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

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.