this study evaluated variables already in the literature , but the breakdown and comparison among different ethnic groups is new and important to understand and be able to address the specific needs of older adults from these groups .
we evaluated a convenience sample of ethnically diverse community - dwelling older adults residing in south florida who volunteered to participate in the study .
the participants were recruited using adds and by word of mouth at health fairs , senior centers , housing developments , and by referrals from other participants from 2012 to 2014 .
the inclusion criteria were : age 60 years , walking independently or using an assistive device , age / education - adjusted mini mental state examination score 23 , and self - reported to belong to one of the four ethnic groups studied ( african - americans , afro - caribbeans , hispanic americans , and european americans ) .
the sample included 550 community - dwelling south floridians with mean ( standard deviation [ sd ] ) age of 75 ( 9 ) years .
all instruments were translated into spanish and creole , and administered by bilingual speakers of english 
haitian creole , or english  spanish at the participants home or at a community center . given the inclusion criteria ( age / education - adjusted mini mental state examination score 23 ) , the participants had good cognitive status ; therefore , they responded to the questions themselves .
the questions were read for the participants and the research assistants filled in all answers .
falls were assessed using the question :  have you fallen down in the last two years ? 
characteristics previously found to be associated with falls in community - dwelling older adults were tabulated , including : age , sex , ethnicity , physical activity , feet swelling , difficulty remembering , difficulty shopping , ambulatory devices , fatigue , medications , shortness of breath , dizziness , back pain , and urinary incontinence.14 we used a limited dataset of questions and information on participant characteristics to minimize the effects of multiple testing when comparing between groups .
the variables were selected based on the previous literature in this area and physiological plausibility for a relationship with falls .
univariable and multivariable analyses of association between falls and the characteristics were conducted , and generalized linear models were used to derive risk ratios ( rrs ) and 95% confidence intervals.15 multiple imputations were used to create 20 imputed datasets to address missing covariate data points.16 to analyze the association between falls and age , we dichotomized those above and below the mean age of the sample ( 75 years ) to compare their risk of falls . a multivariable analysis stratified by ethnicity
all p - values are two - sided and the analyses were conducted using stata ( stata statistical software 2013 : release 13 .
we evaluated a convenience sample of ethnically diverse community - dwelling older adults residing in south florida who volunteered to participate in the study .
the participants were recruited using adds and by word of mouth at health fairs , senior centers , housing developments , and by referrals from other participants from 2012 to 2014 .
the inclusion criteria were : age 60 years , walking independently or using an assistive device , age / education - adjusted mini mental state examination score 23 , and self - reported to belong to one of the four ethnic groups studied ( african - americans , afro - caribbeans , hispanic americans , and european americans ) .
the sample included 550 community - dwelling south floridians with mean ( standard deviation [ sd ] ) age of 75 ( 9 ) years .
all instruments were translated into spanish and creole , and administered by bilingual speakers of english 
haitian creole , or english  spanish at the participants home or at a community center . given the inclusion criteria ( age / education - adjusted mini mental state examination score 23 ) , the participants had good cognitive status
the questions were read for the participants and the research assistants filled in all answers .
falls were assessed using the question :  have you fallen down in the last two years ? 
characteristics previously found to be associated with falls in community - dwelling older adults were tabulated , including : age , sex , ethnicity , physical activity , feet swelling , difficulty remembering , difficulty shopping , ambulatory devices , fatigue , medications , shortness of breath , dizziness , back pain , and urinary incontinence.14 we used a limited dataset of questions and information on participant characteristics to minimize the effects of multiple testing when comparing between groups .
the variables were selected based on the previous literature in this area and physiological plausibility for a relationship with falls .
univariable and multivariable analyses of association between falls and the characteristics were conducted , and generalized linear models were used to derive risk ratios ( rrs ) and 95% confidence intervals.15 multiple imputations were used to create 20 imputed datasets to address missing covariate data points.16 to analyze the association between falls and age , we dichotomized those above and below the mean age of the sample ( 75 years ) to compare their risk of falls . a multivariable analysis stratified by ethnicity
all p - values are two - sided and the analyses were conducted using stata ( stata statistical software 2013 : release 13 .
univariable and multivariable analyses of association between falls and the characteristics were conducted , and generalized linear models were used to derive risk ratios ( rrs ) and 95% confidence intervals.15 multiple imputations were used to create 20 imputed datasets to address missing covariate data points.16 to analyze the association between falls and age , we dichotomized those above and below the mean age of the sample ( 75 years ) to compare their risk of falls . a multivariable analysis stratified by ethnicity
all p - values are two - sided and the analyses were conducted using stata ( stata statistical software 2013 : release 13 .
the mean ( sd ) age of the participants was 75 ( 9 ) years ; 40% ( n=222 ) were european americans , 21% ( n=113 ) were hispanics , 20% ( n=109 ) were afro - caribbeans , and 19% ( n=106 ) were african - americans .
ninety - four percent of the african - americans , 78% of the european americans , 6% of the hispanics , and 19% of the afro - caribbeans were born in the usa .
moderate physical activity was performed at least once a week by 63% of the participants ; fatigue - related dysfunction was reported by 59% and back pain by 45% ( table 1 ) .
being male and practicing moderate physical activity at least once a week were the only characteristics not significantly associated with falls in the univariable analysis .
afro - caribbeans were approximately 40% less likely to have fallen than the other groups ( p0.022 ) .
participants were 1.51.9 times more likely to have fallen if they used anxiety medication , were incontinent , had back pain , fatigue - related dysfunction , feet swelling , or difficulty remembering ( p0.004 ) .
age 75 years , taking anxiety medication , feet swelling , back pain , and incontinence were significantly associated with falls in the multivariable analysis .
table 3 shows the adjusted rrs stratified by ethnicity for these covariates ; the trends were similar across ethnic groups , but the rrs were 5% to 12% higher for the afro - caribbeans than for the other groups .
one potential explanation is that foreign - born immigrants tend to have lower rates of falls.12,17 while 78% of the european americans and 94% of the african - americans were born in the usa , only 19% of the afro - caribbeans and 6% of the hispanics were born in the usa .
however , the lower rate of falls among afro - caribbeans compared to hispanics still can not be explained by the reason of being born abroad .
the factors contributing to lower prevalence of falls among afro - caribbeans need further investigation .
this finding indicates that using the falls prevalence data among the general population is not appropriate to assess how afro - caribbeans are doing in relation to falls .
taking anxiety medication , incontinence , back pain , feet swelling , and age 75 years were associated with falls in the multivariable model .
age is a nonmodifiable risk factor , but addressing the underling health issues may help reduce falls risk .
the relationship between taking anxiety medication and falls may be explained by the medication side effects and/or by anxiety itself.18 community - dwelling older adults taking psychotropic medications were found to have 1.53.7 higher odds of falls than those not taking it.19,20 medication review and reconciliation may help reduce the risk of falls among these patients .
also , anxious subjects are likely to present more fear of falls , which increase the risk due to activity restriction and deconditioning.8 as in this study , urinary incontinence among racially diverse cohort of older adults has been found to be related to falls.21 this relationship is likely related to the need to rush to the toilet possibly resulting in inattention to environmental hazards ( eg , carpet edges , cords , wet floors ) .
the increased risk associated with urinary incontinence may be reduced by treating the symptoms as well as by making sure that the path between the person with incontinence bed and bathroom is clear of clutter , furniture , and cords ; that the floors are not wet ; that the person wears proper anti - slip footwear or socks ; and that bathroom night - lights are installed .
back pain may increase the risk of falls because it affects balance and mobility.22 low back pain has been found to be independently associated with falls , and a back exercise program reduced falls in older women.23,24 therefore , interventions to reduce back pain , such as physical therapy , exercises , and weight loss , may also reduce falls risk .
the relationship between feet swelling and falls is likely to be due to decreased proprioception as a result of the compression of the neurovascular structures .
proprioception is the ability to detect joint motion and position , and it depends on mechano - sensory receptors on the joints , ligaments , tendons , and muscles . vision and proprioception interact with the vestibular system and provide the central nervous system with information on the position of body allowing for postural control and balance maintenance.25 when the information sent from the sensory systems is unpredictable , insufficient , or conflicting there is loss of balance and inability to recover from disturbances.26 similarly to back pain and incontinence , addressing the causes and consequences of feet swelling may reduce the risk of falls .
however , older age may be related to falls due to aging - related physiological and functional decline .
gait impairments in older adults are related to declines in balance , muscle strength , and range of motion.27 however , practicing moderate physical activity at least once a week was not associated with falls .
the health benefits of physical activity are well established.28 what may help explain our finding is that the physical activity intensity and frequency is important and  practicing moderate physical activity at least once a week  may be insufficient to reduce the risk of falls .
one of the limitations of the current study is that we did not include physical measures .
another limitation of our study is that the sample was not randomly selected and therefore it may not represent the general population . this is a common limitation of studies conducted in the community where randomization is rarely feasible .
taking anxiety medication , incontinence , back pain , persistent swelling of the feet , and age 75 years were significantly associated with falls after adjusting for confounders .
the strength of association was higher for afro - caribbeans , but this group presented lower prevalence of falls than african - americans , hispanics , and european americans .
 purposeto evaluate rates and factors associated with older adult falls in different ethnic groups.participants and methodsinformation on demographics , medical and falls history , and pain and physical activity levels was collected from 550 community - dwelling older adults ( 759 years old , 222 european americans , 109 afro - caribbeans , 106 african - americans , and 113 hispanics).resultstaking medications for anxiety ( risk ratio [ rr ] = 1.4 , 95% confidence interval [ ci ] = 1.12.0 ) , having incontinence ( rr = 1.4 , 95% ci = 1.11.8 , p=0.013 ) , back pain ( rr = 1.4 , 95% ci = 1.01.8 ) , feet swelling ( rr = 1.3 , 95% ci = 1.11.7 ) , and age 75 years ( rr = 1.3 , 95% ci = 1.01.6 ) were associated with falls . 
 the associations were stronger for afro - caribbeans , but they presented approximately 40% lower prevalence of falls than the other groups.conclusiontaking anxiety medication , incontinence , back pain , feet swelling , and age 75 years were associated with falls , and afro - caribbeans presented lower prevalence of falls . these findings need to be taken into consideration in clinical interventions in aging . 
Introduction
Materials and methods
Subjects
Data collection
Statistical analysis
Results
Discussion
Conclusion