Project Summary Falls are the leading cause of unintentional fatal and non-fatal injuries in older adults. Prevention of fall injuries is a national public health priority (Healthy People 2020 Objective IVP-23.2 and OA-11). To date, most of the studies on elderly falls were conducted in urban neighborhoods. Little is known about the differences in circumstances and consequences of falls among older adults living in rural versus urban neighborhoods. To our knowledge, no study on falls has examined how older adults' space and time use differ in rural and urban neighborhoods, and how such differences are related to risk of falling. This project will investigate 1) the rural- urban differences in time and space use among older adults; and 2) how time and space use influences risks for indoor and outdoor falls among older adults living in different neighborhood environments. We propose to establish a longitudinal cohort of 1,200 older adults age 65 years and older in Worcester County and surrounding towns, including 400 each from urban, suburban and rural neighborhood strata, and composed of at least 33% racial/ethnic minorities. Participants will be followed for three years. Fall events will be tracked using monthly falls calendar and follow-up telephone/online surveys. During the first year, once in late spring/summer/early fall and once in late fall/winter/early spring, participant mobility patterns with respect to space, frequency and duration will be measured using a global positioning system (GPS) unit, and participant timing, frequency, duration and intensity of indoor and outdoor activities will be concurrently measured using a accelerometer (ACC). Between months 18 and 30 the participants will wear the GPS and ACC devices a third time with 50% of the participants randomized to wear the devices during the late spring/summer/early fall seasons and 50% randomized to wear them in the late fall/winter/early spring seasons. During the follow-up years 2 and 3, participants will be followed using mail or online surveys twice a year querying their time and space use and health status. The GPS and ACC data will be integrated with participant reported health, perception and behavioral data as well as neighborhood environment data. The data will be analyzed to achieve the following goals: Aim 1: To quantify the rural-urban differences in space and time use among older adults. Aim 2: To identify predictors of space and time use, with a focus on modifiable factors. Aim 3: To examine rural-urban disparities in fall risks in relation to patterns of space and time use. Aim 4: To examine sex and racial disparities in fall risks in relation to space and time use. Results from this research will inform the design of community-based programs for promoting active living and preventing falls that will be effective across the rural-urban continuum.

Project Narrative Prevention of fall injuries is a national public health priority. This study investigates the differences in time and space use in relation to falls among older adults living in rural, suburban and urban neighborhoods. Results from this study will inform the design of community-based programs for promoting active aging and preventing falls that are effective across the rural- urban continuum.