Perceived Neighborhood Environments and Falls Among Community-Dwelling Older Adults in the United States: The Moderating Role of Functional Limitations

Objectives Neighborhood environments influence falls in later life, but the role of functional limitations in this relationship is unclear. Guided by environmental gerontology theories, we examined whether functional limitations (none/mild/severe) moderated the association between neighborhood social cohesion and physical disorder and subsequent falls. Methods We pooled adults aged ≥65 ( n = 5,075) from the 2014–2016 Health and Retirement Study and assessed falls 2 years later (2016–2018). Survey-weighted logistic regressions estimated associations at each limitation level, adjusting for sociodemographic and health covariates. Results Higher social cohesion and physical disorder were associated with greater odds of falls. Among those with mild limitations, both associations were attenuated, while among those with severe limitations, higher physical disorder was associated with lower odds of falls. Discussion Findings highlight the need to address both environmental and individual factors in fall prevention and suggest that lower risk among limited adults reflects self-restriction, underscoring supervised indoor exercise and accessible transportation.