Date of Award




Document Type


Degree Name

Doctor of Public Health (DrPH)


Department of Health Policy, Management and Behavior

Content Description

1 online resource (vii, 117 pages) : illustrations.

Dissertation/Thesis Chair

Mary Gallant

Committee Members

Benjamin Shaw, Paula Carter


Adults, American, Falls, Native, Older, Falls (Accidents) in old age, Older Indians, Indians of North America

Subject Categories

Gerontology | Public Health


The risk factors for falls and the adverse outcomes of falls have been well documented among the general older adult population. However, fall frequency, fall risk factors, and fall outcomes have rarely been studied among minority groups specifically. Furthermore, to date there are no known studies that exclusively examine falls among Native American older adults. The purpose of this study is to examine falls among Native American older adults, in order to understand the risk and protective factors for falling among this population, and to develop recommendations for intervention. The theoretical framework of the Disablement Process guides this study. The Disablement Process conceptualizes the relationships among pathology, impairments, functional limitations, and disability, as well as among factors that accelerate or inhibit the disability pathway, including predisposing risk factors, intra-individual factors, and extra-individual factors. Bivariate analyses were conducted to determine the relationship between the dependent and independent variables in a sample of 16,056 Native American older adults. Independent sample t-tests, one-way ANOVA, and Chi-square tests were used to examine differences in characteristics between fallers and non-fallers, and between occasional fallers and frequent fallers. Logistic regression analyses examined each construct of the Disablement Process (physical health, predisposing risk factors, intra-individual factors, and extra-individual factors), and their effect on falls. Descriptive statistics and bivariate analyses were conducted to determine the relationship between housing, insurance, usual sources of care, barriers to care, and service utilization among elderly Native Americans and falls, in order to identify the most appropriate people and/or places for falls risk assessments and interventions. The results from this study suggest that female gender, advanced age, depressive symptoms, residing on a reservation, barriers to care, and care-receiving from a family member were all risk factors for the incidence of (any) fall even after controlling for physical health. Additionally, male gender and depressive symptoms were risk factors for frequent falls, while income and being overweight were protective against frequent falls independent of physical health. In both the (any) fall and frequent falls models, physical health was strongly associated with falls. Implications of the results for both public health interventions and future research are discussed.