Purpose Much is known about risk factors and prevention strategies for falls among community-dwelling older adults. However, little is known about how fall risks and falls prevention behaviours may differ between two community-dwelling groups: ambulatory and homebound. This study examined fall risks and behaviours among homebound, compared to non-homebound, older adults.

Methods Data were collected in North Carolina March 2011–September 2013. Ambulatory older adults were recruited at local senior centres, and homebound older adults through Meals on Wheels. Participants were at least 65 years of age, not wheelchair bound, and able to read and write English. An in-home interview, home safety assessment, and medication review were conducted. Interview questions assessed: fall risk factors, falls prevention program participation and implementation of recommended falls prevention behaviours. Negative binomial regression modelled the association between demographic, fall risk factors and number of falls, adjusting for health status.

Results 164 older adults participated: 84 ambulatory (mean age: 75.3 ± 7.3); 80 homebound (mean age: 79.6 ± 8.1). Homebound participants were older, in poorer health and reported limiting activities due to a fear of falling, compared to ambulatory participants (p < 0.01). Homebound older adults completed fewer recommended falls prevention behaviours, including exercise, having throw rugs and avoiding step stools. Ambulatory participants, compared to homebound participants had higher fall rates associated with medication (rate ratio (IDR) = 1.54, 95% CI = 1.26–1.89 vs. IDR = 1.33, 95% CI = 1.00–1.75) and fear of falling (IDR = 1.59, 95% CI = 0.71–3.54 vs. IDR = 1.34, 95% CI = 0.59–3.03). Among all participants, very few reported participating in falls prevention programs (7.3%).

Conclusions Results suggest that homebound older adults are at higher risk for falling and implement fewer prevention strategies than ambulatory older adults

Significance Evidence-based falls prevention strategies have been developed primarily among ambulatory populations. This study demonstrates that these strategies need to be adapted for homebound populations.