Do YoungJoo

Gyeongsang National University College of Nursing, South Korea

Abstract Title: Ecological Determinants of Fall Risk in Urban-Rural Community-Dwelling Older Adults: A Hierarchical Multidomain Analysis

Biography:

Juhee Seo is a doctoral student in Nursing at Gyeongsang National University, South Korea. She is a researcher on the DREAMS (Digital Rural-urban Ecosystem for Active Management & Successful Aging) project funded by the National Research Foundation of Korea, which aims to develop and implement innovative digital-based approaches to support active management and successful aging across rural and urban settings.
Heekyung Chang is a professor of Nursing at Gyeongsang National University, South Korea, and serves as the principal investigator of the DREAMS project.
Minji Park and Youngjoo Do are doctoral students in Nursing and researchers on the DREAMS project, contributing substantially to study design, data collection, and data analysis.

Research Interest:

Background: Falls remain a leading cause of morbidity in older adults, yet how ecological determinants across multiple domains shape fall risk is underexplored.
Purpose: This study examined the incremental contribution of demographic, physical, psychological, social, and community-level factors to fall risk, and compared predictor profiles between urban and rural settings.
Methods: A cross-sectional study included 464 community-dwelling older adults (urban n = 268; rural n = 196) in South Korea. High fall risk was defined as ≥4 on the CDC Stay Independent assessment. Five-step hierarchical logistic regression sequentially entered demographic, physical, psychological, social, and community factors.
Results: Overall, 58.2% had high fall risk, with no urban–rural prevalence difference (p = .186). The full model achieved strong discrimination (AUC = 0.904; Nagelkerke R² = .597). In the full model, frailty (OR = 1.58), chronic conditions (OR = 1.53), and social isolation (OR = 1.12) independently increased fall risk, while physical performance (OR = 0.84), cognitive function (OR = 0.94), and rural residence (OR = 0.45) were protective. Stratified analyses revealed distinct profiles: urban fall risk was driven by chronic conditions (OR = 1.96), frailty (OR = 1.69), and social isolation (OR = 1.26), whereas rural fall risk was linked to male sex (OR = 0.27), living alone (OR = 0.28), and lower income (OR = 0.47).
Conclusions: Equivalent fall risk prevalence masks distinct predictor profiles across settings. Urban fall risk is driven by health-related factors amenable to clinical intervention, while rural fall risk reflects structural and socioeconomic conditions requiring community-level strategies.
 

Keywords: Accidental Falls, Ecological Determinants, Urban-Rural Disparities, Older Adults, Hierarchical Logistic Regression