Social Participation and Modifiable Risk Factors for Falls in Community-Dwelling Adults Aged 50 Years and Older Living in a Low-Density Region

Introduction: Falls and limitations in social participation are common among older adults and often occur alongside age-related health issues. These challenges may be especially significant in areas with low population density, where healthcare disparities and increased social isolation can worsen functional decline. This study aimed to explore the link between social participation and factors related to falls that can be changed among adults aged 50 and older living in Beja, Portugal, as well as to identify the factors most closely related to participation restrictions. Methods: An exploratory, analytical, cross-sectional study was carried out with 77 community-dwelling adults. Researchers collected sociodemographic and clinical data, and participants completed assessments of exercise self-efficacy, balance confidence while walking, anxiety, and sarcopenia. Functional performance was assessed using standardized tests. Descriptive and inferential statistics, correlation analyses, and multiple linear regression models were used to examine the relationships between fall-related factors and restrictions in social participation, measured by the Activities and Participation Profile related to Mobility (PAPM). Results: Participants with a history of stroke or fractures (n=34) showed poorer functional profiles and greater fall-related issues than those without these conditions (n=43). Limitations in social participation were significantly linked to several modifiable fall-related factors. In regression analyses, sarcopenia was identified as the strongest independent factor related to participation restrictions, followed by dyspnoea and anxiety. Together, these variables accounted for 67.2% of the variance in PAPM scores, highlighting how physical, respiratory, and psychological factors influence social participation. Conclusions: Restrictions in social participation among community-dwelling older adults in low-density regions are closely tied to modifiable fall-related factors, especially sarcopenia, dyspnoea, and anxiety. These findings indicate that interventions focusing on muscle health, aerobic capacity, and psychological well-being may help not only preventing falls but also in maintaining social participation and promoting healthy aging. Community-based strategies are particularly important in areas with limited healthcare resources.