risk population. Thus, we descriptively examined falls and falls that needed medical attention as well as their correlates among those with a fear of falling in this at-risk population. Methods We used National Resource Center on Native American Aging survey data collected between 2020 and 2023 from community-dwelling older AIAN peoples. Our analytic sample consisted of data from 6,809 respondents aged ≥ 55 years who had a fear of falling. Logistic regressions were estimated to identify significant correlates of falls and falls that needed medical attention for the entire sample and stratified by gender. Results Findings indicated that 79.3% of the sample had ≥ 1 fall(s) in the past year with a mean of 2.8 ± 5.0 falls. Of those who fell in the past year, 37.2% had ≥ 1 fall(s) needing medical treatment. Correlates for having ≥ 1 fall(s) included male gender, lower annual personal income, depression, and more activities of daily living (ADL) limitations. Correlates of ≥ 1 fall(s) that needed medical treatment included female gender, osteoporosis, poorer self-rated health, and more ADL limitations. For women, correlates of ≥ 1 fall(s) were diabetes, depression, and more ADL limitations, and for men, correlates were lower annual personal income and more ADL limitations. Correlates of falls that needed medical treatment among women were increased body mass index, poorer self-rated health, and more ADL limitations. Correlates of falls that needed medical treatment among men were lower annual personal income, osteoporosis, and more ADL limitations. Conclusion Given AIAN peoples’ increased risk for falls and fall-related injury, it is important that there are efforts to improve our understanding of falls in this population. The need of supporting existing and increasing falls prevention efforts for AIAN peoples will become more critical with the expected growth of this population. Clinical trial number: Not applicable Figures Figure 1 Introduction A fall, or unintentionally or accidentally dropping down to the ground or another lower level, is a major public health concern for older adults due to their high frequency and negative consequences. Most falls occur indoors with approximately 28% of people aged ≥ 65 years in the United States, or 14 million individuals, fell at least once in the past year [ 1 ]. Falls are the leading cause of unintentional injuries among older adults leading to a range of negative outcomes, including physical injury, loss of independence, institutionalization, and death. In fact, half of all unintentional injury-related deaths among older adults are due to falling [ 2 ]. The death rate from unintentional falls for people aged ≥ 65 years is 69.9 per 100,000, with men having higher rates than women. Over the past 20 years, fall-related death rates have steadily risen, with the greatest increase seen in adults aged ≥ 85 years [ 3 ]. The impact of falls on health care costs are also substantial. In the United States, an estimated annual 922,428 inpatient hospitalizations and 2.3 million emergency department visits of older adults are due to falls [ 4 ], costing the health care system approximately $ 80 billion annually for non-fatal falls [ 5 ]. Fear of falling (FOF) is an emotional state where a person feels anxious due to being unable to predict if or when they may fall along with being worried about their vulnerability to falling [ 6 ]. Worldwide, half of older adults have a fear of falling [ 7 ]. This persistent concern about falling often leads to a lack of confidence, activity avoidance, social isolation, and reduced quality of life [ 8 ]. Often FOF turns into a cycle of inactivity and increased fall risk, which has led to a bi-directional association between FOF and falling [ 9 , 10 ]. Fall prevalence varies by race and ethnicity and older American Indian and Alaska Native (AIAN) peoples have a disproportionately higher risk of experiencing a fall than their same-aged peers of other race or ethnicities [ 11 , 12 ]. Researchers found that age adjusted prevalence of at least one fall in the past year among persons aged ≥ 65 years was 36% among AIAN peoples compared to 29% of Whites, 22% of Native Hawaiian and Pacific Islanders, 23% of Blacks, and 24% of Hispanic and Latino persons [ 1 ]. In addition to having an elevated risk for falling, older AIAN peoples have been found more likely to report a fall-related injury (17%) than Whites (11%), Hispanics (11%), and Blacks (8%) [ 11 ]. Further, AIAN peoples have the highest unintentional fall deaths compared to others of different races/ethnicities [ 3 ] with an unintentional fall death rate of 11.9 versus 8.4 for Whites [ 13 ]. However, little is known or understood about FOF among older AIAN peoples [ 14 ] with only one study with a convenience sample of 50 Zuni elders that found 71% had a FOF [ 15 ]. The older AIAN adult population is undergoing a significant demographic shift. Between 2019 and 2060, projections indicate that this population will experience a 2.2-fold increase for those aged ≥ 65 years and a 4.4-fold increase for those aged ≥ 85 years [ 16 ]. Despite the escalating need, older AIAN peoples experience a profound and understudied disparity in falls and fall-related injuries. Crucially, limited research has sought to understand the specific reasons, prevalence, and correlates of falls within this high-risk population hindering the development of effective and responsive fall prevention efforts. Thus, we descriptively examined falls and sociodemographic and health-related correlates of falls among older AIAN peoples with a FOF. Methods Data. Our study analyzed cross-sectional data collected through self-administered surveys. Every three years, the National Resource Center of Native American Aging (NRCNAA) surveys Native Elders who receive Title VI–funded services under the Older Americans Act, administered by the Administration for Community Living. For the present analysis, we used data from the NRCNAA Cycle VIII survey, a comprehensive needs assessment developed by the NRCNAA and conducted between April 2020 and March 2023 (Cycle VIII survey in Supplemental Material). Community-specific findings from this survey are shared by NRCNAA with participating Tribal Nations, and the survey instrument has not been published elsewhere. The analytic sample included older adults from all U.S. regions and represented members of 255 of the 574 federally recognized Tribes at the time of data collection [ 17 ]. This research was approved by the University of North Dakota Institutional Review Board (IRB) and conducted in accordance with the ethical standards of and the 1964 Declaration of Helsinki and its later amendments. In addition, the NRCNAA research team engaged with all participating Tribal Nations and adhered to their respective requirements for research approval. Most Tribal Nations required the NRCNAA to obtain a formal Tribal Council resolution authorizing survey distribution within their communities, and, when applicable, the team also complied with established Tribal IRB protocols. At each participating Tribe, the Title VI Program Director and staff distributed hardcopy surveys to tribal elders. Verbal informed consent was obtained from all participants prior to survey completion. Eligibility for the Title VI Nutrition and Caregiving Program requires that a federally recognized Tribe represent a minimum of 50 American Indian and Alaska Native (AIAN) elders aged ≥ 60 years, although program funds may also be used to serve individuals younger than 60 years. The participating Tribal Nations retain ownership of all data collected by the NRCNAA. Under data-sharing agreements between the University of North Dakota and the participating Tribal Nations, the survey data may be handled and analyzed only by the NRCNAA. Researchers seeking access to these data must therefore contact each participating Tribal Nation individually to request permission. If access is granted, the NRCNAA will transfer to the respective Tribal Nation a data file containing only that Nation’s survey data, which the Tribal Nation may then choose to make available. A total of 21,095 participants completed the survey. For our analyses, we examined participants who were AIAN aged ≥ 55 years. Thus, we excluded participants who did not self-identify as AIAN or who did not report their race ( n = 2,692) and were aged < 55 years or who did not provide their age ( n = 879). We also excluded survey participants who reported that they were not worried about falling ( n = 9,929) or who did not answer the FOF question ( n = 786), resulting in an analytic sample of 6,809 for our study. Measures . We used items in the survey that allowed us to address our study objectives. FOF was captured from responses to the item, “In the last month, did you worry about falling down?” with yes or no response options. Our two dependent variables were falls and falls that needed medical attention. Falls were captured with a single item that asked, “How many falls have you had, if any, in the past year?” We collapsed responses to this item into no falls or ≥ 1 fall(s). Respondents who indicated they had ≥ 1 fall(s), were asked the follow-up question, “In any of these falls, did you injure yourself seriously enough to need medical treatment?” with yes or no response options. The independent variables included sociodemographic and health-related characteristics. For sociodemographic characteristics, age was reported in years and gender was reported as either male or female. We captured whether the participant lived alone or with others by examining responses to a question that asked if they lived with family members, non-family members, with both, or alone. For the analysis, we collapsed responses into either lived along or lived with others. Income captured with the following question, “What is your individual annual income?” with nine response options ranging from $ 0–4,999 to ≥ $ 50,000. We examined 11 health-related characteristics, including body mass index (BMI), arthritis, osteoporosis, diabetes, stroke, depression, self-rated health, vision trouble, hearing trouble, number of over the counter (OTC) and prescription medications, and functional ability. BMI was calculated with the responses to the items, “How tall are you without shoes?” in feet and inches and “How much do you weigh today?” in pounds. We used the Centers for Disease Control and Prevention’s standard BMI categories for adults, which are underweight (< 18.5 kg/m2), normal weight (18.5–24.9 kg/m2), overweight (25.0-29.9 kg/m2) and obese (≥ 30.0 kg/m2) [ 18 ]. Arthritis, osteoporosis, diabetes, stroke, and depression were measured from the yes or no responses to the question “Has a doctor ever told you that you have any of the following diseases…?” Self-rated health was measured with the responses to the question, “Would you say your health in general is excellent, very good, good, fair, or poor?” Vision trouble was determined from yes or no responses to item that asked if the participant had trouble seeing even when wearing corrective lenses. Hearing trouble was determined from the yes or no responses to the item that asked if the participant had trouble hearing even when wearing your hearing aid. The number of over-the-counter medications (OTC) and prescription medications was measured with a single item that asked participants to mark if the following statement was true for them: “I take three or more different prescribed or OTC drugs a day.” Last, we measured functional ability with the responses to the question, “Because of a health or physical problem that last more than three months, did you have any difficulty with the following…”: bathing/showering, dressing, eating, getting in or out of bed, walking, and using and/or getting to the toilet. Respondents identified the activity or activities they had difficulty performing by filling in a space next to each activity, which allowed us to create a count of activities of daily living (ADL) limitations per respondent. Analysis . We generated the count, percentage, mean, and standard deviation (SD) to provide descriptive information on the study’s measures. To identify correlates of our two fall-related outcomes, we estimated two separate binary logistic regression models. The first model explored factors associated with the likelihood of falling [0 = no falls, 1 = ≥ 1 fall(s)] among participants who had a FOF ( n = 6,809). The second model examined correlates of those who required medical attention as the result of a fall (0 = no, 1 = yes) among those who had a FOF and who had reported ≥ 1 fall(s) in the past year ( n = 4,511). We also estimated logistic models stratified by male and female gender for our two outcomes of interest. All the regression models included the same set of independent variables. Categorical variables were dummy coded and included gender, income, BMI, self-rated health, living status, arthritis, diabetes, osteoporosis, stroke, depression, trouble seeing, trouble hearing, and taking ≥ 3 OTC and/or prescription medications a day. Age was treated as a continuous variable, and the total number of ADL limitations was treated as a discrete numeric variable. In calculating ADL limitations, participants who reported no limitations were coded as missing only for this variable, to avoid conflating true zeros with potential missing responses. Prior to our analyses, the data were screened for violations of assumptions across both models. We did not detect any outliers, with all of Cook’s Distance values being under 0.2. Multicollinearity diagnostics were conducted using variance inflation factors (VIF) and tolerance values. All variables had VIFs below two; tolerance values were between .881 and .987 for the first model and .880 and .973 for the second. The assumption of linearity in the logit for the continuous variable of age was tested using the Box-Tidwell procedure and confirmed; this assumption was not applied to the discrete ADL limitations variable due to its non-continuous nature. Categorical predictors met the requirement for minimum expected cell counts in each category. Model fit was assessed using the Hosmer-Lemeshow test, and overall model significance for each was evaluated via the omnibus chi-square test. Odds ratios and 95% confidence intervals were calculated for each independent variable. All analyses were conducted with SPSS Version 31.0 [ 19 ]. Results Our analytic sample had a mean age of 70.8 ± 9.0 with a range of 55–105 years and most (70.8%) were female, 32.5% lived alone, and 58.6% had an annual personal income of ≤ $ 19,999. With respect to health-related characteristics, the mean BMI was 31.1 ± 9.8 which is in the category of obese. Of the five health conditions we examined, the three most prevalent were arthritis (57.9%), diabetes (48.1%), and depression (22.3%). Close to half (47.9%) of the participants had a self-rated health of good/very good or excellent. With respect to sensory abilities, 42.3% and 27.3% reported trouble with vision and hearing, respectively. Forty-two percent took ≥ 3 OTC and/or prescription medications a day and the mean number of ADL limitations was 2.4 ± 1.6 out of a possible six activities. [Insert Table 1 about here] Table 1 Sample characteristics of American Indian and Alaska Native peoples aged ≥ 55 years with a fear of falling Total Sample ≥ 1 Fall(s) ≥ 1 Fall(s) Needed Medical Treatment n = 6809 n = 4511 n = 1633 n (%) Mean ± SD n (%) Mean ± SD n (%) Mean ± SD Age 70.8 ± 9.0 70.6 ± 9.1 70.7 ± 9.3 Gender Females 4,731 (70.8) 3,070 (69.3) 1,179 (73.4) Males 1,955 (29.2) 1,359 (30.7) 427 (26.6) Lives alone 2,119 (32.5) 1,420 (32.7) 521 (33.1) Annual individual income $ 0–9,999 1,590 (26.6) 1,064 (26.8) 420 (29.0) $ 10,000- $ 19,999 1,908 (32.0) 1,293 (32.5) 479 (33.1) $ 20,000- $ 34,999 1,429 (23.9) 955 (24.0) 323 (22.3) $ 35,000- $ 49,999 515 (8.6) 335 (8.4) 122 (8.4) ≥ $ 50,000 527 (8.8) 326 (8.2) 104 (7.2) Body Mass Index 31.1 ± 9.8 30.9 ± 7.8 30.7 ± 8.1 Health Condition Arthritis 3,944 (57.9) 2,690 (59.6) 1,015 (62.2) Osteoporosis 1,074 (15.8) 752 (16.7) 327 (20.0) Diabetes 3,272 (48.1) 2,261 (50.1) 841 (51.5) Stroke 735 (10.8) 552 (12.2) 240 (14.7) Depression 1,520 (22.3) 1,164 (25.8) 465 (28.5) Self-Rated Health Poor 870 (12.9) 673 (15.1) 322 (19.9) Fair 2,636 (39.2) 1,839 (41.3) 665 (41.1) Good/very good 3,063 (45.6) 1,848 (41.5) 601 (37.2) Excellent 152 (2.3) 89 (2.0) 29 (1.8) Vision Trouble 2,676 (42.3) 1,865 (44.5) 737 (48.6) Hearing Trouble 1,601 (27.3) 1,113 (28.7) 404 (28.7) ≥ 3 OTC or Rx medications 2,887 (42.4) 2,004 (44.4) 740 (45.3) ADL Limitations 1.5 ± 1.7 1.7 ± 1.8 2.2 ± 1.9 SD = standard deviation; ADL = Activities of daily living; OTC = over the counter; Rx = prescription medication Descriptively, 79.3% of our sample had ≥ 1 fall(s) in the past year with a mean of 2.8 ± 5.0 falls. Regarding fall frequency, 20.7% had no falls, 43.4% had 1 to 2 fall(s), and 35.9% had ≥ 3 falls in the past year. Of those who fell in the past year, 37.2% had ≥ 1 fall(s) that needed medical attention with a mean of 4.2 ± 5.9 falls. Over half (53.3%) had ≥ 3 falls in the past year. [Insert Figure about here] Table 2 includes the results from the two separate logistic regressions estimating associations between the sociodemographic and health-related characteristics among persons with a FOF with the dependent variables of ≥ 1 fall(s) and ≥ 1 fall(s) that needed medical treatment in the past year. Significant correlates for having ≥ 1 fall(s) in the past year included gender, annual personal income, depression, and ADL limitations. Specifically, females were less likely than males to experience ≥ 1 fall(s) (OR = 0.57, 95% CI = 0.98-1.00). Persons with an annual income of ≥ $ 50,000 were less likely than persons with an annual income between $ 0 and $ 9,999 (OR = 0.66, 95% CI = 0.44–1.01) to experience ≥ 1 fall(s). Persons with depression compared to those without were more likely to experience ≥ 1 fall(s) (OR = 1.45, 95% CI = 1.12–1.88) and persons with an increased number of ADL limitations were more likely to experience ≥ 1 fall(s) (OR = 1.11, 95% CI = 1.03–1.20). Table 2 Logistic regressions estimating ≥ 1 fall(s) and ≥ 1 fall(s) that needed medical treatment in the past year among American Indian and Alaska Native persons aged ≥ 55 years with a fear of falling ≥ 1 Fall(s) ≥ 1 Fall(s) Needed Medical Treatment n = 2556 n = 2083 OR 95% CI OR 95% CI Age 0.99 0.98-1.00 1.00 0.99–1.01 Female 0.57** 0.98-1.00 1.59*** 1.30–1.94 Lives alone 1.04 0.83–1.30 0.90 0.74–1.09 Annual individual income $ 0–9,999 Reference Reference $ 10,000- $ 19,999 0.85 0.65–1.13 1.01 0.80–1.27 $ 20,000- $ 34,999 1.04 0.76–1.43 0.84 0.65–1.09 $ 35,000- $ 49,999 1.09 0.69–1.73 0.91 0.63–1.32 ≥ $ 50,000 0.66* 0.44–1.01 0.78 0.52–1.16 Body Mass Index Under or normal weight Reference Reference Overweight 0.91 0.67–1.25 0.78 0.61–1.01 Obese 0.81 0.61–1.08 0.89 0.70–1.12 Arthritis 0.99 0.79–1.24 1.00 0.82–1.21 Osteoporosis 1.29 0.95–1.76 1.32* 1.03–1.69 Diabetes 1.20 0.96–1.49 1.09 0.91–1.31 Stroke 1.07 0.77–1.50 1.20 0.92–1.56 Depression 1.45* 1.12–1.88 0.93 0.76–1.13 Self-Rated Health Poor Reference Reference Fair 0.92 0.66–1.28 0.72** 0.57–0.93 Very good/good 0.73 0.52–1.03 0.77* 0.59-1.00 Excellent 0.93 0.36–2.38 0.78 0.35–1.76 Vision Trouble 1.18 0.94–1.47 1.05 0.87–1.26 Hearing Trouble 1.19 0.92–1.53 1.01 0.82–1.23 Takes ≥ 3 OTC or Rx medications 0.94 0.75–1.17 1.22 0.71–1.02 ADL Limitations 1.11** 1.03–1.20 1.22*** 1.15–1.29 OR = Odds ratio; CI = Confidence interval; OTC = Over-the-counter; Rx = Prescription; ADL = Activities of daily living; ***≤ 0.001; **≤ 0.01; *≤ 0.05 Significant correlates of ≥ 1 fall(s) in the past year that needed medical treatment included gender, osteoporosis, self-rated health, and ADL limitations. Specifically, females compared than males (OR = 1.59, 95% CI = 1.30–1.94) and persons with osteoporosis than persons without (OR = 1.32, 95% CI = 1.03–1.69) were more likely to experience ≥ 1 fall(s) that needed medical treatment. Persons with fair (OR = 0.72, 95% CI = 0.57–0.93) and very good or good (OR = 0.77, 95% CI = 0.59-1.00) self-rated health compared to poor self-rated health were less likely to experience ≥ 1 fall(s) that needed medical treatment. Persons with an increased number of ADL limitations were more likely to experience of ≥ 1 fall(s) that needed medical treatment (OR = 1.22, 95% CI = 1.15–1.29). [Insert Table 2 about here] Table 3 has the gender stratified results for four separate logistic regressions estimating associations between the sociodemographic and health-related characteristics for the same two fall-related outcomes. For the outcome of experiencing ≥ 1 fall(s) in the past year, significant correlates for women were diabetes (OR = 1.30, 95% CI = 1.01–1.67), depression (OR = 1.45, 95% CI = 1.08–1.93), and increased number of ADL limitations (OR = 1.10, 95% CI = 1.01–1.20). While, among men, significant correlates were annual personal income of ≥ $ 50,000 compared to < $ 10,000 (OR = 0.36, 95% CI = 0.16–0.83) and increased number of ADL limitations (OR = 1.17, 95% CI = 1.00-1.37). Table 3 Logistic regressions estimating ≥ 1 fall(s) and ≥ 1 fall(s) that needed medical treatment in the past year among American Indian and Alaska Native persons aged ≥ 55 years with a fear of falling by gender ≥ 1 Fall(s) ≥ 1 Fall(s) Needed Medical Treatment n = 1755 n = 801 n = 1389 n = 694 Females Males Females Males OR 95% CI OR 95% CI OR 95% CI OR 95% CI Age 0.99 0.98-1.00 1.01 0.98–1.03 1.00 0.98–1.01 1.00 0.98–1.01 Lives alone 1.13 0.87–1.47 0.81 0.50–1.30 0.84 0.67–1.07 1.04 0.74–1.46 Annual individual income $ 0–9,999 Reference Reference Reference Reference $ 10,000- $ 19,999 0.96 0.70–1.32 0.56 0.30–1.06 1.08 0.81–1.42 0.89 0.58–1.36 $ 20,000- $ 34,999 1.12 0.79–1.59 0.77 0.38–1.58 0.84 0.62–1.15 0.84 0.52–1.33 $ 35,000- $ 49,999 1.33 0.78–2.27 0.56 0.22–1.42 0.98 0.62–1.53 0.79 0.40–1.55 ≥ $ 50,000 0.81 0.49–1.32 0.36* 0.16–0.83 1.00 0.62–1.63 0.40* 0.18–0.93 Body Mass Index Under or normal weight Reference Reference Reference Reference Overweight 0.80 0.55–1.15 1.30 0.70–2.40 0.61** 0.44–0.83 1.30 0.83–2.02 Obese 0.75 0.54–1.05 0.99 0.56–1.74 0.78 0.58–1.03 1.18 0.77–1.82 Arthritis 1.01 0.78–1.31 0.98 0.62–1.55 1.03 0.81–1.30 0.95 0.68–1.34 Osteoporosis 1.30 0.94–1.79 1.33 0.50–3.52 1.15 0.88–1.51 2.68*** 1.48–4.85 Diabetes 1.30* 1.01–1.67 0.92 0.60–1.45 1.18 0.95–1.48 0.89 0.64–1.24 Stroke 1.13 0.75–1.69 0.97 0.53–1.78 1.31 0.93–1.85 0.98 0.64–1.52 Depression 1.45** 1.08–1.93 1.49 0.82–2.69 0.96 0.76–1.23 0.79 0.54–1.16 Self-Rated Health Poor Reference Reference Reference Reference Fair 0.93 0.63–1.36 0.91 0.48–1.75 0.68* 0.50–0.94 0.79 0.52–1.20 Good/very good/Excellent 0.79 0.53–1.16 0.61 0.31–1.19 0.76 0.55–1.06 0.75 0.47–1.19 Vision Trouble 1.16 0.90–1.50 1.18 0.75–1.87 1.11 0.88–1.39 0.86 0.62–1.21 Hearing Trouble 1.22 0.90–1.64 1.05 0.64–1.72 0.99 0.77–1.29 1.00 0.70–1.41 Takes ≥ 3 OTC or Rx medications 0.93 0.72–1.19 0.99 0.63–1.56 0.81 0.65–1.02 0.91 0.65–1.27 ADL Limitations 1.10* 1.01–1.20 1.17* 1.00-1.37 1.19*** 1.11–1.27 1.30*** 1.18–1.45 OR = Odds ratio; CI = Confidence interval; OTC = Over-the-counter; Rx = Prescription; ADL = Activities of daily living ***≤ 0.001; **≤ 0.01; *≤ 0.05 [Insert Table 3 about here] For the outcome of experiencing ≥ 1 fall(s) in the past year that needed medical attention, significant correlates for women were overweight compared to persons of normal or underweight (OR = 0.61, 95% CI = 0.44–0.83), fair compared to poor self-rated health (OR = 0.68, 95% CI = 0.50–0.94), and increased number of ADL limitations (OR = 1.19, 95% CI = 1.11–1.27). While, among men, significant correlates were annual personal income of ≥ $ 50,000 compared to < $ 10,000 (OR = 0.40, 95% CI = 0.18–0.93), osteoporosis (OR = 2.68, 95% CI = 1.48–4.85), and increased number of ADL limitations (OR = 1.30, 95% CI = 1.18–1.45). Discussion In our study population of community-dwelling AIAN adults aged ≥ 55 years with a FOF, 79.3% experienced ≥ 1 fall(s) in the past year with an average of 2.8 falls. Among those who had fallen at least once in the past year, 37.2% had ≥ 1 fall(s) that needed medical treatment. Research has found that persons with a FOF compared to those without, experience more falls with approximately 70% of community-dwelling adults aged ≥ 65 years with a FOF have fallen at least once in the past year [ 20 ]. Among those with a FOF and one prior fall, had an average number of 0.73 falls and those with multiple prior falls, had an average of 2.6 falls [ 20 ]. The prevalence of ≥ 1 fall(s) was relatively high in our study as prior research with community-dwelling older adults have found a range of 37% to 71% among those with a FOF who fell in the prior 12 months [ 20 , 21 , 22 ]. We were unable to locate published data on the prevalence of needing medical treatment for a fall among persons with a FOF and thus do not know how our finding differs from prior estimates. We do know, however, that health care costs associated with nonfatal falls in the U.S. was estimated to be $ 80 billion for 2020 [ 5 ]. Correlates of ≥ 1 fall(s) in our study population were male gender, increased income, depression, and increased number of ADL limitations. These significant correlates with falling are also documented in prior studies in other older adult populations apart from gender. That is, overall, prior research suggests that women are more likely to fall than men [ 1 , 23 ] although men in our sample were more likely to have a fall than women. A systematic review found that measures of socioeconomic status, including income, were associated with falls where lower socioeconomic status was associated with increased fall risk [ 24 ]. Other research also found that measures of poorer mental health, including depression, are associated with an increased likelihood of falling [ 1 , 23 ]. In a recent meta-analysis, most of the studies found an association between depression and falling although there was not a pooled effect size between depression and the likelihood of falling [ 25 ]. Correlates of ≥ 1 fall(s) that needed medical treatment were female gender, osteoporosis, poorer self-rated health, and increased number of ADL limitations. The association of gender with falls that need medical treatment seems to be less definitive in the published literature. Women have been found to be more likely to experience a fall that resulted in an injury than men [ 26 ] and men have been found to experience a death because of a fall [ 3 ]. The gender stratified analyses revealed that men with higher income were less likely to have ≥ 1 fall(s) or at least one fall that needed medical treatment while income was not associated with either outcome in women. The stratified regressions also revealed gender differences with respect to the role of health conditions and our two falls-related outcomes. For women, the presence of diabetes and depression were associated with having ≥ 1 fall(s) and lower BMI was associated with having ≥ 1 fall(s) that needed medical treatment. All three conditions, diabetes [ 27 ], depression [ 23 ], and underweight [ 28 ] have been found positively associated with falling in prior research. For men, the presence of osteoporosis was associated with having ≥ 1 fall(s). Osteoporosis among men has been less studied given that it is less prevalent than in women. In the United States, 6% of men and 27% of women aged ≥ 65 years have osteoporosis [ 29 ]. While our findings suggest the importance of screening men for osteoporosis, most health insurance companies do not cover this procedure for men while it is for women despite research indicating that screening older men and follow-up treatment is cost-effective [ 30 ]. There are a few limitations of our study that need to be taken into consideration. First, the surveys were distributed by Title VI staff and self-administered. This approach likely introduced inconsistencies as to how the surveys were distributed across Title VI sites. Further, the self-administered nature of the survey can introduce important methodological issues that can impact the data such as social desirability bias, recall bias, literacy, and misinterpretation of questions due to the absence of an interviewer to clarify questions. Also, we were limited to the information collected in the survey and unable to, for example, examine with greater specificity the exact number and type of OTC and prescription medications. While simultaneously taking ≥ 5 medications is typically used to measure polypharmacy, the nature in which medication use was asked made it so we were unable to examine it in our study. Last, for BMI, there were an insufficient number of respondents who were classified as underweight, so we collapsed the BMI categories of under and normal weight. Consequently, our analysis we were unable to examine the association of underweight with our two outcomes of interest or to examine if there were gender differences with respect to these associations. Our study was motivated by the limited understanding of falls among older AIAN adults and reasons for why fall prevalence is notably higher in this population than other older adult populations. Future research needs to continue examining descriptively FOF, falls, and falls that need medical care in this population. Future research is warranted that examines correlates or predictors of falls and falls that led to medical care with other data and with an eye towards appreciating falls-related protective and modifiable risk factors. Greater understandings can help inform existing and future fall prevention efforts. Further, the role of gender deserves greater investigation especially with respect to the role of osteoporosis in AIAN men and fall-related injury. Unintentional falls have been shown to contribute to the highest number and proportion of traumatic brain injury-related emergency department visits among Indian Health Service and tribally managed health care facilities [ 31 ]. Also, falls have the highest incidence and are the costliest type of injury among all age groups in the Indian Health Service user population, representing an incidence rate of 2,904 per 100,000 person years and $ 653 million in lifetime medical costs for injuries occurring in 2011–2015 [ 32 ]. Undoubtedly, the need for fall prevention for AIAN peoples will become more critical with the expected growth of this population. While there is relatively limited research investigating the reasons for the alarming falls disparity experienced by AIAN peoples and identify their falls-related protective and risk factors, there have been substantial efforts across Tribal communities. The Indian Health Service’s Injury Prevention Program is an important effort in supporting Tribally led fall prevention efforts. This program enables Tribes to develop strategies that are both evidence-based and culturally integrated. Elder-focused falls prevention efforts have been a common activity among the Tribes with 16 of the 27 programs during the last funding cycle (2020–2025) (Personal communication, J. Russell 11/19/25). Also, a recent review of articles in the Indian Health Service Primary Care Provider Newsletter on unintentional injury prevention efforts in AIAN communities found that the most common articles were focused on falls-related injury prevention [ 33 ]. Conclusions Our study highlights the substantial burden of falls and fall-related injuries among community-dwelling older AIAN adults who experience FOF, revealing both a markedly high prevalence of falls and a considerable proportion requiring medical treatment. Our findings underscore the importance of sociodemographic and health—particularly depression, diabetes, osteoporosis, and ADL limitations—and demonstrate that risk profiles differ for men and women. These results point to an urgent need for additional fall prevention strategies that are culturally responsive, gender-informed, and tailored to the unique health realities of older AIAN peoples. As this population continues to grow rapidly, expanding research that identifies modifiable risk factors, explores protective influences, and evaluates community-driven and tribally led prevention efforts will be essential. Strengthening such efforts has the potential to reduce injuries, improve quality of life, and support the well-being and independence of AIAN elders across Tribal Nations. Declarations Ethics approval and consent to participate: This research was approved by the University of North Dakota’s institutional review board (IRB) and conducted in accordance with the ethical standards of and the 1964 Declaration of Helsinki and its later amendments. Further, the National Resource Center for Native American Aging (NRCNAA) research team received a Tribal resolution from the official Tribal Council for participating sites for survey distribution in their respective communities. When required, the NRCNAA team also followed established Tribal IRB protocols to obtain approval. Verbal informed consent was obtained from all participants prior to survey completion. Consent for publication: Not applicable. Funding: This work was supported, in part, by funding from the US Administration on Community Living, Department of Health and Human Services to the NRCNAA at the University of North Dakota (90OIRC0003). Author Contribution RTG: Conceptualization, methodology, visualization, and lead writing of the manuscript.RB: Formal analysis, data curation, and drafting of the manuscript (Methods).CA: Project administration, funding acquisition/oversight (as Director), investigation (data collection), and manuscript review and editing.All authors: Read and approved the final manuscript. Acknowledgement We would like to thank Mandi-Leigh Peterson, a Senior Research Analyst with the North Dakota Healthcare Workforce Group at the University of North Dakota, for their input on the study’s analytic approach. Data Availability The participating Tribal Nations retain ownership of all data collected by the NRCNAA. Under data-sharing agreements between the University of North Dakota and the participating Tribal Nations, the survey data may be handled and analyzed only by the NRCNAA. Researchers seeking access to these data must therefore contact each participating Tribal Nation individually to request permission. If access is granted, the NRCNAA will transfer to the respective Tribal Nation a data file containing only that Nation’s survey data, which the Tribal Nation may then choose to make available. References Kahara R, Bergen G, Burns E, Stevens M. Nonfatal and fatal falls among adults aged ≥ 65 years—United States, 2020–2021. MMWR Morb Mortal Wkly Rep. 2023;72(35):938–43. Kahara R, Lee R, Eckstrom EN. Cause-specific mortality among adults aged ≥ 65 years in the United States, 1999–2020. Public Health Rep. 2024;139(1):54–8. 10.1177/00333549231155869 . Garnett MF, Weeks JD, Zehner AM. Unintentional fall death in adults aged 65 and older: United States, 2023. NCHS Data Brief 2025;(532). Reider L, Falvey JR, Okoye SM, Wolff JL, Levy JF. Cost of US emergency department and inpatient visits for fall injuries in older adults. Injury. 2024;55:111199. 10.1016/j.injury.2023.111199 . Haddad YK, Miller GF, Kakara R, Florence C, Bergen G, Burns ER, Atherly A. Healthcare spending for non-fatal falls among older adults, USA. Inj Prev. 2024;30:272–6. 10.1136/ip-2023-045023 . Lee D, Tak SH. A concept analysis of fear of falling in older adults: insights from qualitative research studies. BMC Geriatr. 2023;23:651. 10.1186/s12877-023-04364-5 . Xiong W, Wang D, Ren W, Liu X, Wen R, Luo Y. Global prevalence and risk factors for fear of falling among older adults: a systematic review and meta-analysis. BMC Geriatr. 2024;24(321):1–28. 10.1186/s12877-024-04882-w . Schoene D, Heller C, Aung YN, Sieber CC, Wolfgang K, Freiberger E. The influence of fear of falling on quality of life in older people: is there a role for falls? Clin Interv Aging. 2019;14:701–19. 10.2147/CIA.S197857 . Freidman SM, Munoz B, West SK, Rubin GS, Fried LP. Falls and fear of falling: which comes first? A longitudinal prediction model suggests strategies for primary and secondary prevention. J Am Geriatr Soc. 2002;50(8):1329–35. MacKay S, Ebert P, Harbidge C, Hogan DB. Fear of falling in older adults: a scoping review of recent literature. Can Geriatr J. 2021;24(4):379–94. Bergen G, Stevens MR, Burns ER. Falls and fall injuries among adults aged ≥ 65 years—United States, 2014. MMWR Morb Mortal Wkly Rep. 2016;65(37):993–8. Moreland BL, Kakara R, Haddad YK, Shakya I, Bergen G. A descriptive analysis of location of older adult falls resulting in emergency department visits in the United States, 2015. Am J Lifestyle Med. 2021;15(6):590–7. 10.1177/1559827620942187 . Murphy T, Pokhrel P, Worthington A, Billie H, Sewell M, Bill N. Unintentional injury mortality among American Indians and Alaska Natives in the United States, 1990–2009. Am J Public Health. 2014;104(Suppl):S470–80. Whitmore C, Neil-Sztramko S, Grenier S, Gough A, Goodarzi Z, Weir E, et al. Factors associated with anxiety and fear of falling in older adults: a rapid systematic review of reviews. PLoS ONE. 2024;19(12):e0315185. 10.1371/journal.pone.0315185 . Popp J, Waters DL, Leekity K, Ghahate D, Bobelu J, Tsikewa R, et al. Using the CDC’s Stay Independent Checklist to engage a community of American Indians and raise awareness about fall risk, 2016. Prev Chronic Dis. 2017;14:E05. 10.5888/pcd14.160395 . Administration for Community Living. 2020 Profile of American Indians and Alaska Natives age 65 years and older. U.S. Department of Health and Human Services; 2021. Available from: https://acl.gov/sites/default/files/Profile%20of%20OA/AIANProfileReport2021.pdf . Accessed 2025 Nov 28. Bureau of Indian Affairs. Indian entities recognized by and eligible to receive services from the United States Bureau of Indian Affairs. Fed Reg. 2024;89(5):944–8. Centers for Disease Control and Prevention. Defining Adult Overweight and Obesity. 2021. Available from: https://www.cdc.gov/obesity/adult/defining.html . Accessed 2021 Sep. IBM Corp. IBM SPSS Statistics for Windows . Version 31.0, IBM Corp., 2025. Asai T, Oshima K, Fukumoto Y, Yonezawa Y, Matsuo A, Misu S. The association between fear of falling and occurrence of falls: a one-year cohort study. BMC Geriatr. 2022;22:393. 10.1186/s12877-022-03018-2 . Lavendan A, Viladrosa M, Jurschik P, Botigue T, Nuin C, Masot O, et al. Fear of falling in community-dwelling older adults: a cause of falls, a consequence, or both? PLoS ONE. 2018;13(3):e0194967. 10.1371/journal.pone.0194967 . Ozturk GB, Kilic C, Bozkurt ME, Karan MA. Prevalence and associates of fear of falling among community-dwelling older adults. J Nutr Health Aging. 2021;25(4):433–9. 10.1007/s12603-020-1535-9 . Li Y, Hou L, Zhao H, Xie R, Yi Y, Ding X. Risk factors for falls among community-dwelling older adults: a systematic review and meta-analysis. Front Med. 2023;9:1019094. 10.3389/fmed.2022.1019094 . Choi SD, Andrade EL. Multiple-level fall risks associated with socioeconomic factors among community-dwelling older adults: a systematic review. Ind Syst Eng Rev. 2022;10(1):10–27. 10.37266/ISER.2022v10i1.pp10-27 . Gambaro E, Gramaglia C, Azzolina D, Campani D, Dal Molin A, Zeppegno P. The complex associations between late life depression, fear of falling and risk of falls: a systematic review and meta-analysis. Ageing Res Rev. 2022;73:101532. 10.1016/j.arr.2021.101532 . Ek S, Rizzuto D, Fratiglioni L, Calderon-Larranaga A, Johnell K, Sjoberg L, Xu W, Welmer A-K. Risk factors for injurious falls in older adults: the role of sex and length of follow-up. J Am Geriatr Soc. 2019;67:246–53. 10.1111/jgs.15657 . Geng Y, Lo JC, Brickner L, Gordon NP. Racial-ethnic differences in fall prevalence among older women: a cross-sectional survey study. BMC Geriatr. 2017;17:65. 10.1186/s12877-017-0447-y . Handrigan GA, Maltais N, Gagne M, Lamontagne P, Hamel D, Teasdale N, et al. Sex-specific association between obesity and self-reported falls and injuries among community-dwelling Canadians aged 65 years and older. Osteoporos Int. 2017;28:483–94. 10.1007/s00198-016-3745-x . Sarafrazi N, Wambogo EA, Shepherd JA. Osteoporosis or low bone mass in older adults: United States, 2017–2018. NCHS Data Brief, no 405. Hyattsville, MD: National Center for Health Statistics. 2021. https://dx.doi.org/10.15620/cdc:103477 Schousboe JT, Taylor BC, Fink HA, Kane RL, Cummings SR, Orwoll ES, et al. Cost-effectiveness of bone densitometry followed by treatment of osteoporosis in older men. JAMA. 2007;298(6):629–37. Sarmiento K, Kennedy J, Daugherty J, Peterson AB, Evans ME, Haberling DL, Bille H. Traumatic brain injury–related emergency department visits among American Indian and Alaska Native persons, 2005–2014. J Head Trauma Rehabil. 2020;35(5):E441–9. 10.1097/HRT.0000000000000570 . Honeycutt AA, Khavjou O, Neuwahl SJ, King GA, Anderson M, Lorden A, Reed M. Incidence, deaths, and lifetime costs of injury among American Indians and Alaska Natives. Inj Epidemiol. 2019;6:44. 10.1186/s40621-019-0221-z . Shields W, Kenney A, Shiang E, Malizia R, Billie H. Unintentional injury prevention in American Indian and Alaska Native communities: a scoping review of the Indian Health Service Primary Care Provider newsletter. Inj Epidemiol. 2024;11:27. 10.1186/s40621-024-00509-1 . Additional Declarations No competing interests reported. Supplementary Files IONCycleVIII1.pdf Cite Share Download PDF Status: Under Review Version 1 posted Reviewers invited by journal 06 Feb, 2026 Editor assigned by journal 06 Feb, 2026 Editor invited by journal 19 Jan, 2026 Submission checks completed at journal 16 Jan, 2026 First submitted to journal 16 Jan, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Turner Goins","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAsElEQVRIiWNgGAWjYLCCBAYGOQiLjRjlbBAtxiRqAYLEBqK1mM9vv/jg4Y669A3HzxgwfCg7TFiLzDGeYoPEM4dzN5zJMWCccY4ILRJsPGkSiW0Hcrfd4DFg5m0jXktduhlIy1/itLAfA2phTgBrYSROSw6zQWLbYcP9Z9IKDvacSydCC/Pxhw9/ttXJS7Yf3vjgR5k1YS0MDDwGcOYBYtQDAfsDIhWOglEwCkbBiAUAY0M37p33i6kAAAAASUVORK5CYII=","orcid":"","institution":"Western Carolina University","correspondingAuthor":true,"prefix":"","firstName":"R.","middleName":"Turner","lastName":"Goins","suffix":""},{"id":588422330,"identity":"bcb6bcc5-15e9-4226-a927-1d2b533bf313","order_by":1,"name":"Robin Besse","email":"","orcid":"","institution":"University of North Dakota","correspondingAuthor":false,"prefix":"","firstName":"Robin","middleName":"","lastName":"Besse","suffix":""},{"id":588422331,"identity":"2879be3e-091e-4572-81bf-a8e725eacfec","order_by":2,"name":"Collette Adamsen","email":"","orcid":"","institution":"University of North Dakota","correspondingAuthor":false,"prefix":"","firstName":"Collette","middleName":"","lastName":"Adamsen","suffix":""}],"badges":[],"createdAt":"2026-01-09 16:08:28","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8562738/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8562738/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":102384347,"identity":"9268e9f9-b916-4ec3-aec8-14d3e9e00c48","added_by":"auto","created_at":"2026-02-11 07:25:57","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":54129,"visible":true,"origin":"","legend":"\u003cp\u003eSee image above for figure legend\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-8562738/v1/74395a859134fd5a028a979e.png"},{"id":102398436,"identity":"56e15e14-635b-4501-a5f7-640a3fb189f0","added_by":"auto","created_at":"2026-02-11 10:22:42","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1093949,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8562738/v1/be058bb3-3266-4b24-a3ee-41e9eedf8e06.pdf"},{"id":102384339,"identity":"70037d4c-d121-49b1-b51e-8c6ab3469787","added_by":"auto","created_at":"2026-02-11 07:25:54","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":2162846,"visible":true,"origin":"","legend":"","description":"","filename":"IONCycleVIII1.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8562738/v1/e3d1810584d33f80ff2980f5.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Older American Indian and Alaska Native adults with a fear of falling: Prevalence and correlates of falling and falls needing medical treatment","fulltext":[{"header":"Introduction","content":"\u003cp\u003eA fall, or unintentionally or accidentally dropping down to the ground or another lower level, is a major public health concern for older adults due to their high frequency and negative consequences. Most falls occur indoors with approximately 28% of people aged\u0026thinsp;\u0026ge;\u0026thinsp;65 years in the United States, or 14\u0026nbsp;million individuals, fell at least once in the past year [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Falls are the leading cause of unintentional injuries among older adults leading to a range of negative outcomes, including physical injury, loss of independence, institutionalization, and death. In fact, half of all unintentional injury-related deaths among older adults are due to falling [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. The death rate from unintentional falls for people aged\u0026thinsp;\u0026ge;\u0026thinsp;65 years is 69.9 per 100,000, with men having higher rates than women. Over the past 20 years, fall-related death rates have steadily risen, with the greatest increase seen in adults aged\u0026thinsp;\u0026ge;\u0026thinsp;85 years [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. The impact of falls on health care costs are also substantial. In the United States, an estimated annual 922,428 inpatient hospitalizations and 2.3\u0026nbsp;million emergency department visits of older adults are due to falls [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e], costing the health care system approximately \u003cspan\u003e$\u003c/span\u003e80\u0026nbsp;billion annually for non-fatal falls [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eFear of falling (FOF) is an emotional state where a person feels anxious due to being unable to predict if or when they may fall along with being worried about their vulnerability to falling [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Worldwide, half of older adults have a fear of falling [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. This persistent concern about falling often leads to a lack of confidence, activity avoidance, social isolation, and reduced quality of life [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Often FOF turns into a cycle of inactivity and increased fall risk, which has led to a bi-directional association between FOF and falling [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eFall prevalence varies by race and ethnicity and older American Indian and Alaska Native (AIAN) peoples have a disproportionately higher risk of experiencing a fall than their same-aged peers of other race or ethnicities [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Researchers found that age adjusted prevalence of at least one fall in the past year among persons aged\u0026thinsp;\u0026ge;\u0026thinsp;65 years was 36% among AIAN peoples compared to 29% of Whites, 22% of Native Hawaiian and Pacific Islanders, 23% of Blacks, and 24% of Hispanic and Latino persons [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn addition to having an elevated risk for falling, older AIAN peoples have been found more likely to report a fall-related injury (17%) than Whites (11%), Hispanics (11%), and Blacks (8%) [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Further, AIAN peoples have the highest unintentional fall deaths compared to others of different races/ethnicities [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e] with an unintentional fall death rate of 11.9 versus 8.4 for Whites [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. However, little is known or understood about FOF among older AIAN peoples [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] with only one study with a convenience sample of 50 Zuni elders that found 71% had a FOF [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe older AIAN adult population is undergoing a significant demographic shift. Between 2019 and 2060, projections indicate that this population will experience a 2.2-fold increase for those aged\u0026thinsp;\u0026ge;\u0026thinsp;65 years and a 4.4-fold increase for those aged\u0026thinsp;\u0026ge;\u0026thinsp;85 years [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Despite the escalating need, older AIAN peoples experience a profound and understudied disparity in falls and fall-related injuries. Crucially, limited research has sought to understand the specific reasons, prevalence, and correlates of falls within this high-risk population hindering the development of effective and responsive fall prevention efforts. Thus, we descriptively examined falls and sociodemographic and health-related correlates of falls among older AIAN peoples with a FOF.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eData. Our study analyzed cross-sectional data collected through self-administered surveys. Every three years, the National Resource Center of Native American Aging (NRCNAA) surveys Native Elders who receive Title VI\u0026ndash;funded services under the Older Americans Act, administered by the Administration for Community Living. For the present analysis, we used data from the NRCNAA Cycle VIII survey, a comprehensive needs assessment developed by the NRCNAA and conducted between April 2020 and March 2023 (Cycle VIII survey in Supplemental Material). Community-specific findings from this survey are shared by NRCNAA with participating Tribal Nations, and the survey instrument has not been published elsewhere. The analytic sample included older adults from all U.S. regions and represented members of 255 of the 574 federally recognized Tribes at the time of data collection [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e This research was approved by the University of North Dakota Institutional Review Board (IRB) and conducted in accordance with the ethical standards of and the 1964 Declaration of Helsinki and its later amendments. In addition, the NRCNAA research team engaged with all participating Tribal Nations and adhered to their respective requirements for research approval. Most Tribal Nations required the NRCNAA to obtain a formal Tribal Council resolution authorizing survey distribution within their communities, and, when applicable, the team also complied with established Tribal IRB protocols.\u003c/p\u003e \u003cp\u003eAt each participating Tribe, the Title VI Program Director and staff distributed hardcopy surveys to tribal elders. Verbal informed consent was obtained from all participants prior to survey completion. Eligibility for the Title VI Nutrition and Caregiving Program requires that a federally recognized Tribe represent a minimum of 50 American Indian and Alaska Native (AIAN) elders aged\u0026thinsp;\u0026ge;\u0026thinsp;60 years, although program funds may also be used to serve individuals younger than 60 years.\u003c/p\u003e \u003cp\u003eThe participating Tribal Nations retain ownership of all data collected by the NRCNAA. Under data-sharing agreements between the University of North Dakota and the participating Tribal Nations, the survey data may be handled and analyzed only by the NRCNAA. Researchers seeking access to these data must therefore contact each participating Tribal Nation individually to request permission. If access is granted, the NRCNAA will transfer to the respective Tribal Nation a data file containing only that Nation\u0026rsquo;s survey data, which the Tribal Nation may then choose to make available.\u003c/p\u003e \u003cp\u003eA total of 21,095 participants completed the survey. For our analyses, we examined participants who were AIAN aged\u0026thinsp;\u0026ge;\u0026thinsp;55 years. Thus, we excluded participants who did not self-identify as AIAN or who did not report their race (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;2,692) and were aged\u0026thinsp;\u0026lt;\u0026thinsp;55 years or who did not provide their age (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;879). We also excluded survey participants who reported that they were not worried about falling (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;9,929) or who did not answer the FOF question (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;786), resulting in an analytic sample of 6,809 for our study.\u003c/p\u003e \u003cp\u003e \u003cb\u003eMeasures\u003c/b\u003e. We used items in the survey that allowed us to address our study objectives. FOF was captured from responses to the item, \u0026ldquo;In the last month, did you worry about falling down?\u0026rdquo; with yes or no response options. Our two dependent variables were falls and falls that needed medical attention. Falls were captured with a single item that asked, \u0026ldquo;How many falls have you had, if any, in the past year?\u0026rdquo; We collapsed responses to this item into no falls or \u0026ge;\u0026thinsp;1 fall(s). Respondents who indicated they had\u0026thinsp;\u0026ge;\u0026thinsp;1 fall(s), were asked the follow-up question, \u0026ldquo;In any of these falls, did you injure yourself seriously enough to need medical treatment?\u0026rdquo; with yes or no response options.\u003c/p\u003e \u003cp\u003eThe independent variables included sociodemographic and health-related characteristics. For sociodemographic characteristics, age was reported in years and gender was reported as either male or female. We captured whether the participant lived alone or with others by examining responses to a question that asked if they lived with family members, non-family members, with both, or alone. For the analysis, we collapsed responses into either lived along or lived with others. Income captured with the following question, \u0026ldquo;What is your individual annual income?\u0026rdquo; with nine response options ranging from \u003cspan\u003e$\u003c/span\u003e0\u0026ndash;4,999 to \u0026ge; \u003cspan\u003e$\u003c/span\u003e50,000.\u003c/p\u003e \u003cp\u003eWe examined 11 health-related characteristics, including body mass index (BMI), arthritis, osteoporosis, diabetes, stroke, depression, self-rated health, vision trouble, hearing trouble, number of over the counter (OTC) and prescription medications, and functional ability. BMI was calculated with the responses to the items, \u0026ldquo;How tall are you without shoes?\u0026rdquo; in feet and inches and \u0026ldquo;How much do you weigh today?\u0026rdquo; in pounds. We used the Centers for Disease Control and Prevention\u0026rsquo;s standard BMI categories for adults, which are underweight (\u0026lt;\u0026thinsp;18.5 kg/m2), normal weight (18.5\u0026ndash;24.9 kg/m2), overweight (25.0-29.9 kg/m2) and obese (\u0026ge;\u0026thinsp;30.0 kg/m2) [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eArthritis, osteoporosis, diabetes, stroke, and depression were measured from the yes or no responses to the question \u0026ldquo;Has a doctor ever told you that you have any of the following diseases\u0026hellip;?\u0026rdquo; Self-rated health was measured with the responses to the question, \u0026ldquo;Would you say your health in general is excellent, very good, good, fair, or poor?\u0026rdquo; Vision trouble was determined from yes or no responses to item that asked if the participant had trouble seeing even when wearing corrective lenses. Hearing trouble was determined from the yes or no responses to the item that asked if the participant had trouble hearing even when wearing your hearing aid. The number of over-the-counter medications (OTC) and prescription medications was measured with a single item that asked participants to mark if the following statement was true for them: \u0026ldquo;I take three or more different prescribed or OTC drugs a day.\u0026rdquo;\u003c/p\u003e \u003cp\u003eLast, we measured functional ability with the responses to the question, \u0026ldquo;Because of a health or physical problem that last more than three months, did you have any difficulty with the following\u0026hellip;\u0026rdquo;: bathing/showering, dressing, eating, getting in or out of bed, walking, and using and/or getting to the toilet. Respondents identified the activity or activities they had difficulty performing by filling in a space next to each activity, which allowed us to create a count of activities of daily living (ADL) limitations per respondent.\u003c/p\u003e \u003cp\u003e \u003cb\u003eAnalysis\u003c/b\u003e. We generated the count, percentage, mean, and standard deviation (SD) to provide descriptive information on the study\u0026rsquo;s measures. To identify correlates of our two fall-related outcomes, we estimated two separate binary logistic regression models. The first model explored factors associated with the likelihood of falling [0\u0026thinsp;=\u0026thinsp;no falls, 1\u0026thinsp;=\u0026thinsp;\u0026ge;\u0026thinsp;1 fall(s)] among participants who had a FOF (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;6,809). The second model examined correlates of those who required medical attention as the result of a fall (0\u0026thinsp;=\u0026thinsp;no, 1\u0026thinsp;=\u0026thinsp;yes) among those who had a FOF and who had reported\u0026thinsp;\u0026ge;\u0026thinsp;1 fall(s) in the past year (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;4,511). We also estimated logistic models stratified by male and female gender for our two outcomes of interest.\u003c/p\u003e \u003cp\u003eAll the regression models included the same set of independent variables. Categorical variables were dummy coded and included gender, income, BMI, self-rated health, living status, arthritis, diabetes, osteoporosis, stroke, depression, trouble seeing, trouble hearing, and taking\u0026thinsp;\u0026ge;\u0026thinsp;3 OTC and/or prescription medications a day. Age was treated as a continuous variable, and the total number of ADL limitations was treated as a discrete numeric variable. In calculating ADL limitations, participants who reported no limitations were coded as missing only for this variable, to avoid conflating true zeros with potential missing responses.\u003c/p\u003e \u003cp\u003ePrior to our analyses, the data were screened for violations of assumptions across both models. We did not detect any outliers, with all of Cook\u0026rsquo;s Distance values being under 0.2. Multicollinearity diagnostics were conducted using variance inflation factors (VIF) and tolerance values. All variables had VIFs below two; tolerance values were between .881 and .987 for the first model and .880 and .973 for the second. The assumption of linearity in the logit for the continuous variable of age was tested using the Box-Tidwell procedure and confirmed; this assumption was not applied to the discrete ADL limitations variable due to its non-continuous nature. Categorical predictors met the requirement for minimum expected cell counts in each category.\u003c/p\u003e \u003cp\u003eModel fit was assessed using the Hosmer-Lemeshow test, and overall model significance for each was evaluated via the omnibus chi-square test. Odds ratios and 95% confidence intervals were calculated for each independent variable. All analyses were conducted with SPSS Version 31.0 [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eOur analytic sample had a mean age of 70.8\u0026thinsp;\u0026plusmn;\u0026thinsp;9.0 with a range of 55\u0026ndash;105 years and most (70.8%) were female, 32.5% lived alone, and 58.6% had an annual personal income of \u0026le; \u003cspan\u003e$\u003c/span\u003e19,999. With respect to health-related characteristics, the mean BMI was 31.1\u0026thinsp;\u0026plusmn;\u0026thinsp;9.8 which is in the category of obese. Of the five health conditions we examined, the three most prevalent were arthritis (57.9%), diabetes (48.1%), and depression (22.3%). Close to half (47.9%) of the participants had a self-rated health of good/very good or excellent. With respect to sensory abilities, 42.3% and 27.3% reported trouble with vision and hearing, respectively. Forty-two percent took\u0026thinsp;\u0026ge;\u0026thinsp;3 OTC and/or prescription medications a day and the mean number of ADL limitations was 2.4\u0026thinsp;\u0026plusmn;\u0026thinsp;1.6 out of a possible six activities.\u003c/p\u003e\n\u003ch3\u003e[Insert Table 1 about here] \u003c/h3\u003e\n\u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSample characteristics of American Indian and Alaska Native peoples aged\u0026thinsp;\u0026ge;\u0026thinsp;55 years with a fear of falling\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eTotal Sample\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;1 Fall(s)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;1 Fall(s) Needed Medical Treatment\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;6809\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;4511\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;1633\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e70.8\u0026thinsp;\u0026plusmn;\u0026thinsp;9.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e70.6\u0026thinsp;\u0026plusmn;\u0026thinsp;9.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e70.7\u0026thinsp;\u0026plusmn;\u0026thinsp;9.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemales\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4,731 (70.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3,070 (69.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1,179 (73.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMales\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1,955 (29.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1,359 (30.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e427 (26.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eLives alone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2,119 (32.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1,420 (32.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e521 (33.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eAnnual individual income\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e0\u0026ndash;9,999\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1,590 (26.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1,064 (26.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e420 (29.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e10,000-\u003cspan\u003e$\u003c/span\u003e19,999\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1,908 (32.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1,293 (32.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e479 (33.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e20,000-\u003cspan\u003e$\u003c/span\u003e34,999\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1,429 (23.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e955 (24.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e323 (22.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e35,000-\u003cspan\u003e$\u003c/span\u003e49,999\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e515 (8.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e335 (8.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e122 (8.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ge;\u003cspan\u003e$\u003c/span\u003e50,000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e527 (8.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e326 (8.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e104 (7.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eBody Mass Index\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e31.1\u0026thinsp;\u0026plusmn;\u0026thinsp;9.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e30.9\u0026thinsp;\u0026plusmn;\u0026thinsp;7.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e30.7\u0026thinsp;\u0026plusmn;\u0026thinsp;8.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eHealth Condition\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eArthritis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3,944 (57.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2,690 (59.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1,015 (62.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOsteoporosis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1,074 (15.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e752 (16.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e327 (20.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDiabetes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3,272 (48.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2,261 (50.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e841 (51.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStroke\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e735 (10.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e552 (12.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e240 (14.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDepression\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1,520 (22.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1,164 (25.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e465 (28.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eSelf-Rated Health\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePoor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e870 (12.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e673 (15.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e322 (19.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFair\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2,636 (39.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1,839 (41.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e665 (41.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGood/very good\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3,063 (45.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1,848 (41.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e601 (37.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eExcellent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e152 (2.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e89 (2.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e29 (1.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eVision Trouble\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2,676 (42.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1,865 (44.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e737 (48.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eHearing Trouble\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1,601 (27.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1,113 (28.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e404 (28.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;3 OTC or Rx medications\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2,887 (42.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2,004 (44.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e740 (45.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eADL Limitations\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.5\u0026thinsp;\u0026plusmn;\u0026thinsp;1.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.7\u0026thinsp;\u0026plusmn;\u0026thinsp;1.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2.2\u0026thinsp;\u0026plusmn;\u0026thinsp;1.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003eSD\u0026thinsp;=\u0026thinsp;standard deviation; ADL\u0026thinsp;=\u0026thinsp;Activities of daily living; OTC\u0026thinsp;=\u0026thinsp;over the counter; Rx\u0026thinsp;=\u0026thinsp;prescription medication\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eDescriptively, 79.3% of our sample had\u0026thinsp;\u0026ge;\u0026thinsp;1 fall(s) in the past year with a mean of 2.8\u0026thinsp;\u0026plusmn;\u0026thinsp;5.0 falls. Regarding fall frequency, 20.7% had no falls, 43.4% had 1 to 2 fall(s), and 35.9% had\u0026thinsp;\u0026ge;\u0026thinsp;3 falls in the past year. Of those who fell in the past year, 37.2% had\u0026thinsp;\u0026ge;\u0026thinsp;1 fall(s) that needed medical attention with a mean of 4.2\u0026thinsp;\u0026plusmn;\u0026thinsp;5.9 falls. Over half (53.3%) had\u0026thinsp;\u0026ge;\u0026thinsp;3 falls in the past year.\u003c/p\u003e \u003cp\u003e \u003cb\u003e[Insert Figure about here]\u003c/b\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e includes the results from the two separate logistic regressions estimating associations between the sociodemographic and health-related characteristics among persons with a FOF with the dependent variables of \u0026ge;\u0026thinsp;1 fall(s) and \u0026ge;\u0026thinsp;1 fall(s) that needed medical treatment in the past year. Significant correlates for having\u0026thinsp;\u0026ge;\u0026thinsp;1 fall(s) in the past year included gender, annual personal income, depression, and ADL limitations. Specifically, females were less likely than males to experience\u0026thinsp;\u0026ge;\u0026thinsp;1 fall(s) (OR\u0026thinsp;=\u0026thinsp;0.57, 95% CI\u0026thinsp;=\u0026thinsp;0.98-1.00). Persons with an annual income of \u0026ge; \u003cspan\u003e$\u003c/span\u003e50,000 were less likely than persons with an annual income between \u003cspan\u003e$\u003c/span\u003e0 and \u003cspan\u003e$\u003c/span\u003e9,999 (OR\u0026thinsp;=\u0026thinsp;0.66, 95% CI\u0026thinsp;=\u0026thinsp;0.44\u0026ndash;1.01) to experience\u0026thinsp;\u0026ge;\u0026thinsp;1 fall(s). Persons with depression compared to those without were more likely to experience\u0026thinsp;\u0026ge;\u0026thinsp;1 fall(s) (OR\u0026thinsp;=\u0026thinsp;1.45, 95% CI\u0026thinsp;=\u0026thinsp;1.12\u0026ndash;1.88) and persons with an increased number of ADL limitations were more likely to experience\u0026thinsp;\u0026ge;\u0026thinsp;1 fall(s) (OR\u0026thinsp;=\u0026thinsp;1.11, 95% CI\u0026thinsp;=\u0026thinsp;1.03\u0026ndash;1.20).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eLogistic regressions estimating\u0026thinsp;\u0026ge;\u0026thinsp;1 fall(s) and \u0026ge;\u0026thinsp;1 fall(s) that needed medical treatment in the past year among American Indian and Alaska Native persons aged\u0026thinsp;\u0026ge;\u0026thinsp;55 years with a fear of falling\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;1 Fall(s)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;1 Fall(s) Needed Medical Treatment\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;2556\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;2083\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eOR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eOR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.98-1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.99\u0026ndash;1.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.57**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.98-1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.59***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.30\u0026ndash;1.94\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eLives alone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.83\u0026ndash;1.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.74\u0026ndash;1.09\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eAnnual individual income\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e0\u0026ndash;9,999\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e10,000-\u003cspan\u003e$\u003c/span\u003e19,999\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.65\u0026ndash;1.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.80\u0026ndash;1.27\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e20,000-\u003cspan\u003e$\u003c/span\u003e34,999\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.76\u0026ndash;1.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.65\u0026ndash;1.09\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e35,000-\u003cspan\u003e$\u003c/span\u003e49,999\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.69\u0026ndash;1.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.63\u0026ndash;1.32\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ge;\u003cspan\u003e$\u003c/span\u003e50,000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.66*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.44\u0026ndash;1.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.52\u0026ndash;1.16\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eBody Mass Index\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnder or normal weight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOverweight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.67\u0026ndash;1.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.61\u0026ndash;1.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eObese\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.61\u0026ndash;1.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.70\u0026ndash;1.12\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eArthritis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.79\u0026ndash;1.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.82\u0026ndash;1.21\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eOsteoporosis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.95\u0026ndash;1.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.32*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.03\u0026ndash;1.69\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eDiabetes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.96\u0026ndash;1.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.91\u0026ndash;1.31\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eStroke\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.77\u0026ndash;1.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.92\u0026ndash;1.56\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eDepression\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.45*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.12\u0026ndash;1.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.76\u0026ndash;1.13\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eSelf-Rated Health\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePoor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFair\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.66\u0026ndash;1.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.72**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.57\u0026ndash;0.93\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eVery good/good\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.52\u0026ndash;1.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.77*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.59-1.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eExcellent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.36\u0026ndash;2.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.35\u0026ndash;1.76\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eVision Trouble\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.94\u0026ndash;1.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.87\u0026ndash;1.26\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eHearing Trouble\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.92\u0026ndash;1.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.82\u0026ndash;1.23\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eTakes\u0026thinsp;\u0026ge;\u0026thinsp;3 OTC or Rx medications\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.75\u0026ndash;1.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.71\u0026ndash;1.02\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eADL Limitations\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.11**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.03\u0026ndash;1.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.22***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.15\u0026ndash;1.29\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003eOR\u0026thinsp;=\u0026thinsp;Odds ratio; CI\u0026thinsp;=\u0026thinsp;Confidence interval; OTC\u0026thinsp;=\u0026thinsp;Over-the-counter; Rx\u0026thinsp;=\u0026thinsp;Prescription; ADL\u0026thinsp;=\u0026thinsp;Activities of daily living; ***\u0026le; 0.001; **\u0026le; 0.01; *\u0026le; 0.05\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eSignificant correlates of \u0026ge;\u0026thinsp;1 fall(s) in the past year that needed medical treatment included gender, osteoporosis, self-rated health, and ADL limitations. Specifically, females compared than males (OR\u0026thinsp;=\u0026thinsp;1.59, 95% CI\u0026thinsp;=\u0026thinsp;1.30\u0026ndash;1.94) and persons with osteoporosis than persons without (OR\u0026thinsp;=\u0026thinsp;1.32, 95% CI\u0026thinsp;=\u0026thinsp;1.03\u0026ndash;1.69) were more likely to experience\u0026thinsp;\u0026ge;\u0026thinsp;1 fall(s) that needed medical treatment. Persons with fair (OR\u0026thinsp;=\u0026thinsp;0.72, 95% CI\u0026thinsp;=\u0026thinsp;0.57\u0026ndash;0.93) and very good or good (OR\u0026thinsp;=\u0026thinsp;0.77, 95% CI\u0026thinsp;=\u0026thinsp;0.59-1.00) self-rated health compared to poor self-rated health were less likely to experience\u0026thinsp;\u0026ge;\u0026thinsp;1 fall(s) that needed medical treatment. Persons with an increased number of ADL limitations were more likely to experience of \u0026ge;\u0026thinsp;1 fall(s) that needed medical treatment (OR\u0026thinsp;=\u0026thinsp;1.22, 95% CI\u0026thinsp;=\u0026thinsp;1.15\u0026ndash;1.29).\u003c/p\u003e\n\u003ch3\u003e[Insert Table 2 about here] \u003c/h3\u003e\n\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e has the gender stratified results for four separate logistic regressions estimating associations between the sociodemographic and health-related characteristics for the same two fall-related outcomes. For the outcome of experiencing\u0026thinsp;\u0026ge;\u0026thinsp;1 fall(s) in the past year, significant correlates for women were diabetes (OR\u0026thinsp;=\u0026thinsp;1.30, 95% CI\u0026thinsp;=\u0026thinsp;1.01\u0026ndash;1.67), depression (OR\u0026thinsp;=\u0026thinsp;1.45, 95% CI\u0026thinsp;=\u0026thinsp;1.08\u0026ndash;1.93), and increased number of ADL limitations (OR\u0026thinsp;=\u0026thinsp;1.10, 95% CI\u0026thinsp;=\u0026thinsp;1.01\u0026ndash;1.20). While, among men, significant correlates were annual personal income of \u0026ge; \u003cspan\u003e$\u003c/span\u003e50,000 compared to \u0026lt; \u003cspan\u003e$\u003c/span\u003e10,000 (OR\u0026thinsp;=\u0026thinsp;0.36, 95% CI\u0026thinsp;=\u0026thinsp;0.16\u0026ndash;0.83) and increased number of ADL limitations (OR\u0026thinsp;=\u0026thinsp;1.17, 95% CI\u0026thinsp;=\u0026thinsp;1.00-1.37).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eLogistic regressions estimating\u0026thinsp;\u0026ge;\u0026thinsp;1 fall(s) and \u0026ge;\u0026thinsp;1 fall(s) that needed medical treatment in the past year among American Indian and Alaska Native persons aged\u0026thinsp;\u0026ge;\u0026thinsp;55 years with a fear of falling by gender\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"11\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c6\" namest=\"c3\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;1 Fall(s)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c11\" namest=\"c8\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;1 Fall(s) Needed Medical Treatment\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;1755\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;801\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;1389\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e \u003cp\u003e\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;694\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eFemales\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003eMales\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003eFemales\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e \u003cp\u003eMales\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eOR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eOR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eOR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eOR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.98-1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.98\u0026ndash;1.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.98\u0026ndash;1.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.98\u0026ndash;1.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eLives alone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.87\u0026ndash;1.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.50\u0026ndash;1.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.67\u0026ndash;1.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e1.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.74\u0026ndash;1.46\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eAnnual individual income\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e0\u0026ndash;9,999\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e10,000-\u003cspan\u003e$\u003c/span\u003e19,999\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.70\u0026ndash;1.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.30\u0026ndash;1.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.81\u0026ndash;1.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.58\u0026ndash;1.36\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e20,000-\u003cspan\u003e$\u003c/span\u003e34,999\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.79\u0026ndash;1.59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.38\u0026ndash;1.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.62\u0026ndash;1.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.52\u0026ndash;1.33\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e35,000-\u003cspan\u003e$\u003c/span\u003e49,999\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.78\u0026ndash;2.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.22\u0026ndash;1.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.62\u0026ndash;1.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.40\u0026ndash;1.55\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ge;\u003cspan\u003e$\u003c/span\u003e50,000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.49\u0026ndash;1.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.36*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.16\u0026ndash;0.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.62\u0026ndash;1.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.40*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.18\u0026ndash;0.93\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eBody Mass Index\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnder or normal weight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOverweight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.55\u0026ndash;1.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.70\u0026ndash;2.40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.61**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.44\u0026ndash;0.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e1.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.83\u0026ndash;2.02\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eObese\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.54\u0026ndash;1.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.56\u0026ndash;1.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.58\u0026ndash;1.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e1.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.77\u0026ndash;1.82\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eArthritis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.78\u0026ndash;1.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.62\u0026ndash;1.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.81\u0026ndash;1.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.68\u0026ndash;1.34\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eOsteoporosis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.94\u0026ndash;1.79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.50\u0026ndash;3.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.88\u0026ndash;1.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e2.68***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e1.48\u0026ndash;4.85\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eDiabetes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.30*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.01\u0026ndash;1.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.60\u0026ndash;1.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.95\u0026ndash;1.48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.64\u0026ndash;1.24\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eStroke\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.75\u0026ndash;1.69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.53\u0026ndash;1.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.93\u0026ndash;1.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.64\u0026ndash;1.52\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eDepression\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.45**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.08\u0026ndash;1.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.82\u0026ndash;2.69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.76\u0026ndash;1.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.54\u0026ndash;1.16\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eSelf-Rated Health\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePoor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFair\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.63\u0026ndash;1.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.48\u0026ndash;1.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.68*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.50\u0026ndash;0.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.52\u0026ndash;1.20\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGood/very good/Excellent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.53\u0026ndash;1.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.31\u0026ndash;1.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.55\u0026ndash;1.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.47\u0026ndash;1.19\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eVision Trouble\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.90\u0026ndash;1.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.75\u0026ndash;1.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.88\u0026ndash;1.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.62\u0026ndash;1.21\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eHearing Trouble\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.90\u0026ndash;1.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.64\u0026ndash;1.72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.77\u0026ndash;1.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.70\u0026ndash;1.41\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eTakes\u0026thinsp;\u0026ge;\u0026thinsp;3 OTC or Rx medications\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.72\u0026ndash;1.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.63\u0026ndash;1.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.65\u0026ndash;1.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.65\u0026ndash;1.27\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eADL Limitations\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.10*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.01\u0026ndash;1.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.17*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.00-1.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.19***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1.11\u0026ndash;1.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e1.30***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e1.18\u0026ndash;1.45\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"11\" nameend=\"c11\" namest=\"c1\"\u003e \u003cp\u003eOR\u0026thinsp;=\u0026thinsp;Odds ratio; CI\u0026thinsp;=\u0026thinsp;Confidence interval; OTC\u0026thinsp;=\u0026thinsp;Over-the-counter; Rx\u0026thinsp;=\u0026thinsp;Prescription; ADL\u0026thinsp;=\u0026thinsp;Activities of daily living\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e***\u0026le; 0.001; **\u0026le; 0.01; *\u0026le; 0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e\n\u003ch3\u003e[Insert Table 3 about here]\u003c/h3\u003e\n\u003cp\u003eFor the outcome of experiencing\u0026thinsp;\u0026ge;\u0026thinsp;1 fall(s) in the past year that needed medical attention, significant correlates for women were overweight compared to persons of normal or underweight (OR\u0026thinsp;=\u0026thinsp;0.61, 95% CI\u0026thinsp;=\u0026thinsp;0.44\u0026ndash;0.83), fair compared to poor self-rated health (OR\u0026thinsp;=\u0026thinsp;0.68, 95% CI\u0026thinsp;=\u0026thinsp;0.50\u0026ndash;0.94), and increased number of ADL limitations (OR\u0026thinsp;=\u0026thinsp;1.19, 95% CI\u0026thinsp;=\u0026thinsp;1.11\u0026ndash;1.27). While, among men, significant correlates were annual personal income of \u0026ge; \u003cspan\u003e$\u003c/span\u003e50,000 compared to \u0026lt;\u003cspan\u003e$\u003c/span\u003e10,000 (OR\u0026thinsp;=\u0026thinsp;0.40, 95% CI\u0026thinsp;=\u0026thinsp;0.18\u0026ndash;0.93), osteoporosis (OR\u0026thinsp;=\u0026thinsp;2.68, 95% CI\u0026thinsp;=\u0026thinsp;1.48\u0026ndash;4.85), and increased number of ADL limitations (OR\u0026thinsp;=\u0026thinsp;1.30, 95% CI\u0026thinsp;=\u0026thinsp;1.18\u0026ndash;1.45).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn our study population of community-dwelling AIAN adults aged\u0026thinsp;\u0026ge;\u0026thinsp;55 years with a FOF, 79.3% experienced\u0026thinsp;\u0026ge;\u0026thinsp;1 fall(s) in the past year with an average of 2.8 falls. Among those who had fallen at least once in the past year, 37.2% had\u0026thinsp;\u0026ge;\u0026thinsp;1 fall(s) that needed medical treatment. Research has found that persons with a FOF compared to those without, experience more falls with approximately 70% of community-dwelling adults aged\u0026thinsp;\u0026ge;\u0026thinsp;65 years with a FOF have fallen at least once in the past year [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Among those with a FOF and one prior fall, had an average number of 0.73 falls and those with multiple prior falls, had an average of 2.6 falls [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. The prevalence of \u0026ge;\u0026thinsp;1 fall(s) was relatively high in our study as prior research with community-dwelling older adults have found a range of 37% to 71% among those with a FOF who fell in the prior 12 months [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. We were unable to locate published data on the prevalence of needing medical treatment for a fall among persons with a FOF and thus do not know how our finding differs from prior estimates. We do know, however, that health care costs associated with nonfatal falls in the U.S. was estimated to be \u003cspan\u003e$\u003c/span\u003e80\u0026nbsp;billion for 2020 [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eCorrelates of \u0026ge;\u0026thinsp;1 fall(s) in our study population were male gender, increased income, depression, and increased number of ADL limitations. These significant correlates with falling are also documented in prior studies in other older adult populations apart from gender. That is, overall, prior research suggests that women are more likely to fall than men [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e] although men in our sample were more likely to have a fall than women. A systematic review found that measures of socioeconomic status, including income, were associated with falls where lower socioeconomic status was associated with increased fall risk [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Other research also found that measures of poorer mental health, including depression, are associated with an increased likelihood of falling [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. In a recent meta-analysis, most of the studies found an association between depression and falling although there was not a pooled effect size between depression and the likelihood of falling [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eCorrelates of \u0026ge;\u0026thinsp;1 fall(s) that needed medical treatment were female gender, osteoporosis, poorer self-rated health, and increased number of ADL limitations. The association of gender with falls that need medical treatment seems to be less definitive in the published literature. Women have been found to be more likely to experience a fall that resulted in an injury than men [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e] and men have been found to experience a death because of a fall [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe gender stratified analyses revealed that men with higher income were less likely to have \u0026ge;\u0026thinsp;1 fall(s) or at least one fall that needed medical treatment while income was not associated with either outcome in women. The stratified regressions also revealed gender differences with respect to the role of health conditions and our two falls-related outcomes. For women, the presence of diabetes and depression were associated with having\u0026thinsp;\u0026ge;\u0026thinsp;1 fall(s) and lower BMI was associated with having\u0026thinsp;\u0026ge;\u0026thinsp;1 fall(s) that needed medical treatment. All three conditions, diabetes [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e], depression [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e], and underweight [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e] have been found positively associated with falling in prior research.\u003c/p\u003e \u003cp\u003eFor men, the presence of osteoporosis was associated with having\u0026thinsp;\u0026ge;\u0026thinsp;1 fall(s). Osteoporosis among men has been less studied given that it is less prevalent than in women. In the United States, 6% of men and 27% of women aged\u0026thinsp;\u0026ge;\u0026thinsp;65 years have osteoporosis [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. While our findings suggest the importance of screening men for osteoporosis, most health insurance companies do not cover this procedure for men while it is for women despite research indicating that screening older men and follow-up treatment is cost-effective [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThere are a few limitations of our study that need to be taken into consideration. First, the surveys were distributed by Title VI staff and self-administered. This approach likely introduced inconsistencies as to how the surveys were distributed across Title VI sites. Further, the self-administered nature of the survey can introduce important methodological issues that can impact the data such as social desirability bias, recall bias, literacy, and misinterpretation of questions due to the absence of an interviewer to clarify questions. Also, we were limited to the information collected in the survey and unable to, for example, examine with greater specificity the exact number and type of OTC and prescription medications. While simultaneously taking\u0026thinsp;\u0026ge;\u0026thinsp;5 medications is typically used to measure polypharmacy, the nature in which medication use was asked made it so we were unable to examine it in our study. Last, for BMI, there were an insufficient number of respondents who were classified as underweight, so we collapsed the BMI categories of under and normal weight. Consequently, our analysis we were unable to examine the association of underweight with our two outcomes of interest or to examine if there were gender differences with respect to these associations.\u003c/p\u003e \u003cp\u003eOur study was motivated by the limited understanding of falls among older AIAN adults and reasons for why fall prevalence is notably higher in this population than other older adult populations. Future research needs to continue examining descriptively FOF, falls, and falls that need medical care in this population. Future research is warranted that examines correlates or predictors of falls and falls that led to medical care with other data and with an eye towards appreciating falls-related protective and modifiable risk factors. Greater understandings can help inform existing and future fall prevention efforts. Further, the role of gender deserves greater investigation especially with respect to the role of osteoporosis in AIAN men and fall-related injury.\u003c/p\u003e \u003cp\u003eUnintentional falls have been shown to contribute to the highest number and proportion of traumatic brain injury-related emergency department visits among Indian Health Service and tribally managed health care facilities [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. Also, falls have the highest incidence and are the costliest type of injury among all age groups in the Indian Health Service user population, representing an incidence rate of 2,904 per 100,000 person years and \u003cspan\u003e$\u003c/span\u003e653\u0026nbsp;million in lifetime medical costs for injuries occurring in 2011\u0026ndash;2015 [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. Undoubtedly, the need for fall prevention for AIAN peoples will become more critical with the expected growth of this population.\u003c/p\u003e \u003cp\u003eWhile there is relatively limited research investigating the reasons for the alarming falls disparity experienced by AIAN peoples and identify their falls-related protective and risk factors, there have been substantial efforts across Tribal communities. The Indian Health Service\u0026rsquo;s Injury Prevention Program is an important effort in supporting Tribally led fall prevention efforts. This program enables Tribes to develop strategies that are both evidence-based and culturally integrated. Elder-focused falls prevention efforts have been a common activity among the Tribes with 16 of the 27 programs during the last funding cycle (2020\u0026ndash;2025) (Personal communication, J. Russell 11/19/25). Also, a recent review of articles in the Indian Health Service Primary Care Provider Newsletter on unintentional injury prevention efforts in AIAN communities found that the most common articles were focused on falls-related injury prevention [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e].\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eOur study highlights the substantial burden of falls and fall-related injuries among community-dwelling older AIAN adults who experience FOF, revealing both a markedly high prevalence of falls and a considerable proportion requiring medical treatment. Our findings underscore the importance of sociodemographic and health\u0026mdash;particularly depression, diabetes, osteoporosis, and ADL limitations\u0026mdash;and demonstrate that risk profiles differ for men and women. These results point to an urgent need for additional fall prevention strategies that are culturally responsive, gender-informed, and tailored to the unique health realities of older AIAN peoples. As this population continues to grow rapidly, expanding research that identifies modifiable risk factors, explores protective influences, and evaluates community-driven and tribally led prevention efforts will be essential. Strengthening such efforts has the potential to reduce injuries, improve quality of life, and support the well-being and independence of AIAN elders across Tribal Nations.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003cstrong\u003eEthics approval and consent to participate:\u003c/strong\u003e \u003cp\u003e This research was approved by the University of North Dakota\u0026rsquo;s institutional review board (IRB) and conducted in accordance with the ethical standards of and the 1964 Declaration of Helsinki and its later amendments. Further, the National Resource Center for Native American Aging (NRCNAA) research team received a Tribal resolution from the official Tribal Council for participating sites for survey distribution in their respective communities. When required, the NRCNAA team also followed established Tribal IRB protocols to obtain approval. Verbal informed consent was obtained from all participants prior to survey completion.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent for publication:\u003c/strong\u003e \u003cp\u003eNot applicable.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding:\u003c/h2\u003e \u003cp\u003eThis work was supported, in part, by funding from the US Administration on Community Living, Department of Health and Human Services to the NRCNAA at the University of North Dakota (90OIRC0003).\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eRTG: Conceptualization, methodology, visualization, and lead writing of the manuscript.RB: Formal analysis, data curation, and drafting of the manuscript (Methods).CA: Project administration, funding acquisition/oversight (as Director), investigation (data collection), and manuscript review and editing.All authors: Read and approved the final manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eWe would like to thank Mandi-Leigh Peterson, a Senior Research Analyst with the North Dakota Healthcare Workforce Group at the University of North Dakota, for their input on the study\u0026rsquo;s analytic approach.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe participating Tribal Nations retain ownership of all data collected by the NRCNAA. Under data-sharing agreements between the University of North Dakota and the participating Tribal Nations, the survey data may be handled and analyzed only by the NRCNAA. Researchers seeking access to these data must therefore contact each participating Tribal Nation individually to request permission. If access is granted, the NRCNAA will transfer to the respective Tribal Nation a data file containing only that Nation\u0026rsquo;s survey data, which the Tribal Nation may then choose to make available.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eKahara R, Bergen G, Burns E, Stevens M. Nonfatal and fatal falls among adults aged\u0026thinsp;\u0026ge;\u0026thinsp;65 years\u0026mdash;United States, 2020\u0026ndash;2021. MMWR Morb Mortal Wkly Rep. 2023;72(35):938\u0026ndash;43.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKahara R, Lee R, Eckstrom EN. 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Osteoporosis or low bone mass in older adults: United States, 2017\u0026ndash;2018. NCHS Data Brief, no 405. Hyattsville, MD: National Center for Health Statistics. 2021. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://dx.doi.org/10.15620/cdc:103477\u003c/span\u003e\u003cspan address=\"10.15620/cdc:103477\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSchousboe JT, Taylor BC, Fink HA, Kane RL, Cummings SR, Orwoll ES, et al. Cost-effectiveness of bone densitometry followed by treatment of osteoporosis in older men. JAMA. 2007;298(6):629\u0026ndash;37.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSarmiento K, Kennedy J, Daugherty J, Peterson AB, Evans ME, Haberling DL, Bille H. Traumatic brain injury\u0026ndash;related emergency department visits among American Indian and Alaska Native persons, 2005\u0026ndash;2014. 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Unintentional injury prevention in American Indian and Alaska Native communities: a scoping review of the Indian Health Service Primary Care Provider newsletter. Inj Epidemiol. 2024;11:27. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s40621-024-00509-1\u003c/span\u003e\u003cspan address=\"10.1186/s40621-024-00509-1\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-8562738/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8562738/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOlder American Indian and Alaska Native (AIAN) peoples are at greatest risk for falls and fall-related injuries than any race or ethnic group. Compared to same-aged peers of other races, older AIAN peoples have the highest rate of falls. Yet, little research has been pursued that would improve our understanding of falls within this high-risk population. Thus, we descriptively examined falls and falls that needed medical attention as well as their correlates among those with a fear of falling in this at-risk population.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe used National Resource Center on Native American Aging survey data collected between 2020 and 2023 from community-dwelling older AIAN peoples. Our analytic sample consisted of data from 6,809 respondents aged ≥ 55 years who had a fear of falling. Logistic regressions were estimated to identify significant correlates of falls and falls that needed medical attention for the entire sample and stratified by gender.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFindings indicated that 79.3% of the sample had ≥ 1 fall(s) in the past year with a mean of 2.8 ± 5.0 falls. Of those who fell in the past year, 37.2% had ≥ 1 fall(s) needing medical treatment. Correlates for having ≥ 1 fall(s) included male gender, lower annual personal income, depression, and more activities of daily living (ADL) limitations. Correlates of ≥ 1 fall(s) that needed medical treatment included female gender, osteoporosis, poorer self-rated health, and more ADL limitations. For women, correlates of ≥ 1 fall(s) were diabetes, depression, and more ADL limitations, and for men, correlates were lower annual personal income and more ADL limitations. Correlates of falls that needed medical treatment among women were increased body mass index, poorer self-rated health, and more ADL limitations. Correlates of falls that needed medical treatment among men were lower annual personal income, osteoporosis, and more ADL limitations.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eGiven AIAN peoples’ increased risk for falls and fall-related injury, it is important that there are efforts to improve our understanding of falls in this population. The need of supporting existing and increasing falls prevention efforts for AIAN peoples will become more critical with the expected growth of this population.\u003c/p\u003e\n\u003cp\u003eClinical trial number: Not applicable\u003c/p\u003e","manuscriptTitle":"Older American Indian and Alaska Native adults with a fear of falling: Prevalence and correlates of falling and falls needing medical treatment","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-11 07:24:59","doi":"10.21203/rs.3.rs-8562738/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewersInvited","content":"","date":"2026-02-06T12:48:41+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-02-06T08:26:56+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-01-19T06:24:21+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-01-16T15:38:25+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Public Health","date":"2026-01-16T15:32:55+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"b7f06bd7-bb76-42bb-8c2a-396028dc2fe3","owner":[],"postedDate":"February 11th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-02-11T07:24:59+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-11 07:24:59","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8562738","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8562738","identity":"rs-8562738","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}