Preventive Behaviors Associated with Fall Incidence Among Older Adults Living in Rural Communities of Thailand: A Cross-Sectional Study

Preventive Behaviors Associated with Fall Incidence Among Older Adults Living in Rural Communities of Thailand: A Cross-Sectional Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Preventive Behaviors Associated with Fall Incidence Among Older Adults Living in Rural Communities of Thailand: A Cross-Sectional Study Rujira Nonsa-ard, Sirapat Khodseewong, Kasama Wongprachum, Chaiwut Bourneow, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8781848/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 10 You are reading this latest preprint version Abstract Background The escalating population of older adults poses a significant challenge, particularly in lower-middle-income countries like Thailand. Falls represent a critical public health concern in this demographic. This study aimed to identify risk factors influencing fall occurrence in older adults within a specific rural community context, where the majority of participants remain engaged in farm work. Methods A cross-sectional study design was utilized, involving 1,256 participants. Data were collected via a questionnaire that included: demographic information, the Thai version of the Barthel Activities of Daily Living (ADL), the Thai Fall Risk Assessment Tool (FRAT), House Risk assessment, the Timed Up and Go Test (TUGT), the Oxford Knee Score (OKS), and an assessment of fall prevention behaviors. Principal Component Analysis (PCA) was employed to classify groups of fall prevention behaviors, and binary logistic regression was used to determine the association between these factors and fall incidence. Results The study was predominantly female (73.2%), with more than half of the participants aged over 70 years (51.0%; mean age 70.6 ± 7.2 years old) and 93.1% having six or fewer years of education. The results indicated that 34.5% of participants had experienced at least one fall within the preceding six months. PCA categorized fall prevention behaviors into five factors: environmental safety and house management Cronbach’s α = 0.840), appropriate clothing and footwear Cronbach’s α = 0.774), physical activity and safe medication (Cronbach’s α = 0.701), self-management (Cronbach’s α = 0.495), and movement and mobility safety (Cronbach’s α = 0.597). In the crude analysis, fall incidence was significantly associated with environmental safety and house management (Crude OR = 0.45, p = 0.004) and appropriate clothing and footwear (Crude OR = 0.52, p = 0.016). After adjusting for age, education, OKS, and TUGT, only the association with environmental safety and house management (aOR = 0.55, p = 0.041) and movement and mobility safety remained statistically significant (aOR = 0.64, p = 0.041). Conclusion These findings from a rural context suggest that promoting environmental safety and proper house management may be the most crucial and resilient strategy for reducing fall incidence among older adults. However, fall prevention in older adults is an interplay of multiple factors, all factors identified must be considered in comprehensive intervention strategies. falls community-dwelling older adults prevention behavior Figures Figure 1 Figure 2 Background The world is undergoing a significant demographic shift, with the proportion of older adults steadily increasing due to sustained reductions in fertility and mortality rates. While this represents a major public health achievement, it is also accompanied by a higher prevalence of chronic illnesses, functional decline, and age-related conditions, which in turn increases the risk of falls [ 1 , 2 ]. The World Health Organization projects that the number of people aged 60 years and over will more than double by 2050 [ 3 ]. These demographic changes pose a particular challenge in rural areas of low- and middle-income countries (LMICs). By 2050, two-thirds of the world’s population aged 60 years and over will reside in LMICs [ 3 ]. Thailand, classified as an LMIC, is experiencing a rapid increase in its older population and is now classified as an aging society. Falls among older adults remain a major global public health concern, yet most research focuses on urban populations, with fewer studies conducted in rural communities [ 4 ]. In rural settings, fall risk is exacerbated by socioeconomic disadvantage, lower educational attainment, housing types, reduced physical activity, and lower safety scores of home environments [ 5 ]. In Thailand, households are commonly multi-generational and follow traditional housing patterns. Typically, these dwellings are two-storied, with the upper floor constructed of wood and the lower floor built from concrete. Architectural features such as steep staircases leading to the bedrooms, inadequate lighting, and the placement of toilets outside the house or at a considerable distance from bedrooms are prevalent. These environmental characteristics are recognized as significant risk factors for falls among older adults, with the accessibility and condition of toilets being of particular concern [ 6 ]. In addition, these risks may be intensified by limited use of preventive behaviors. A comprehensive assessment of demographic, health-related, behavioral, and environmental determinants is therefore essential to understand how these factors interact and to develop targeted, context-specific strategies for fall prevention among rural-dwelling older adults. The aim of this study was to investigate the falls history and factors associated with falls, including participant characteristics, Thai Fall Risk Assessment Tool (Thai-FRAT), house risk assessment, knee osteoarthritis, Timed Up and Go Test (TUGT), and a preventative behaviors questionnaire. Participants and method Research design and setting This cross-sectional study was conducted between October 2024 and April 2025 in Mahasarakham Province, Thailand. Prior to data collection, ten public health undergraduate students received training to ensure consistent understanding and administration of the questionnaire. To further ensure the quality of the data collection, a small-scale pilot survey was initially conducted using a questionnaire-based approach with 265 participants from one village. The pilot study also served as practical training for research staff in managing both data collection and data entry processes. Participants Older adults aged 60 years and above, living in rural communities in Mahasarakham Province, were eligible if they were independent in mobility, defined as scoring more than 11 points on the Thai version Barthel Activities of Daily Living (ADL) Index which is the Ministry of Public Health’s recommended screening tool [ 7 ]. This study targeted independent older adults because the results are intended to be applied in developing preventive interventions for falls in this population. The sample size needed for the planned analysis was 1,309 participants. This was calculated using G*Power software version 3.1, with an Odds ratio of 1.3, the probability of 20% having falls, and a further 10% allowance for dropout [ 8 ]. The required sample size of 1,309 participants was recruited. Of these, 53 participants were excluded due to incomplete questionnaires, resulting in a final analytical sample of 1,256 older adults. Instruments and measurements Thai-FRAT Assessment Thai FRAT was designed to assess the falls risk factors for Thai community-dwelling elderly. This tool comprises six items: gender, vision, balance, medication use, history of falls, and living area. Scores of 0–3 indicate a low risk of falls, while scores of 4–11 indicate a high risk. Sensitivity and specificity were 0.92 and 0.83 respectively [ 9 ]. House Risk Assessment In Thailand there are several versions of house risk assessment [ 10 – 12 ]. Although a shortened version of Thai Home Falls Hazards Assessment Tool (Thai-HFHAT) has been developed, it still presents limitations as a community screening tool due to the time required for interviewing. In fieldwork settings, where multiple questionnaires are typically used during interviews, its length may not be suitable for community-dwelling older adults. This study used the 10-item house risk assessment including to number of house stories, lighting, obstructions, handrails, bed type, bathroom safety, and appropriate furniture size. This questionnaire was adapted based on the previous study [ 11 ] for rapid risk identification in community using simple dichotomous (“Yes” or “No”) responses. The 0–3 score represents the unsafe house environment. While the score 4–10 indicates a safe house environment (Additional file 1). Oxford Knee Score assessment (OKS) The OKS was originally developed to assess knee pain and function in the group of patients with total knee replacement and non-operative management for knee osteoarthritis [ 13 , 14 ]. It is a 12-item patient-reported outcome measure (PROM). The score ranges from 0–48 on a five-point Likert scale. The higher score indicates better joint function. This study used the Thai-version of the OKS which was adapted by Charoencholvanich and Pongcharoen (2005) for knee arthroplasty patients in Thailand. High internal consistency reliability was reported (Cronbach's alpha = 0.918) [ 15 ]. Timed Up and Go Test (TUGT) The TUGT is a simple, widely used, and reliable clinical tool designed to assess a person's mobility, balance, and risk of falling. It measures the time it takes for an individual to perform a sequence of common movements: rising from a chair, walking 3 meters, turning, walking back, and sitting down again. This test is able to identify community-dwelling adults who are at risk for falls with the 87% of sensitivity and 87% of specificity [ 16 ]. Fall prevention questionnaire The fall prevention behaviors questionnaire consists of 18 items covering postures and movements, appropriateness of footwear and clothing, health check-ups and medication, exercise and balance training, restroom accessibility, obstruction hazards, and use of support equipment. This questionnaire was developed based on the guideline for health promotion to slow aging and live a long life (Individual Wellness Plan) [ 17 ]. Items were rated on a three-point scale: “Regularly”, “Sometimes”, or “Never” with the reliability coefficient was 0.828 for our sample (Additional file 2). Statistical analysis Data analysis was conducted using SPSS version 23 (IBM Corp., Armonk, NY) and STATA version 12 (Stata Corp LP, College Station, TX). Descriptive statistics (frequencies, percentages, medians, and interquartile ranges) were used to summarize participant characteristics and responses. Associations between falls and demographic variables were assessed using the Chi-square test. Logistic regression analysis was performed to examine risk factors associated with falls, with results presented as odds ratios (OR) and 95% confidence intervals (CI). All the data of fall prevention behaviors were computed to two categories “Regularly” and “Sometimes”, based on the distribution of the data in each item. Kolmogorov–Smirnov test was used to assess normality in continuous variables. Comparisons of the OKS between fallers and non-fallers were conducted using the Mann–Whitney U test. To identify the group risk factors principal component analysis (PCA) was used. The Kaiser–Meyer–Olkin (KMO) statistical test was used to verify the applicability of the factor analysis. A KMO value of < 0.50 was deemed unacceptable. Varimax orthogonal rotation was used to simplify data interpretation. Preventive behavior items with factor loads ≥ 0.40 were considered representative of each risk pattern and were deemed to be the most informative in describing the risk pattern. A p value of < 0.05 was considered statistically significant. Results Participant characteristics The majority of participants were female (73.2%). More than half of the participants (51.0%) were aged over 70 years (age range: 60–94 years old; mean age 70.6 ± 7.2 years old), and this age group had a significantly higher proportion of fallers compared to those aged 60–69 years (56.9% vs. 43.1%, p = 0.002). In terms of education, the vast majority (93.1%) had six or fewer years of formal schooling. A higher proportion of fallers with more than six years of education was observed higher in non-fallers group compared to fallers group (8.2% vs. 4.6%, p = 0.019). Farming was the predominant occupation (86.3%), with a non-significant trend toward a higher proportion of farmers among fallers compared to non-fallers (88.7% vs. 85.0%, p = 0.072), as shown in Table 1 . Table 1 Demographic data of participants (n = 1,256) Variables All (n = 1,256) Fallers (n = 434) Non fallers (n = 822) p value Gender 0.835 Male 337 (26.8) 118 (27.2) 219 (26.6) Female 919 (73.2) 316 (72.8) 603 (73.4) Age (year) 0.002 60–69 615 (49.0) 187 (43.1) 428 (52.1) More than 70 641 (51.0) 247 (56.9) 394 (47.9) Status 0.617 Single 111 (8.8) 35 (8.1) 76 (9.2) Marriage 783 (62.3) 278 (64.1) 505 (61.4) Widowed/separated 362 (28.8) 121 (27.9) 241 (29.3) Education levels 0.019 Equal or less than 6 years 1169 (93.1) 414 (95.4) 755 (91.8) More than 6 years 87 (6.9) 20 (4.6) 67 (8.2) Occupation 0.072 Farmer 1084 (86.3) 385 (88.7) 699 (85.0) Non-farmer 172 (13.7) 49 (11.3) 123 (15.0) The data are presented by frequency (percentage). The correlations were analyzed by using Chi-square (χ 2 ) test. Falls experience The results revealed 434 people experienced at least one fall within the past six months. Falls were more frequent outside of the house (59.9%), the most common reported cause of falls was slipping (51.4%), followed closely by tripping over obstacles (36.9%). Most participants (55.1%) managed any injuries from the fall through self-treatment; the remainder (44.9%) received treatment at a hospital. In terms of household composition, the majority of participants who had fallen lived with their children or other relatives (57.8%), followed by those living only with their spouse (31.8%). Only a small proportion (10.4%) lived alone (Table 2 ). Table 2 Falls experience of the participants (n = 434) Variables No. (%) Falls experience within six months Yes 434 (34.5) No 822 (65.4) Places of falls Inside the house 174 (40.1) Outside the house 260 (59.9) Causes of falls Slip 223 (51.4) Tripped over an obstacle/ 160 (36.9) Dizziness 51 (11.8) Medical treatment Receive treatment at the hospital 195 (44.9) Self-treatment 239 (55.1) Who are the family members you currently live with? Single 45 (10.4) Spouse 138 (31.8) Children/relatives 251 (57.8) The data are presented by frequency (percentage). Thai-FRAT Assessment Classification of falls risk was assessed with the Thai-FRAT instrument. More than half of the total participants (52.7%) were categorized as low risk (0–3 scores), while 47.3% were classified as high risk (4–11 scores). Notably, all fallers were in the high-risk group, whereas the majority of non-fallers (80.5%) were in the low-risk group. This association between Thai-FRAT score and fall history was statistically significant ( p < 0.001), indicating that higher Thai-FRAT scores were strongly linked to fall occurrence (Table 3 ). Table 3 Thai-FRAT risk assessment score (n = 1,256) Thai-FRAT score All (n = 1,256) Fallers (n = 434) Non fallers (n = 822) p value < 0.001 Low risk (0–3 scores) 662 (52.7) 0 (0.0) 662 (80.5) High risk (4–11 scores) 594 (47.3) 434 (100.0) 160 (19.5) The data are presented by frequency (percentage). The correlations were analyzed by using Fisher’s Exact Test. House risk Assessment All participants (99.0%) reported their house was low risk for falls; there was no significant difference between fallers and non-fallers (Table 4 ). However, the item-level analysis of house risk factors revealed the most reported concerns were absence of a bed or sleeping on mattress on the floor (23.4%), bathroom located outside of the house (19.0%), and absence of handrails (15.5%) (Fig. 1 ). Table 4 House risk assessment score (n = 1,256) House risk score All (n = 1,256) Fallers (n = 434) Non fallers (n = 822) p value 0.560 High risk (0–3 scores) 12 (1.0) 3 (0.7) 9 (1.1) Low risk (4–11 scores) 1,244 (99.0) 431 (99.3) 813 (98.9) The data are presented by frequency (percentage). Oxford Knee Score Assessment The result of this study was found the group of fallers had significantly lower score [median (IQR); 32.0 (25.0–40.0)] meaning poorer joint function when compared to the higher score of the non-fallers [median (IQR); 39.0 (31.0–47.0)] ( p = 0.043) (Fig. 2 ). Timed Up and Go Test (TUGT) The TUGT results showed that those participants who had fallen had a significantly slower walking speed (≥ 30 seconds) compared to non-fallers ( p < 0.001) (Table 5 ). Table 5 Timed up and go test (n = 1,256) Time All (n = 1,256) Fallers (n = 434) Non fallers (n = 822) p value < 0.001 Less than 30 s 927 (73.8) 294 (67.7) 633 (77.0) Equal or more than 30 s 329 (26.2) 140 (32.3) 189 (23.0) The data are presented by frequency (percentage). The correlations were analyzed by using Chi-square (χ 2 ) test. Fall prevention behaviors Table 6 shows that several preventive behaviors were significantly different between the two groups. Fallers reported more often than non-fallers that they were only “sometimes” being careful: when standing up and sitting down; negotiating uneven floors; going up and down stairs; when walking through, or avoiding, slippery areas (12.4% vs. 7.9%, p = 0.009). Similarly, a higher proportion of fallers reported sometimes wearing shoes that fit properly (9.9% vs. 5.5%, p = 0.003). Table 6 Fall prevention behavior (n = 1,256) Fall prevention behavior Fallers (n = 434) Non fallers (n = 822) p value You take care when standing up and sitting down and going up and down stairs. You avoid or take care walking where the floor is slippery or uneven. Sometimes 54 (12.4) 65 (7.9) 0.009 Regularly 380 (87.6) 757 (92.1) You change positions correctly, sitting and standing slowly with confidence. Sometimes 66 (15.2) 112 (13.6) 0.445 Regularly 368 (84.8) 710 (86.4) You use a firm support when reaching or bending down. Sometimes 178 (41.0) 324 (39.4) 0.583 Regularly 256 (59.0) 498 (60.6) You wear shoes that fit your feet. Sometimes 43 (9.9) 45 (5.5) 0.003 Regularly 391 (90.1) 777 (94.5) You wear flat shoes. Sometimes 48 (11.1) 73 (8.9) 0.213 Regularly 386 (88.9) 749 (91.1) Your shoes have good traction on the floor. Sometimes 39 (9.0) 52 (6.3) 0.084 Regularly 395 (91.0) 770 (93.7) You wear clothes that fit well, are not too loose or have long pants that drag on the floor. Sometimes 45 (10.4) 62 (7.5) 0.088 Regularly 389 (89.6) 760 (92.5) You go for regular eye check-ups and seek treatment when you have problems. Sometimes 186 (42.9) 321 (39.1) 0.191 Regularly 248 (57.1) 501 (60.9) You always consult your doctor when you have problems with taking your medication or side effects such as dizziness or faintness. Sometimes 117 (27.0) 210 (25.5) 0.588 Regularly 317 (73.0) 612 (74.5) You only take your own medication, such as sleeping pills. Sometimes 338 (77.9) 674 (82.0) 0.080 Regularly 96 (22.1) 148 (18.0) You exercise at least 30 minutes a day. Sometimes 172 (39.6) 310 (37.7) 0.506 Regularly 262 (60.4) 512 (62.3) You do exercises that increase muscle strength and balance. Sometimes 171 (39.4) 292 (35.5) 0.176 Regularly 263 (60.6) 530 (64.5) You keep your bathroom floor dry and separate wet and dry areas. Sometimes 59 (13.6) 104 (12.7) 0.636 Regularly 375 (86.4) 718 (87.3) You keep your things in your house organized and keep walkways clear. Sometimes 37 (8.5) 51 (6.2) 0.125 Regularly 397 (91.5) 771 (93.8) You make sure extension cords do not across walkways to prevent trips and falls. Sometimes 64 (14.7) 76 (9.2) 0.003 Regularly 370 (85.3) 746 (90.8) Your house is well let so that you can see walkways and stairs clearly. Sometimes 40 (9.2) 36 (4.4) < 0.001 Regularly 394 (90.8) 786 (95.6) You place your regularly used items within easy to reach – not too high. Sometimes 42 (9.7) 49 (6.0) 0.016 Regularly 392 (90.3) 773 (94.0) You take care of and prepare your aids and equipment to help getting up and sitting down. Sometimes 45 (10.4) 52 (6.3) 0.011 Regularly 389 (89.6) 770 (93.7) The data are presented by frequency (percentage). The correlations were analyzed by using Chi-square (χ 2 ) test. Environmental safety also differed between groups, fallers were more likely to report only sometimes taking care of extension cords to prevent tripping hazards (14.7% vs. 9.2%, p = 0.003), sometimes ensuring adequate lighting for walkways and stairs (9.2% vs. 4.4%, p < 0.001), sometimes placing regularly used items within easy reach (9.7% vs. 6.0%, p = 0.016), and sometimes preparing or maintaining assistive equipment to facilitate getting up and sitting down (10.4% vs. 6.3%, p = 0.011). Principal component analysis (PCA) revealed five group factors of fall prevention behaviors. The factor 1, environmental safety and house management, demonstrated high internal consistency (Cronbach’s α = 0.840). The factor 2 comprised items concerning appropriate clothing and footwear (Cronbach’s α = 0.774), while the factor 3 pertained to physical activity and safe medication (Cronbach’s α = 0.701). The final two factors identified were self-management (Cronbach’s α = 0.495) and movement and mobility safety (Cronbach’s α = 0.597). Furthermore, factors 3, 4, and 5 were conceptually grouped into a single broader category, defined as personal health care, which yielded a combined Cronbach's alpha of 0.651 (Table 7 ). Table 7 The patterns of preventive behaviors (n = 1,256) Fall prevention behavior Factor 1 Factor 2 Factor 3 Factor 4 Factor 5 You place your regularly used items within easy to reach – not too high. 0.792 Your house is well let so that you can see walkways and stairs clearly. 0.786 You take care of and prepare your aids and equipment to help getting up and sitting down. 0.750 You make sure extension cords do not across walkways to prevent trips and falls. 0.721 You keep your things in your house organized and keep walkways clear. 0.549 You keep your bathroom floor dry and separate wet and dry areas. 0.445 Your shoes have good traction on the floor. 0.756 You wear shoes that fit your feet. 0.755 You wear flat shoes. 0.707 You wear clothes that fit well, are not too loose or have long pants that drag on the floor. 0.668 You exercise at least 30 minutes a day. 0.878 You do exercises that increase muscle strength and balance. 0.866 You only take your own medication, such as sleeping pills. 0.504 You go for regular eye check-ups and seek treatment when you have problems. 0.772 You always consult your doctor when you have problems with taking your medication or side effects such as dizziness or faintness. 0.701 You use a firm support when reaching or bending down. 0.752 You change positions correctly, sitting and standing slowly with confidence. 0.599 You take care when standing up and sitting down and going up and down stairs. You avoid or take care walking where the floor is slippery or uneven. 0.447 0.569 Factorial loads ≥ 0.40. The association between falls and the pattern of prevention behaviors among the participants The association between and the pattern of prevention behaviors and fall incidence among older adults. In the crude analysis, the significant associations were found only between falls and environmental safety and house management (factor 1) (Crude OR = 0.45 [0.26–0.89], p = 0.004) and appropriate clothing and footwear (factor 2) (Crude OR = 0.52 [0.31– 0.89], p = 0.016. After adjusting for age and education level (Model a), these associations remained statistically significant, with adjusted odds ratios ranging from 0.44 to 0.50 in factor 1 aOR = 0.44 [0.26–0.76], p = 0.003) and 2 aOR = 0.50 [0.29–0.85], p = 0.011) respectively. In Model b, after normalized musculoskeletal effect found only environmental safety and house management (factor 1) remained significant (aOR = 0.56 [0.32–0.99], p = 0.048). When combined Model a and b (Model c), environmental safety and house management (factor 1) (aOR = 0.55 [0.31–0.98], p = 0.041) and movement and mobility safety remained significance difference (Factor 5) (aOR = 0.64 [0.41–0.98], p = 0.041) were found significant difference (Table 8 ). Table 8 Analysis of crude and adjusted associations and respective confidence intervals between falls associated with fall prevention behavior patterns of older adults (n = 1,256) Falls Crude OR (95% CI) p value aOR a (95% CI) p value aOR b (95% CI) p value aOR c (95% CI) p value Environmental safety and house management 0.45 (0.26–0.89) 0.004 0.44 (0.26–0.76) 0.003 0.56 (0.32–0.99) 0.048 0.55 (0.31–0.98) 0.041 Appropriate clothing and footwear 0.52 (0.31–0.89) 0.016 0.50 (0.29–0.85) 0.011 0.68 (0.39–1.21) 0.192 0.66 (0.37–1.17) 0.153 Physical activity and safe medication 0.96 (0.70–1.32) 0.786 0.96 (0.70–1.32) 0.808 1.00 (0.72–1.38) 0.979 1.00 (0.72–1.38) 0.979 Self-management 0.84 (0.62–1.13) 0.246 0.85 (0.62–1.15) 0.282 0.78 (0.57–1.07) 0.119 0.78 (0.57–1.07) 0.129 Movement and mobility safety 0.72 (0.48–1.09) 0.120 0.67 (0.45–1.02) 0.061 0.67 (0.44–1.04) 0.071 0.64 (0.41–0.98) 0.041 The data were used the bivariate logistic regression to perform statistical analyze. a Model a: Adjusting for age (continues), education levels b Model b: Adjusting for OKS, and TUGT. c Model c: Model a + Model b Discussion This study is the first of a planned program of research at Mahasarakham University (MSU) focusing on falls reduction, dementia prevention, and nutrition promotion, to promote well-being for older adults living in rural Thailand, especially in the northeastern region. The philosophy underpinning the research program is to co-design solutions with local people and work to put research evidence into action to support older people. The aim was to survey older people in the villages surrounding MSU as a baseline for monitoring the impact of the research program, and importantly to identify problems and potential solutions for reducing health risks in this population. Using the model of falls risk prevention published by the Thai department of health [ 17 ], the team constructed a survey from established measures, using the most simplified version possible to reduce survey fatigue. With the assistance of 10 trained public health students, over 1,200 older people were surveyed and tested for falls risk including physical activity, risk behaviors and home-based environmental hazards. As expected, the findings show that poorer performance on physical activity tests, and less attention to footwear, personal risk behaviors or environmental hazards were all associated with having fallen in the prior six months. The fallers in this study were active adults who worked on farms. Consequently, their falls typically occurred outdoors and were caused by slipping or tripping. This situation is common in rural areas, where older adults often continue to work in agriculture even while living with their children. This finding is consistent with research from rural China, which found that a higher incidence of falls was associated with multiple factors, including education level, marital status, physical activity, and the safety of the home environment [ 5 ]. However, the agriculture work in fall risk is controversial. A study conducted in Nakhon Si Thammarat, the southern region of Thailand, found that agricultural employment was actually a protective factor against falls [ 18 ]. Despite this key difference, other findings from that study such as falls resulting in minor injuries and being primarily caused by slipping and tripping were quite similar to the results of our study [ 18 ]. Falls have multifactorial causes, involving a complex interaction between a person's internal risk factors including age, gender, disease conditions, visual impairment, and depression and external risk factors, such as environmental and behavioral elements [ 19 ]. In this study, participants who had fallen not only showed worse physical activity, as explained above, but also demonstrated poorer knee function. This was indicated by the faller group having lower Oxford Knee Scores (OKS) compared to non-fallers. The factor analysis of preventive behaviors revealed five groups. After adjusting for covariates, statistically significant differences were found in three groups related to external factors “environmental safety and home management”, “appropriate clothing and footwear”, and “movement and mobility safety”. These findings underscore the pivotal role of external factors in preventing falls in the rural community’s context. Interestingly, virtually all participants rated their homes as low risk for falls despite the research team noting obvious hazards such as the high risers on steps of rickety construction leading to the upper floor of the house (Additional file 3). Risks such as the steps were in a sense unseen by participants as it was the usual type of construction for the houses. Focus on the items of house risk assessment, the absence of bed or sleeping on a mattress placed directly on the floor is one of the critical domains. The previous study found that lower extremity strength is a crucial determinant of mobility, gait stability, and fall risk in older adults [ 20 ]. The combination of poor knee function and inappropriate bed or mattress height may exacerbate movement difficulty and subsequently increase fall risk [ 21 ]. Although sleeping on the floor with or without a mattress is commonly observed in rural settings, the presence of bathrooms located outside the house or at a distance from the bedroom further exacerbates house environmental hazards, thereby increasing the risk of falls among older adults. To promote the environmental safety and home management for preventing falls perceived severity of falls among older adults and perceived self-efficacy of home environmental safety management, mobility and movement safety need to be a concern [ 22 ]. Appropriate clothing and footwear are one of the issues related to falls in this study. There was a study in 2025 showed appropriate shoe had effectiveness to improve balance, walking ability, and decrease of fear of falling [ 23 ]. Although it obviously indicates that proper clothing and appropriate footwear provide benefits for walking and play a role in reducing fall-related problems as explained above, it is undeniable that many older adults in rural communities continue to wear unsuitable shoes (Additional file 4). This behavior poses a risk to their mobility and safety. Therefore, it highlights the necessity of implementing measures to address this issue, ensuring that older adults receive proper guidance and support in adopting footwear that enhances both stability and fall prevention. Conclusion The factors influencing falls occurrence among older adults have been driven by multifactor. This study suggests that in the rural setting indicate that enhancing environmental safety and improving household management practices may represent the most robust and sustainable approaches to reducing fall incidence among older adults. Nevertheless, a comprehensive intervention strategy should address all identified determinants, including movement awareness, appropriate clothing and footwear. Improving quality of life requires coordinated multi-sectoral engagement and close collaboration with communities to ensure societal preparedness for a rapidly ageing population, with the goal of promoting healthy longevity rather than longevity accompanied by sickness. Declarations Clinical trial number: Not applicable. Ethics approval and consent to participate: All participants provided written informed consent after receiving both verbal and written explanations of the study procedures. The study was conducted in accordance with the Declaration of Helsinki and was approved by the Ethics Committee of the Center for Ethics in Human Research, Mahasarakham University (Approval No. 457-416/2024; date approved: July 25, 2024). Consent for publication: Not applicable. A variability of data and materials: Not applicable. Competing interests: The authors declare no competing interests. Funding: This study was funded by the Faculty of Public Health, Mahasarakham University. Author Contributors: Conceptualization, SG, DP; formal analysis, RN.; funding acquisition, SG.; investigation, SG, RN, and SK.; KW.; CB supervision, DP; validation, RN and SG; writing original draft preparation, RN; writing review and editing, SG, RN, and SK.; KW.; CB, and DP; visualization, RN. All authors have read and agreed to the published version of the manuscript. Acknowledgment: We thank all staff who participated in this project across four districts in Mahasarakham Province, Thailand. We also acknowledge the Faculty of Public Health, Mahasarakham University, for providing financial support. References Immonen M, Haapea M, Similä H, Enwald H, Keränen N, Kangas M, et al. Association between chronic diseases and falls among a sample of older people in Finland. BMC Geriatr. 2020;20:225. https://doi.org/10.1186/s12877-020-01621-9 . Li Z, Zhang Z, Ren Y, Wang Y, Fang J, Yue H, et al. Aging and age-related diseases: from mechanisms to therapeutic strategies. Biogerontology. 2021;22:165–87. https://doi.org/10.1007/s10522-021-09910-5 . United Nations, Department of Economic and Social Affairs, Population Division. World population ageing 2019: highlights. New York: United Nations; 2019. Nov 12 2025. https://www.un.org/en/developmentdesa/population/publications/pdf/ageing/WorldPopulationAgeing2019-Highlights.pdf . Zhang H, Zhao Y, Wei F, Han M, Chen J, Peng S, et al. Prevalence and Risk Factors for Fall among Rural Elderly: A County-Based Cross-Sectional Survey. Int J Clin Pract. 2022;2022:8042915. https://doi.org/10.1155/2022/8042915 . Yoo JS, Kim CG, Yim J, Jeon MY. Factors influencing falls in the frail elderly individuals in urban and rural areas. Aging Clin Exp Res. 2016;28:687–97. https://doi.org/10.1007/s40520-015-0469-2 . Iamtrakul P, Chayphong S, Jomnonkwao S, Ratanavaraha V. The Association of Falls Risk in Older Adults and Their Living Environment: A Case Study of Rural Area. Thail Sustain. 2021;13:13756. https://doi.org/10.3390/su132413756 . Ministry of Public Health (Thailand). Handbook for screening and health assessment of older adults B.E. 2564. Thailand: Ministry of Public Health. 2021. Aug 27 2023. https://shorturl.at/xN6DN Faul F, Erdfelder E, Lang A-G, Buchner A. G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods. 2007;39:175–91. https://doi.org/10.3758/bf03193146 . Thiamwong L, Thamarpirat J, Maneesriwongul W, Jitapunkul S. Thai falls risk assessment test (Thai-FRAT) developed for community-dwelling Thai elderly. J Med Assoc Thai. 2008;91:1823–31. Jiamjarasrangsi W, ADAPTATION AND EVALUATION OF HOME FALL RISK ASSESSMENT TOOLS FOR THE ELDERLY IN. THAILAND: Charupa Lektip1, Thanapoom Rattananupong1, Kitti-On Sirisuk2, Plaiwan Suttanon3, Wiroj Jiamjarasrangsi1. Southeast Asian J Trop Med Public Health. 2020;51:65–76. Lektip C, Lapmanee S, Petsirasan R, Chaipinyo K, Lektip S, Nawarat J. Construction of the Short-Form Thai-Home Fall Hazard Assessment Tool (Thai-HFHAT-SF) and Testing Its Validity and Reliability in the Elderly. Int J Environ Res Public Health. 2022;19:5187. https://doi.org/10.3390/ijerph19095187 . Wittayapun Y, Nawarat J, Lapmanee S, Mackenzie L, Lektip C. Reliability of the 44-question Home Fall Hazard Assessment Tool and demographic characteristics associated with home hazards among the Thai elderly. 2023. https://doi.org/10.12688/f1000research.126690.4 Dawson J, Fitzpatrick R, Murray D, Carr A. Questionnaire on the perceptions of patients about total knee replacement. J Bone Joint Surg Br Volume. 1998;80–B:63–9. https://doi.org/10.1302/0301-620X.80B1.0800063 . Harris KK, Dawson J, Jones LD, Beard DJ, Price AJ. Extending the use of PROMs in the NHS—using the Oxford Knee Score in patients undergoing non-operative management for knee osteoarthritis: a validation study. 2013. https://doi.org/10.1136/bmjopen-2013-003365 Charoencholvanich K, Pongcharoen B. Oxford knee score and SF-36: translation & reliability for use with total knee arthroscopy patients in Thailand. J Med Assoc Thai. 2005;88:1194–202. Shumway-Cook A, Brauer S, Woollacott M. Predicting the Probability for Falls in Community-Dwelling Older Adults Using the Timed Up & Go Test. Phys Ther. 2000;80:896–903. https://doi.org/10.1093/ptj/80.9.896 . Department of Health, Bureau of Elderly Health, Ministry of Public Health (Thailand). In: Banpuan W, editor. Guideline for health promotion: healthy ageing and longevity (health promotion & prevention individual wellness plan). 2nd ed. Bangkok. Office of Printing Mill, The War Veterans Organization of Thailand; 2021. Srimoke W, Thanapop C, Sangchart P, Chitpong S, Hnoophet J, Rueangkhanap N, et al. Protective Factors for Falls Among Independent Older Adults: A Cross-Sectional Study. Int J Environ Res Public Health. 2025;22:1202. https://doi.org/10.3390/ijerph22081202 . 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. https://doi.org/10.3389/fmed.2022.1019094 . Peoples BM, Harrison KD, Santamaria-Guzman KG, Campos-Vargas SE, Monaghan PG, Roper JA. Functional lower extremity strength influences stepping strategy in community-dwelling older adults during single and dual-task walking. Sci Rep. 2024;14:13379. https://doi.org/10.1038/s41598-024-64293-0 . Capezuti E, Wagner L, Brush BL, Boltz M, Renz S, Secic M. Bed and Toilet Height as Potential Environmental Risk Factors. Clin Nurs Res. 2008;17:50–66. https://doi.org/10.1177/1054773807311408 . Songthap A, Suphunnakul P, Rakprasit J. Factors affecting home environmental safety management for fall prevention for older adults in northern Thailand. BMC Geriatr. 2023;23:704. https://doi.org/10.1186/s12877-023-04419-7 . Norouzi S, Błachnio A, Zeynalzadeh Ghoochani B, Asadollahi A, Kaveh MH. Effectiveness of Shoes With Non-Slip Insole on Balance, Fear of Falling, and Fall Prevention Among Older Women: A Parallel RCT. Sage Open Aging. 2025;11:30495334251358528. https://doi.org/10.1177/30495334251358528 . Additional Declarations No competing interests reported. Supplementary Files Additionalfile1HouseRisksAssessment.docx Additional file 1 House Risks Assessment Additionalfile2FallPreventionBehaviorQuestionnaire.docx Additional file 2 Fall Prevention Behavior Questionnaire Additionalfile3Thestaircaselacksbilateralhandrails.pptx Additional file 3 The staircase lacks bilateral handrails and has steep incline structural features frequently observed in the homes of older adults in community settings. Additionalfile4Wearingillfittingorinadequatelysupportivefootwear.pptx Additional file 4 Wearing ill-fitting or inadequately supportive footwear, particularly loose sandals, is common among older adults in rural communities. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 27 Apr, 2026 Reviews received at journal 21 Apr, 2026 Reviewers agreed at journal 07 Apr, 2026 Reviews received at journal 29 Mar, 2026 Reviewers agreed at journal 05 Mar, 2026 Reviewers invited by journal 24 Feb, 2026 Editor assigned by journal 22 Feb, 2026 Editor invited by journal 16 Feb, 2026 Submission checks completed at journal 16 Feb, 2026 First submitted to journal 16 Feb, 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. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8781848","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":596172194,"identity":"ac85ed57-e977-4d6e-ac0a-d4f0e072cb19","order_by":0,"name":"Rujira Nonsa-ard","email":"","orcid":"","institution":"Mahasarakham University","correspondingAuthor":false,"prefix":"","firstName":"Rujira","middleName":"","lastName":"Nonsa-ard","suffix":""},{"id":596172195,"identity":"3de3142e-99d0-4d42-bf4f-881f5ba089f2","order_by":1,"name":"Sirapat Khodseewong","email":"","orcid":"","institution":"Mahasarakham University","correspondingAuthor":false,"prefix":"","firstName":"Sirapat","middleName":"","lastName":"Khodseewong","suffix":""},{"id":596172196,"identity":"e7f0a290-2b49-44fe-9862-e47995967ada","order_by":2,"name":"Kasama Wongprachum","email":"","orcid":"","institution":"Mahasarakham University","correspondingAuthor":false,"prefix":"","firstName":"Kasama","middleName":"","lastName":"Wongprachum","suffix":""},{"id":596172197,"identity":"cd9f8333-d936-4704-a4f6-d3c875c7e8a3","order_by":3,"name":"Chaiwut Bourneow","email":"","orcid":"","institution":"Mahasarakham University","correspondingAuthor":false,"prefix":"","firstName":"Chaiwut","middleName":"","lastName":"Bourneow","suffix":""},{"id":596172198,"identity":"5b69fc7d-9fb3-49da-acd2-abf97a5aaa4c","order_by":4,"name":"Ploypailin Aneknan","email":"","orcid":"","institution":"Mahasarakham University","correspondingAuthor":false,"prefix":"","firstName":"Ploypailin","middleName":"","lastName":"Aneknan","suffix":""},{"id":596172199,"identity":"f2d1755e-9802-442d-b5c3-277373cafd5e","order_by":5,"name":"Sumattana Glangkarn","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA60lEQVRIiWNgGAWjYJADxgcwFjNBtQcSIAoNYHqbidXCJkGUFvkZ2YmfP/6wy+NvYL9WdePPYQb+9gPsjwvwaDG4kbtZ4kBCcrHEAZ6y27lthxkkziQwNs/Ap0UidwNQC3NiwwGetNu5DYcZGG4AHcaD12G5m38cSKhPnA/UUpwDdJg8IS0MN3K3AW05nLjhAPsx5hy2w0CnEtBicObtNoszaccTNx7mYZbObUvnMTyT2Dgbr8PaczffqLCpTpx3vP3h55w/1nJyxw8f+IzXYXDAzAOOSaBixgaiNAAB+wNiVY6CUTAKRsEIAwCWzVGK+bNMmAAAAABJRU5ErkJggg==","orcid":"","institution":"Mahasarakham University","correspondingAuthor":true,"prefix":"","firstName":"Sumattana","middleName":"","lastName":"Glangkarn","suffix":""},{"id":596172200,"identity":"f9eb232c-1042-424d-9645-edb8cfcc98e2","order_by":6,"name":"Davina Porock","email":"","orcid":"","institution":"Excellent Center for Community Aged Care","correspondingAuthor":false,"prefix":"","firstName":"Davina","middleName":"","lastName":"Porock","suffix":""}],"badges":[],"createdAt":"2026-02-04 04:54:03","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8781848/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8781848/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":103587136,"identity":"ba56bdf1-28b9-4c20-8005-64c6a9b8e290","added_by":"auto","created_at":"2026-02-27 11:27:18","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":80498,"visible":true,"origin":"","legend":"\u003cp\u003eThe distribution of house risk items between groups of falls and non-fallers\u003c/p\u003e\n\u003cp\u003eThe distribution of house risk items between groups of falls and non fallers. Bars show the percentage of households. Light blue stands for non fallers (n = 822), medium blue stands for fallers (n = 434), and dark blue stands for total (n = 1,256).\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8781848/v1/d1d0320c36d5e2caecb997c6.jpg"},{"id":103587058,"identity":"ac7a17fc-ac41-4867-a1cc-d0fecdb541fa","added_by":"auto","created_at":"2026-02-27 11:27:05","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":24672,"visible":true,"origin":"","legend":"\u003cp\u003eThe Oxford Knee Score between groups of falls and non-fallers\u003c/p\u003e\n\u003cp\u003eThe Oxford Knee Score between groups of falls and non fallers. Light blue stands for non fallers (n = 822), medium blue stands for fallers (n = 434).\u003c/p\u003e","description":"","filename":"2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8781848/v1/bf452f10de6ab16e1df62fde.jpg"},{"id":103587359,"identity":"5581653f-0409-4da7-ad4a-1a0923802f02","added_by":"auto","created_at":"2026-02-27 11:27:47","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1371025,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8781848/v1/ae6f3e79-861a-4e1a-97a4-2a39c422f2aa.pdf"},{"id":103587215,"identity":"2a1188fc-61a8-4a0e-8315-1deb6c93351c","added_by":"auto","created_at":"2026-02-27 11:27:29","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":18437,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eAdditional file 1 \u003c/strong\u003eHouse Risks Assessment\u003c/p\u003e","description":"","filename":"Additionalfile1HouseRisksAssessment.docx","url":"https://assets-eu.researchsquare.com/files/rs-8781848/v1/215f64e87c37fac48affb534.docx"},{"id":103587128,"identity":"da87617f-6cd1-414a-8866-d7cec72d684d","added_by":"auto","created_at":"2026-02-27 11:27:17","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":20034,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eAdditional file 2 \u003c/strong\u003eFall Prevention Behavior Questionnaire\u003c/p\u003e","description":"","filename":"Additionalfile2FallPreventionBehaviorQuestionnaire.docx","url":"https://assets-eu.researchsquare.com/files/rs-8781848/v1/e35c73f2ead762d657137b7e.docx"},{"id":103587255,"identity":"6e633fe5-2147-4d37-8775-996631d95662","added_by":"auto","created_at":"2026-02-27 11:27:36","extension":"pptx","order_by":3,"title":"","display":"","copyAsset":false,"role":"supplement","size":380240,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eAdditional file 3 \u003c/strong\u003eThe staircase lacks bilateral handrails and has steep incline structural features frequently observed in the homes of older adults in community settings.\u003c/p\u003e","description":"","filename":"Additionalfile3Thestaircaselacksbilateralhandrails.pptx","url":"https://assets-eu.researchsquare.com/files/rs-8781848/v1/d041a5b57cbf9ec1bf65f080.pptx"},{"id":103587196,"identity":"a4198795-b5f8-40d0-b039-ee2415ef1b6e","added_by":"auto","created_at":"2026-02-27 11:27:24","extension":"pptx","order_by":4,"title":"","display":"","copyAsset":false,"role":"supplement","size":598867,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eAdditional file 4 \u003c/strong\u003eWearing ill-fitting or inadequately supportive footwear, particularly loose sandals, is common among older adults in rural communities.\u003c/p\u003e","description":"","filename":"Additionalfile4Wearingillfittingorinadequatelysupportivefootwear.pptx","url":"https://assets-eu.researchsquare.com/files/rs-8781848/v1/9d261984689fcb942734e1ef.pptx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Preventive Behaviors Associated with Fall Incidence Among Older Adults Living in Rural Communities of Thailand: A Cross-Sectional Study","fulltext":[{"header":"Background","content":"\u003cp\u003eThe world is undergoing a significant demographic shift, with the proportion of older adults steadily increasing due to sustained reductions in fertility and mortality rates. While this represents a major public health achievement, it is also accompanied by a higher prevalence of chronic illnesses, functional decline, and age-related conditions, which in turn increases the risk of falls [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. The World Health Organization projects that the number of people aged 60 years and over will more than double by 2050 [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThese demographic changes pose a particular challenge in rural areas of low- and middle-income countries (LMICs). By 2050, two-thirds of the world\u0026rsquo;s population aged 60 years and over will reside in LMICs [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Thailand, classified as an LMIC, is experiencing a rapid increase in its older population and is now classified as an aging society. Falls among older adults remain a major global public health concern, yet most research focuses on urban populations, with fewer studies conducted in rural communities [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. In rural settings, fall risk is exacerbated by socioeconomic disadvantage, lower educational attainment, housing types, reduced physical activity, and lower safety scores of home environments [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. In Thailand, households are commonly multi-generational and follow traditional housing patterns. Typically, these dwellings are two-storied, with the upper floor constructed of wood and the lower floor built from concrete. Architectural features such as steep staircases leading to the bedrooms, inadequate lighting, and the placement of toilets outside the house or at a considerable distance from bedrooms are prevalent. These environmental characteristics are recognized as significant risk factors for falls among older adults, with the accessibility and condition of toilets being of particular concern [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn addition, these risks may be intensified by limited use of preventive behaviors. A comprehensive assessment of demographic, health-related, behavioral, and environmental determinants is therefore essential to understand how these factors interact and to develop targeted, context-specific strategies for fall prevention among rural-dwelling older adults. The aim of this study was to investigate the falls history and factors associated with falls, including participant characteristics, Thai Fall Risk Assessment Tool (Thai-FRAT), house risk assessment, knee osteoarthritis, Timed Up and Go Test (TUGT), and a preventative behaviors questionnaire.\u003c/p\u003e"},{"header":"Participants and method","content":"\u003cp\u003eResearch design and setting\u003c/p\u003e \u003cp\u003eThis cross-sectional study was conducted between October 2024 and April 2025 in Mahasarakham Province, Thailand. Prior to data collection, ten public health undergraduate students received training to ensure consistent understanding and administration of the questionnaire. To further ensure the quality of the data collection, a small-scale pilot survey was initially conducted using a questionnaire-based approach with 265 participants from one village. The pilot study also served as practical training for research staff in managing both data collection and data entry processes.\u003c/p\u003e \u003cp\u003eParticipants\u003c/p\u003e \u003cp\u003eOlder adults aged 60 years and above, living in rural communities in Mahasarakham Province, were eligible if they were independent in mobility, defined as scoring more than 11 points on the Thai version Barthel Activities of Daily Living (ADL) Index which is the Ministry of Public Health\u0026rsquo;s recommended screening tool [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. This study targeted independent older adults because the results are intended to be applied in developing preventive interventions for falls in this population. The sample size needed for the planned analysis was 1,309 participants. This was calculated using G*Power software version 3.1, with an Odds ratio of 1.3, the probability of 20% having falls, and a further 10% allowance for dropout [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. The required sample size of 1,309 participants was recruited. Of these, 53 participants were excluded due to incomplete questionnaires, resulting in a final analytical sample of 1,256 older adults.\u003c/p\u003e \u003cp\u003eInstruments and measurements\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eThai-FRAT Assessment\u003c/h2\u003e \u003cp\u003eThai FRAT was designed to assess the falls risk factors for Thai community-dwelling elderly. This tool comprises six items: gender, vision, balance, medication use, history of falls, and living area. Scores of 0\u0026ndash;3 indicate a low risk of falls, while scores of 4\u0026ndash;11 indicate a high risk. Sensitivity and specificity were 0.92 and 0.83 respectively [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eHouse Risk Assessment\u003c/h3\u003e\n\u003cp\u003eIn Thailand there are several versions of house risk assessment [\u003cspan additionalcitationids=\"CR11\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Although a shortened version of Thai Home Falls Hazards Assessment Tool (Thai-HFHAT) has been developed, it still presents limitations as a community screening tool due to the time required for interviewing. In fieldwork settings, where multiple questionnaires are typically used during interviews, its length may not be suitable for community-dwelling older adults. This study used the 10-item house risk assessment including to number of house stories, lighting, obstructions, handrails, bed type, bathroom safety, and appropriate furniture size. This questionnaire was adapted based on the previous study [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e] for rapid risk identification in community using simple dichotomous (\u0026ldquo;Yes\u0026rdquo; or \u0026ldquo;No\u0026rdquo;) responses. The 0\u0026ndash;3 score represents the unsafe house environment. While the score 4\u0026ndash;10 indicates a safe house environment (Additional file 1).\u003c/p\u003e\n\u003ch3\u003eOxford Knee Score assessment (OKS)\u003c/h3\u003e\n\u003cp\u003eThe OKS was originally developed to assess knee pain and function in the group of patients with total knee replacement and non-operative management for knee osteoarthritis [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. It is a 12-item patient-reported outcome measure (PROM). The score ranges from 0\u0026ndash;48 on a five-point Likert scale. The higher score indicates better joint function. This study used the Thai-version of the OKS which was adapted by Charoencholvanich and Pongcharoen (2005) for knee arthroplasty patients\u003c/p\u003e \u003cp\u003ein Thailand. High internal consistency reliability was reported (Cronbach's alpha\u0026thinsp;=\u0026thinsp;0.918) [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e\n\u003ch3\u003eTimed Up and Go Test (TUGT)\u003c/h3\u003e\n\u003cp\u003eThe TUGT is a simple, widely used, and reliable clinical tool designed to assess a person's mobility, balance, and risk of falling. It measures the time it takes for an individual to perform a sequence of common movements: rising from a chair, walking 3 meters, turning, walking back, and sitting down again. This test is able to identify community-dwelling adults who are at risk for falls with the 87% of sensitivity and 87% of specificity [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e\n\u003ch3\u003eFall prevention questionnaire\u003c/h3\u003e\n\u003cp\u003eThe fall prevention behaviors questionnaire consists of 18 items covering postures and movements, appropriateness of footwear and clothing, health check-ups and medication, exercise and balance training, restroom accessibility, obstruction hazards, and use of support equipment. This questionnaire was developed based on the guideline for health promotion to slow aging and live a long life (Individual Wellness Plan) [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Items were rated on a three-point scale: \u0026ldquo;Regularly\u0026rdquo;, \u0026ldquo;Sometimes\u0026rdquo;, or \u0026ldquo;Never\u0026rdquo; with the reliability coefficient was 0.828 for our sample (Additional file 2).\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eData analysis was conducted using SPSS version 23 (IBM Corp., Armonk, NY) and STATA version 12 (Stata Corp LP, College Station, TX). Descriptive statistics (frequencies, percentages, medians, and interquartile ranges) were used to summarize participant characteristics and responses. Associations between falls and demographic variables were assessed using the Chi-square test. Logistic regression analysis was performed to examine risk factors associated with falls, with results presented as odds ratios (OR) and 95% confidence intervals (CI). All the data of fall prevention behaviors were computed to two categories \u0026ldquo;Regularly\u0026rdquo; and \u0026ldquo;Sometimes\u0026rdquo;, based on the distribution of the data in each item. Kolmogorov\u0026ndash;Smirnov test was used to assess normality in continuous variables. Comparisons of the OKS between fallers and non-fallers were conducted using the Mann\u0026ndash;Whitney U test. To identify the group risk factors principal component analysis (PCA) was used. The Kaiser\u0026ndash;Meyer\u0026ndash;Olkin (KMO) statistical test was used to verify the applicability of the factor analysis. A KMO value of \u0026lt;\u0026thinsp;0.50 was deemed unacceptable. Varimax orthogonal rotation was used to simplify data interpretation. Preventive behavior items with factor loads\u0026thinsp;\u0026ge;\u0026thinsp;0.40 were considered representative of each risk pattern and were deemed to be the most informative in describing the risk pattern. A \u003cem\u003ep\u003c/em\u003e value of \u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eParticipant characteristics\u003c/h2\u003e \u003cp\u003eThe majority of participants were female (73.2%). More than half of the participants (51.0%) were aged over 70 years (age range: 60\u0026ndash;94 years old; mean age 70.6\u0026thinsp;\u0026plusmn;\u0026thinsp;7.2 years old), and this age group had a significantly higher proportion of fallers compared to those aged 60\u0026ndash;69 years (56.9% vs. 43.1%, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.002). In terms of education, the vast majority (93.1%) had six or fewer years of formal schooling. A higher proportion of fallers with more than six years of education was observed higher in non-fallers group compared to fallers group (8.2% vs. 4.6%, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.019). Farming was the predominant occupation (86.3%), with a non-significant trend toward a higher proportion of farmers among fallers compared to non-fallers (88.7% vs. 85.0%, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.072), as shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \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\u003eDemographic data of participants (n\u0026thinsp;=\u0026thinsp;1,256)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAll\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;1,256)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFallers\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;434)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNon fallers\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;822)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\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=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.835\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e337 (26.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e118 (27.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e219 (26.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e919 (73.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e316 (72.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e603 (73.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (year)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\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=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e60\u0026ndash;69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e615 (49.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e187 (43.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e428 (52.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMore than 70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e641 (51.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e247 (56.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e394 (47.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStatus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\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=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.617\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e111 (8.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e35 (8.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e76 (9.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarriage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e783 (62.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e278 (64.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e505 (61.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWidowed/separated\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e362 (28.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e121 (27.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e241 (29.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEducation levels\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\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=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.019\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEqual or less than 6 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1169 (93.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e414 (95.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e755 (91.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMore than 6 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e87 (6.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e20 (4.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e67 (8.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOccupation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\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=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.072\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFarmer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1084 (86.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e385 (88.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e699 (85.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNon-farmer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e172 (13.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e49 (11.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e123 (15.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eThe data are presented by frequency (percentage). The correlations were analyzed by using Chi-square (χ\u003csup\u003e2\u003c/sup\u003e) test.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eFalls experience\u003c/h2\u003e \u003cp\u003eThe results revealed 434 people experienced at least one fall within the past six months. Falls were more frequent outside of the house (59.9%), the most common reported cause of falls was slipping (51.4%), followed closely by tripping over obstacles (36.9%). Most participants (55.1%) managed any injuries from the fall through self-treatment; the remainder (44.9%) received treatment at a hospital. In terms of household composition, the majority of participants who had fallen lived with their children or other relatives (57.8%), followed by those living only with their spouse (31.8%). Only a small proportion (10.4%) lived alone (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\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\u003eFalls experience of the participants (n\u0026thinsp;=\u0026thinsp;434)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo. (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFalls experience within six months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e434 (34.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e822 (65.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePlaces of falls\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInside the house\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e174 (40.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOutside the house\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e260 (59.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCauses of falls\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSlip\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e223 (51.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTripped over an obstacle/\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e160 (36.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDizziness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e51 (11.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedical treatment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReceive treatment at the hospital\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e195 (44.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSelf-treatment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e239 (55.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWho are the family members you currently live with?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e45 (10.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSpouse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e138 (31.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChildren/relatives\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e251 (57.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"2\"\u003eThe data are presented by frequency (percentage).\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eThai-FRAT Assessment\u003c/h2\u003e \u003cp\u003eClassification of falls risk was assessed with the Thai-FRAT instrument. More than half of the total participants (52.7%) were categorized as low risk (0\u0026ndash;3 scores), while 47.3% were classified as high risk (4\u0026ndash;11 scores). Notably, all fallers were in the high-risk group, whereas the majority of non-fallers (80.5%) were in the low-risk group. This association between Thai-FRAT score and fall history was statistically significant (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), indicating that higher Thai-FRAT scores were strongly linked to fall occurrence (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\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\u003eThai-FRAT risk assessment score (n\u0026thinsp;=\u0026thinsp;1,256)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThai-FRAT score\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAll\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;1,256)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFallers\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;434)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNon fallers\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;822)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e value\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\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLow risk (0\u0026ndash;3 scores)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e662 (52.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e662 (80.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh risk (4\u0026ndash;11 scores)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e594 (47.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e434 (100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e160 (19.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eThe data are presented by frequency (percentage). The correlations were analyzed by using Fisher\u0026rsquo;s Exact Test.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eHouse risk Assessment\u003c/h2\u003e \u003cp\u003eAll participants (99.0%) reported their house was low risk for falls; there was no significant difference between fallers and non-fallers (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). However, the item-level analysis of house risk factors revealed the most reported concerns were absence of a bed or sleeping on mattress on the floor (23.4%), bathroom located outside of the house (19.0%), and absence of handrails (15.5%) (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eHouse risk assessment score (n\u0026thinsp;=\u0026thinsp;1,256)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHouse risk score\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAll\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;1,256)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFallers\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;434)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNon fallers\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;822)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e value\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\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.560\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh risk (0\u0026ndash;3 scores)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e12 (1.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3 (0.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e9 (1.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLow risk (4\u0026ndash;11 scores)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1,244 (99.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e431 (99.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e813 (98.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eThe data are presented by frequency (percentage).\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eOxford Knee Score Assessment\u003c/h2\u003e \u003cp\u003eThe result of this study was found the group of fallers had significantly lower score [median (IQR); 32.0 (25.0\u0026ndash;40.0)] meaning poorer joint function when compared to the higher score of the non-fallers [median (IQR); 39.0 (31.0\u0026ndash;47.0)] (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.043) (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eTimed Up and Go Test (TUGT)\u003c/h2\u003e \u003cp\u003eThe TUGT results showed that those participants who had fallen had a significantly slower walking speed (\u0026ge;\u0026thinsp;30 seconds) compared to non-fallers (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eTimed up and go test (n\u0026thinsp;=\u0026thinsp;1,256)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTime\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAll\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;1,256)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFallers\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;434)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNon fallers\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;822)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e value\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\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLess than 30 s\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e927 (73.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e294 (67.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e633 (77.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEqual or more than 30 s\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e329 (26.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e140 (32.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e189 (23.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eThe data are presented by frequency (percentage). The correlations were analyzed by using Chi-square (χ\u003csup\u003e2\u003c/sup\u003e) test.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eFall prevention behaviors\u003c/h2\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e shows that several preventive behaviors were significantly different between the two groups. Fallers reported more often than non-fallers that they were only \u0026ldquo;sometimes\u0026rdquo; being careful: when standing up and sitting down; negotiating uneven floors; going up and down stairs; when walking through, or avoiding, slippery areas (12.4% vs. 7.9%, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.009). Similarly, a higher proportion of fallers reported sometimes wearing shoes that fit properly (9.9% vs. 5.5%, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.003).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eFall prevention behavior (n\u0026thinsp;=\u0026thinsp;1,256)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\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 \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFall prevention behavior\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFallers\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;434)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eNon fallers\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;822)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYou take care when standing up and sitting down and going up and down stairs. You avoid or take care walking where the floor is slippery or uneven.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSometimes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e54 (12.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e65 (7.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0.009\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\u003eRegularly\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e380 (87.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e757 (92.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYou change positions correctly, sitting and standing slowly with confidence.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSometimes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e66 (15.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e112 (13.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0.445\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\u003eRegularly\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e368 (84.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e710 (86.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYou use a firm support when reaching or bending down.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSometimes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e178 (41.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e324 (39.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0.583\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\u003eRegularly\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e256 (59.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e498 (60.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYou wear shoes that fit your feet.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSometimes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e43 (9.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e45 (5.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0.003\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\u003eRegularly\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e391 (90.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e777 (94.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYou wear flat shoes.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSometimes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e48 (11.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e73 (8.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0.213\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\u003eRegularly\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e386 (88.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e749 (91.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYour shoes have good traction on the floor.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSometimes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e39 (9.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e52 (6.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0.084\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\u003eRegularly\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e395 (91.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e770 (93.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYou wear clothes that fit well, are not too loose or have long pants that drag on the floor.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSometimes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e45 (10.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e62 (7.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0.088\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\u003eRegularly\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e389 (89.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e760 (92.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYou go for regular eye check-ups and seek treatment when you have problems.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSometimes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e186 (42.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e321 (39.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0.191\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\u003eRegularly\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e248 (57.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e501 (60.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYou always consult your doctor when you have problems with taking your medication or side effects such as dizziness or faintness.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSometimes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e117 (27.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e210 (25.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0.588\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\u003eRegularly\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e317 (73.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e612 (74.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYou only take your own medication, such as sleeping pills.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSometimes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e338 (77.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e674 (82.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0.080\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\u003eRegularly\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e96 (22.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e148 (18.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYou exercise at least 30 minutes a day.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSometimes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e172 (39.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e310 (37.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0.506\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\u003eRegularly\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e262 (60.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e512 (62.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYou do exercises that increase muscle strength and balance.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSometimes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e171 (39.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e292 (35.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0.176\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\u003eRegularly\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e263 (60.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e530 (64.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYou keep your bathroom floor dry and separate wet and dry areas.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSometimes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e59 (13.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e104 (12.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0.636\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\u003eRegularly\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e375 (86.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e718 (87.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYou keep your things in your house organized and keep walkways clear.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSometimes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e37 (8.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e51 (6.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0.125\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\u003eRegularly\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e397 (91.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e771 (93.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYou make sure extension cords do not across walkways to prevent trips and falls.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSometimes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e64 (14.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e76 (9.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0.003\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\u003eRegularly\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e370 (85.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e746 (90.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYour house is well let so that you can see walkways and stairs clearly.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSometimes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40 (9.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e36 (4.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\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\u003eRegularly\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e394 (90.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e786 (95.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYou place your regularly used items within easy to reach \u0026ndash; not too high.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSometimes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e42 (9.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e49 (6.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0.016\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\u003eRegularly\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e392 (90.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e773 (94.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYou take care of and prepare your aids and equipment to help getting up and sitting down.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSometimes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e45 (10.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e52 (6.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0.011\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\u003eRegularly\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e389 (89.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e770 (93.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eThe data are presented by frequency (percentage). The correlations were analyzed by using Chi-square (χ\u003csup\u003e2\u003c/sup\u003e) test.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eEnvironmental safety also differed between groups, fallers were more likely to report only sometimes taking care of extension cords to prevent tripping hazards (14.7% vs. 9.2%, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.003), sometimes ensuring adequate lighting for walkways and stairs (9.2% vs. 4.4%, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), sometimes placing regularly used items within easy reach (9.7% vs. 6.0%, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.016), and sometimes preparing or maintaining assistive equipment to facilitate getting up and sitting down (10.4% vs. 6.3%, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.011).\u003c/p\u003e \u003cp\u003ePrincipal component analysis (PCA) revealed five group factors of fall prevention behaviors. The factor 1, environmental safety and house management, demonstrated high internal consistency (Cronbach\u0026rsquo;s α\u0026thinsp;=\u0026thinsp;0.840). The factor 2 comprised items concerning appropriate clothing and footwear (Cronbach\u0026rsquo;s α\u0026thinsp;=\u0026thinsp;0.774), while the factor 3 pertained to physical activity and safe medication (Cronbach\u0026rsquo;s α\u0026thinsp;=\u0026thinsp;0.701). The final two factors identified were self-management (Cronbach\u0026rsquo;s α\u0026thinsp;=\u0026thinsp;0.495) and movement and mobility safety (Cronbach\u0026rsquo;s α\u0026thinsp;=\u0026thinsp;0.597). Furthermore, factors 3, 4, and 5 were conceptually grouped into a single broader category, defined as personal health care, which yielded a combined Cronbach's alpha of 0.651 (Table\u0026nbsp;\u003cspan refid=\"Tab7\" class=\"InternalRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab7\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 7\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe patterns of preventive behaviors (n\u0026thinsp;=\u0026thinsp;1,256)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\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 \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFall prevention behavior\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFactor 1\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFactor 2\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eFactor 3\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eFactor 4\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eFactor 5\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYou place your regularly used items within easy to reach \u0026ndash; not too high.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.792\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 \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYour house is well let so that you can see walkways and stairs clearly.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.786\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 \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYou take care of and prepare your aids and equipment to help getting up and sitting down.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.750\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 \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYou make sure extension cords do not across walkways to prevent trips and falls.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.721\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 \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYou keep your things in your house organized and keep walkways clear.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.549\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 \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYou keep your bathroom floor dry and separate wet and dry areas.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.445\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 \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYour shoes have good traction on the floor.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.756\u003c/p\u003e \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 \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYou wear shoes that fit your feet.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.755\u003c/p\u003e \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 \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYou wear flat shoes.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.707\u003c/p\u003e \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 \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYou wear clothes that fit well, are not too loose or have long pants that drag on the floor.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.668\u003c/p\u003e \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 \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYou exercise at least 30 minutes a day.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.878\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYou do exercises that increase muscle strength and balance.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.866\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYou only take your own medication, such as sleeping pills.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.504\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYou go for regular eye check-ups and seek treatment when you have problems.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\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 \u003cp\u003e0.772\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYou always consult your doctor when you have problems with taking your medication or side effects such as dizziness or faintness.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\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 \u003cp\u003e0.701\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYou use a firm support when reaching or bending down.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\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 \u003cp\u003e0.752\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYou change positions correctly, sitting and standing slowly with confidence.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\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 \u003cp\u003e0.599\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYou take care when standing up and sitting down and going up and down stairs. You avoid or take care walking where the floor is slippery or uneven.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.447\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 \u003cp\u003e0.569\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eFactorial loads\u0026thinsp;\u0026ge;\u0026thinsp;0.40.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eThe association between falls and the pattern of prevention behaviors among the participants\u003c/h2\u003e \u003cp\u003eThe association between and the pattern of prevention behaviors and fall incidence among older adults. In the crude analysis, the significant associations were found only between falls and environmental safety and house management (factor 1) (Crude OR\u0026thinsp;=\u0026thinsp;0.45 [0.26\u0026ndash;0.89], \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.004) and appropriate clothing and footwear (factor 2) (Crude OR\u0026thinsp;=\u0026thinsp;0.52 [0.31\u0026ndash; 0.89], \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.016.\u003c/p\u003e \u003cp\u003eAfter adjusting for age and education level (Model a), these associations remained statistically significant, with adjusted odds ratios ranging from 0.44 to 0.50 in factor 1 aOR\u0026thinsp;=\u0026thinsp;0.44 [0.26\u0026ndash;0.76], \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.003) and 2 aOR\u0026thinsp;=\u0026thinsp;0.50 [0.29\u0026ndash;0.85], \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.011) respectively. In Model b, after normalized musculoskeletal effect found only environmental safety and house management (factor 1) remained significant (aOR\u0026thinsp;=\u0026thinsp;0.56 [0.32\u0026ndash;0.99], \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.048). When combined Model a and b (Model c), environmental safety and house management (factor 1) (aOR\u0026thinsp;=\u0026thinsp;0.55 [0.31\u0026ndash;0.98], \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.041) and movement and mobility safety remained significance difference (Factor 5) (aOR\u0026thinsp;=\u0026thinsp;0.64 [0.41\u0026ndash;0.98], \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.041) were found significant difference (Table\u0026nbsp;\u003cspan refid=\"Tab8\" class=\"InternalRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab8\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 8\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAnalysis of crude and adjusted associations and respective confidence intervals between falls associated with fall prevention behavior patterns of older adults (n\u0026thinsp;=\u0026thinsp;1,256)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"10\"\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 \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFalls\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCrude OR (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eaOR\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003cp\u003e(95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eaOR\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003cp\u003e(95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eaOR\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e \u003cp\u003e(95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEnvironmental safety and house management\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.45 (0.26\u0026ndash;0.89)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.004\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.44 (0.26\u0026ndash;0.76)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.56 (0.32\u0026ndash;0.99)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.048\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.55 (0.31\u0026ndash;0.98)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.041\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAppropriate clothing and footwear\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.52 (0.31\u0026ndash;0.89)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.016\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.50 (0.29\u0026ndash;0.85)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.011\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.68 (0.39\u0026ndash;1.21)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.192\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.66 (0.37\u0026ndash;1.17)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.153\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePhysical activity and safe medication\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.96 (0.70\u0026ndash;1.32)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.786\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.96 (0.70\u0026ndash;1.32)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.808\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.00 (0.72\u0026ndash;1.38)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.979\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.00 (0.72\u0026ndash;1.38)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.979\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSelf-management\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.84 (0.62\u0026ndash;1.13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.246\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.85 (0.62\u0026ndash;1.15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.282\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.78 (0.57\u0026ndash;1.07)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.119\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.78 (0.57\u0026ndash;1.07)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.129\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMovement and mobility safety\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.72 (0.48\u0026ndash;1.09)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.120\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.67 (0.45\u0026ndash;1.02)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.061\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.67 (0.44\u0026ndash;1.04)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.071\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.64 (0.41\u0026ndash;0.98)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.041\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"10\"\u003eThe data were used the bivariate logistic regression to perform statistical analyze.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"10\"\u003e\u003csup\u003ea\u003c/sup\u003e Model a: Adjusting for age (continues), education levels\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"10\"\u003e\u003csup\u003eb\u003c/sup\u003e Model b: Adjusting for OKS, and TUGT.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"10\"\u003e\u003csup\u003ec\u003c/sup\u003e Model c: Model a\u0026thinsp;+\u0026thinsp;Model b\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study is the first of a planned program of research at Mahasarakham University (MSU) focusing on falls reduction, dementia prevention, and nutrition promotion, to promote well-being for older adults living in rural Thailand, especially in the northeastern region. The philosophy underpinning the research program is to co-design solutions with local people and work to put research evidence into action to support older people.\u003c/p\u003e \u003cp\u003eThe aim was to survey older people in the villages surrounding MSU as a baseline for monitoring the impact of the research program, and importantly to identify problems and potential solutions for reducing health risks in this population. Using the model of falls risk prevention published by the Thai department of health [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e], the team constructed a survey from established measures, using the most simplified version possible to reduce survey fatigue. With the assistance of 10 trained public health students, over 1,200 older people were surveyed and tested for falls risk including physical activity, risk behaviors and home-based environmental hazards.\u003c/p\u003e \u003cp\u003eAs expected, the findings show that poorer performance on physical activity tests, and less attention to footwear, personal risk behaviors or environmental hazards were all associated with having fallen in the prior six months.\u003c/p\u003e \u003cp\u003eThe fallers in this study were active adults who worked on farms. Consequently, their falls typically occurred outdoors and were caused by slipping or tripping. This situation is common in rural areas, where older adults often continue to work in agriculture even while living with their children. This finding is consistent with research from rural China, which found that a higher incidence of falls was associated with multiple factors, including education level, marital status, physical activity, and the safety of the home environment [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. However, the agriculture work in fall risk is controversial. A study conducted in Nakhon Si Thammarat, the southern region of Thailand, found that agricultural employment was actually a protective factor against falls [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Despite this key difference, other findings from that study such as falls resulting in minor injuries and being primarily caused by slipping and tripping were quite similar to the results of our study [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Falls have multifactorial causes, involving a complex interaction between a person's internal risk factors including age, gender, disease conditions, visual impairment, and depression and external risk factors, such as environmental and behavioral elements [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. In this study, participants who had fallen not only showed worse physical activity, as explained above, but also demonstrated poorer knee function. This was indicated by the faller group having lower Oxford Knee Scores (OKS) compared to non-fallers.\u003c/p\u003e \u003cp\u003eThe factor analysis of preventive behaviors revealed five groups. After adjusting for covariates, statistically significant differences were found in three groups related to external factors \u0026ldquo;environmental safety and home management\u0026rdquo;, \u0026ldquo;appropriate clothing and footwear\u0026rdquo;, and \u0026ldquo;movement and mobility safety\u0026rdquo;. These findings underscore the pivotal role of external factors in preventing falls in the rural community\u0026rsquo;s context. Interestingly, virtually all participants rated their homes as low risk for falls despite the research team noting obvious hazards such as the high risers on steps of rickety construction leading to the upper floor of the house (Additional file 3). Risks such as the steps were in a sense unseen by participants as it was the usual type of construction for the houses. Focus on the items of house risk assessment, the absence of bed or sleeping on a mattress placed directly on the floor is one of the critical domains. The previous study found that lower extremity strength is a crucial determinant of mobility, gait stability, and fall risk in older adults [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. The combination of poor knee function and inappropriate bed or mattress height may exacerbate movement difficulty and subsequently increase fall risk [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Although sleeping on the floor with or without a mattress is commonly observed in rural settings, the presence of bathrooms located outside the house or at a distance from the bedroom further exacerbates house environmental hazards, thereby increasing the risk of falls among older adults. To promote the environmental safety and home management for preventing falls perceived severity of falls among older adults and perceived self-efficacy of home environmental safety management, mobility and movement safety need to be a concern [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Appropriate clothing and footwear are one of the issues related to falls in this study. There was a study in 2025 showed appropriate shoe had effectiveness to improve balance, walking ability, and decrease of fear of falling [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Although it obviously indicates that proper clothing and appropriate footwear provide benefits for walking and play a role in reducing fall-related problems as explained above, it is undeniable that many older adults in rural communities continue to wear unsuitable shoes (Additional file 4). This behavior poses a risk to their mobility and safety. Therefore, it highlights the necessity of implementing measures to address this issue, ensuring that older adults receive proper guidance and support in adopting footwear that enhances both stability and fall prevention.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe factors influencing falls occurrence among older adults have been driven by multifactor. This study suggests that in the rural setting indicate that enhancing environmental safety and improving household management practices may represent the most robust and sustainable approaches to reducing fall incidence among older adults. Nevertheless, a comprehensive intervention strategy should address all identified determinants, including movement awareness, appropriate clothing and footwear. Improving quality of life requires coordinated multi-sectoral engagement and close collaboration with communities to ensure societal preparedness for a rapidly ageing population, with the goal of promoting healthy longevity rather than longevity accompanied by sickness.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eClinical trial number:\u0026nbsp;\u003c/strong\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate:\u0026nbsp;\u003c/strong\u003eAll participants provided written informed consent after receiving both verbal and written explanations of the study procedures. The study was conducted in accordance with the Declaration of Helsinki and was approved by the Ethics Committee of the Center for Ethics in Human Research, Mahasarakham University (Approval No. 457-416/2024; date approved: July 25, 2024).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u0026nbsp;\u003c/strong\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eA variability of data and materials:\u0026nbsp;\u003c/strong\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u0026nbsp;\u003c/strong\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e This study was funded by the Faculty of Public Health, Mahasarakham University.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributors:\u0026nbsp;\u003c/strong\u003eConceptualization, SG, DP; formal analysis, RN.; funding acquisition, SG.; investigation, SG, RN, and SK.; KW.; CB supervision, DP; validation, RN and SG; writing original draft preparation, RN; writing review and editing, SG, RN, and SK.; KW.; CB, and DP; visualization, RN. All authors have read and agreed to the published version of the manuscript.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgment:\u0026nbsp;\u003c/strong\u003eWe thank all staff who participated in this project across four districts in Mahasarakham Province, Thailand. We also acknowledge the Faculty of Public Health, Mahasarakham University, for providing financial support.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eImmonen M, Haapea M, Simil\u0026auml; H, Enwald H, Ker\u0026auml;nen N, Kangas M, et al. Association between chronic diseases and falls among a sample of older people in Finland. 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Sage Open Aging. 2025;11:30495334251358528. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1177/30495334251358528\u003c/span\u003e\u003cspan address=\"10.1177/30495334251358528\" 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-geriatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bgtc","sideBox":"Learn more about [BMC Geriatrics](http://bmcgeriatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bgtc/default.aspx","title":"BMC Geriatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"falls, community-dwelling older adults, prevention, behavior","lastPublishedDoi":"10.21203/rs.3.rs-8781848/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8781848/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eThe escalating population of older adults poses a significant challenge, particularly in lower-middle-income countries like Thailand. Falls represent a critical public health concern in this demographic. This study aimed to identify risk factors influencing fall occurrence in older adults within a specific rural community context, where the majority of participants remain engaged in farm work.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA cross-sectional study design was utilized, involving 1,256 participants. Data were collected via a questionnaire that included: demographic information, the Thai version of the Barthel Activities of Daily Living (ADL), the Thai Fall Risk Assessment Tool (FRAT), House Risk assessment, the Timed Up and Go Test (TUGT), the Oxford Knee Score (OKS), and an assessment of fall prevention behaviors. Principal Component Analysis (PCA) was employed to classify groups of fall prevention behaviors, and binary logistic regression was used to determine the association between these factors and fall incidence.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe study was predominantly female (73.2%), with more than half of the participants aged over 70 years (51.0%; mean age 70.6\u0026thinsp;\u0026plusmn;\u0026thinsp;7.2 years old) and 93.1% having six or fewer years of education. The results indicated that 34.5% of participants had experienced at least one fall within the preceding six months. PCA categorized fall prevention behaviors into five factors: environmental safety and house management Cronbach\u0026rsquo;s α\u0026thinsp;=\u0026thinsp;0.840), appropriate clothing and footwear Cronbach\u0026rsquo;s α\u0026thinsp;=\u0026thinsp;0.774), physical activity and safe medication (Cronbach\u0026rsquo;s α\u0026thinsp;=\u0026thinsp;0.701), self-management (Cronbach\u0026rsquo;s α\u0026thinsp;=\u0026thinsp;0.495), and movement and mobility safety (Cronbach\u0026rsquo;s α\u0026thinsp;=\u0026thinsp;0.597). In the crude analysis, fall incidence was significantly associated with environmental safety and house management (Crude OR\u0026thinsp;=\u0026thinsp;0.45, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.004) and appropriate clothing and footwear (Crude OR\u0026thinsp;=\u0026thinsp;0.52, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.016). After adjusting for age, education, OKS, and TUGT, only the association with environmental safety and house management (aOR\u0026thinsp;=\u0026thinsp;0.55, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.041) and movement and mobility safety remained statistically significant (aOR\u0026thinsp;=\u0026thinsp;0.64, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.041).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThese findings from a rural context suggest that promoting environmental safety and proper house management may be the most crucial and resilient strategy for reducing fall incidence among older adults. However, fall prevention in older adults is an interplay of multiple factors, all factors identified must be considered in comprehensive intervention strategies.\u003c/p\u003e","manuscriptTitle":"Preventive Behaviors Associated with Fall Incidence Among Older Adults Living in Rural Communities of Thailand: A Cross-Sectional Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-27 11:25:01","doi":"10.21203/rs.3.rs-8781848/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-04-27T12:35:43+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-22T03:45:14+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"118304344335483399991701235004191056399","date":"2026-04-07T23:33:49+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-30T03:00:21+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"42427936190908534591663201757411853793","date":"2026-03-06T00:27:44+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-02-24T09:08:45+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-02-22T08:10:36+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-02-17T04:35:16+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-02-16T14:13:27+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Geriatrics","date":"2026-02-16T14:09:20+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-geriatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bgtc","sideBox":"Learn more about [BMC Geriatrics](http://bmcgeriatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bgtc/default.aspx","title":"BMC Geriatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"b4ddf2a3-c792-4008-a869-7366f7c2a8f0","owner":[],"postedDate":"February 27th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-13T14:35:53+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-27 11:25:01","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8781848","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8781848","identity":"rs-8781848","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}