ParAge: A pilot study using participatory methods to assess outdoor environmental fall risks in older adults

Abstract

Population aging and urbanization have made age-friendly urban design a global priority. While the WHO’s Age-Friendly Cities and Communities framework identifies outdoor spaces as a critical domain, fall prevention remains under-addressed. Falls are a leading cause of injury and loss of autonomy, with approximately 73% of outdoor falls triggered by modifiable environmental factors. This study developed and evaluated a participatory, geolocated method based on the Our Voice citizen science framework to identify environmental fall risks and generate consensus-based solutions. Twenty-eight participants engaged in a workshop, using a mobile app to record 314 geotagged environmental features during diagnostic walks. These data were then reviewed in facilitated sessions where participants co-analyzed findings and rated potential solutions. The research specifically examined whether outputs diverged based on participant profiles, such as age, fall history, or fear of falling. Results highlighted seven categories of risk factors, most frequently involving poor surface conditions, lack of maintenance, and obstacles. Notably, participants with a history of falls or a greater fear of falling reported different risks, suggesting varied perceptions of the urban environment. However, no significant differences were observed in proposed solutions, such as infrastructure maintenance and improved signage, indicating a strong consensus on feasible interventions. Qualitative feedback confirmed the method’s acceptability and feasibility, praising its inclusive, field-based nature. This participatory approach complements existing walkability indices by capturing overlooked hazards. By integrating diverse lived experiences into environmental assessments, this method can contribute to safer pedestrian mobility and the development of truly inclusive cities for all ages.