Investigation of the Relationship Between Health Literacy and Fall-Prevention Behaviours in Older Adults.

Background/

Objectives

Falls are a leading cause of morbidity and loss of independence in later life, and more than half are preventable. Health literacy has been proposed as a modifiable determinant of preventive behaviour, but the evidence rests largely on unadjusted associations and on outcomes such as fear of falling rather than on behaviour itself. This study examined how health literacy relates to fall-prevention behaviour in community-dwelling older adults, and whether that relationship holds once sociodemographic and health-related characteristics are considered.

Methods

In this cross-sectional study, 253 adults aged 65 years and over completed a structured questionnaire comprising the Turkey Health Literacy Scale-32 (THLS-32) and the Falls Behavioural Scale for Older People (FaBS) between December 2023 and March 2024. The primary multivariable analysis used hierarchical multiple linear regression, with covariates selected on theoretical and clinical grounds and no automated variable selection.

Results

Health literacy was inadequate or problematic-limited in 73.5% of participants. Health literacy and fall-prevention behaviour were negatively correlated (r = -0.304, p < 0.001). Exploratory subscale analyses showed the strongest inverse estimates for protective mobility (r = -0.388), practical strategies (r = -0.342) and avoidance (r = -0.331), whereas awareness-related subscales were not associated with health literacy. The sociodemographic and health-related covariate block explained 28.1% of the variance; in the final model, male sex, higher educational attainment, and assistive-device use were associated with FaBS scores. THLS-32 did not significantly improve the model (ΔR2 = 0.006, p = 0.151).

Conclusions

Fall-prevention behaviour was more strongly associated with measured sociodemographic and health-related characteristics than with health literacy. Higher FaBS scores may partly reflect activity restriction as well as protective behaviour. These findings do not support the assumption that higher general health literacy alone is associated with greater use of the behaviours captured by the FaBS.