{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,25]],"date-time":"2026-01-25T04:59:25Z","timestamp":1769317165288,"version":"3.49.0"},"reference-count":52,"publisher":"Public Library of Science (PLoS)","issue":"4","license":[{"start":{"date-parts":[[2024,4,25]],"date-time":"2024-04-25T00:00:00Z","timestamp":1714003200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Australian National Health and Medical Research Council","award":["1170898"],"award-info":[{"award-number":["1170898"]}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\"><jats:title>Background<\/jats:title><jats:p>Active engagement in leisure activities has positive effects on individuals\u2019 health outcomes and social functioning; however, there is limited understanding of the link between participation in leisure activities, particularly non-exercise activities, and falls in older adults. This study aimed to determine the relationship between participation in leisure activities and the incidence of falls, and the variation of this relationship by dementia status in residential aged care facilities (RACFs).<\/jats:p><\/jats:sec><jats:sec id=\"sec002\"><jats:title>Methods<\/jats:title><jats:p>A retrospective longitudinal cohort study utilising routinely collected data (January 2021-August 2022) from 25 RACFs in Sydney, Australia, was conducted. The cohort included 3,024 older permanent residents (1,493 with dementia and 1,531 without) aged \u226565 and with a stay of \u22651 week. The level of participation in leisure activities was measured using the number of leisure activities per 1,000 resident days and divided into quartiles. Outcome measures were the incidence rate of all falls and injurious falls (i.e., number of falls per 1,000 resident days). We used multilevel negative binary regression to examine the relationship between leisure participation and fall incidence.<\/jats:p><\/jats:sec><jats:sec id=\"sec003\"><jats:title>Results<\/jats:title><jats:p>For the whole sample, leisure participation was significantly inversely associated with the incidence rate of all falls and injurious falls. For example, residents in the high leisure participation group were 26% less likely to experience a fall compared to those in the low leisure participation group after controlling for confounders (incidence rate ratio = 0.74, 95% confidence interval = 0.60, 0.91). Such inverse relationship was observed in both exercise and non-exercise activities and was stronger among residents without dementia.<\/jats:p><\/jats:sec><jats:sec id=\"sec004\"><jats:title>Conclusions<\/jats:title><jats:p>Leisure participation is associated with a lower rate of falls, a key quality indicator by which RACFs are benchmarked and funded in Australia and many other countries. More recognition and attention are needed for the currently underfunded leisure activities in RACFs in future funding arrangement.<\/jats:p><\/jats:sec>","DOI":"10.1371\/journal.pone.0302678","type":"journal-article","created":{"date-parts":[[2024,4,25]],"date-time":"2024-04-25T17:28:08Z","timestamp":1714066088000},"page":"e0302678","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":2,"title":["The relationship between participation in leisure activities and incidence of falls in residential aged care"],"prefix":"10.1371","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5772-0584","authenticated-orcid":true,"given":"Guogui","family":"Huang","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nasir","family":"Wabe","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Magdalena Z.","family":"Raban","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"S. 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WHO global report on falls prevention in older age. 2007. 2007."},{"issue":"1","key":"pone.0302678.ref016","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12875-018-0741-6","article-title":"Falls and long-term care: a report from the care by design observational cohort study","volume":"19","author":"EJ Cameron","year":"2018","journal-title":"Bmc Fam Pract"},{"issue":"9500","key":"pone.0302678.ref017","doi-asserted-by":"crossref","first-page":"1885","DOI":"10.1016\/S0140-6736(05)67604-0","article-title":"Prevention of falls and consequent injuries in elderly people","volume":"366","author":"P Kannus","year":"2005","journal-title":"The Lancet"},{"issue":"16","key":"pone.0302678.ref018","doi-asserted-by":"crossref","first-page":"1055","DOI":"10.1056\/NEJM198904203201606","article-title":"Prevention of falls among the elderly","volume":"320","author":"ME Tinetti","year":"1989","journal-title":"New Engl J Med"},{"issue":"5","key":"pone.0302678.ref019","doi-asserted-by":"crossref","first-page":"P283","DOI":"10.1093\/geronb\/58.5.P283","article-title":"Fear of falling in elderly persons: association with falls, functional ability, and quality of life","volume":"58","author":"F Li","year":"2003","journal-title":"The Journals of Gerontology Series B: Psychological Sciences and Social Sciences"},{"issue":"8","key":"pone.0302678.ref020","doi-asserted-by":"crossref","first-page":"883","DOI":"10.1111\/j.1532-5415.2000.tb06884.x","article-title":"Physical activity, falls, and fractures among older adults: a review of the epidemiologic evidence","volume":"48","author":"EW Gregg","year":"2000","journal-title":"J Am Geriatr Soc"},{"key":"pone.0302678.ref021","doi-asserted-by":"crossref","first-page":"710","DOI":"10.6061\/clinics\/2013(05)20","article-title":"Exercise training as a preventive tool for age-related disorders: a brief review","volume":"68","author":"EG Ciolac","year":"2013","journal-title":"Clinics"},{"issue":"17","key":"pone.0302678.ref022","doi-asserted-by":"crossref","first-page":"1341","DOI":"10.1001\/jama.1995.03520410035023","article-title":"The effects of exercise on falls in elderly patients: a preplanned meta-analysis of the FICSIT trials","volume":"273","author":"MA Province","year":"1995","journal-title":"Jama"},{"issue":"7115","key":"pone.0302678.ref023","doi-asserted-by":"crossref","first-page":"1065","DOI":"10.1136\/bmj.315.7115.1065","article-title":"Randomised controlled trial of a general practice programme of home based exercise to prevent falls in elderly women","volume":"315","author":"AJ Campbell","year":"1997","journal-title":"Bmj"},{"issue":"11","key":"pone.0302678.ref024","doi-asserted-by":"crossref","first-page":"2157","DOI":"10.1111\/ggi.13052","article-title":"Effects of a simple home-based exercise program on fall prevention in older adults: A 12-month primary care setting, randomized controlled 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elderly","volume":"348","author":"J Verghese","year":"2003","journal-title":"New Engl J Med"},{"issue":"15","key":"pone.0302678.ref031","first-page":"e1651","article-title":"Leisure activities and the risk of dementia: a systematic review and meta-analysis","volume":"99","author":"S Su","year":"2022","journal-title":"Neurology"},{"issue":"2","key":"pone.0302678.ref032","doi-asserted-by":"crossref","first-page":"161","DOI":"10.3138\/ptc.2016-14","article-title":"Risk factors associated with falls in older adults with dementia: a systematic review","volume":"69","author":"E Fernando","year":"2017","journal-title":"Physiotherapy Canada"},{"issue":"5","key":"pone.0302678.ref033","doi-asserted-by":"crossref","first-page":"484","DOI":"10.1016\/j.jagp.2013.01.008","article-title":"The complex interplay of depression and falls in older adults: a clinical review","volume":"21","author":"A Iaboni","year":"2013","journal-title":"The American Journal of Geriatric 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C"},{"issue":"1","key":"pone.0302678.ref037","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12877-022-02973-0","article-title":"The use and predictive performance of the Peninsula Health Falls Risk Assessment Tool (PH-FRAT) in 25 residential aged care facilities: a retrospective cohort study using routinely collected data","volume":"22","author":"N Wabe","year":"2022","journal-title":"Bmc Geriatr"},{"issue":"11","key":"pone.0302678.ref038","doi-asserted-by":"crossref","first-page":"1645","DOI":"10.1046\/j.1532-5415.2003.51518.x","article-title":"Differing Risk Factors for Falls in Nursing Home and Intermediate-Care Residents Who Can and Cannot Stand Unaided","volume":"51","author":"SR Lord","year":"2003","journal-title":"Journal of the American Geriatrics Society"},{"issue":"3","key":"pone.0302678.ref039","doi-asserted-by":"crossref","first-page":"407","DOI":"10.1016\/j.archger.2012.12.006","article-title":"Risk factors for falls in older people in nursing homes and hospitals. 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Activities for people with dementia. website. https:\/\/www.dementia.org.au\/about-dementia\/i-am-a-carer-family-member-or-friend\/activities-for-people-with-dementia. Accessed July 06, 2023."},{"issue":"2","key":"pone.0302678.ref051","doi-asserted-by":"crossref","first-page":"146","DOI":"10.1111\/opn.12071","article-title":"What carers and family said about music therapy on behaviours of older people with dementia in residential aged care","volume":"10","author":"AG Tuckett","year":"2015","journal-title":"International journal of older people nursing"},{"key":"pone.0302678.ref052","doi-asserted-by":"crossref","first-page":"73","DOI":"10.3389\/fneur.2012.00073","article-title":"Behavioral and psychological symptoms of dementia","volume":"3","author":"J Cerejeira","year":"2012","journal-title":"Frontiers in neurology"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0302678","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,11,17]],"date-time":"2024-11-17T01:55:34Z","timestamp":1731808534000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0302678"}},"subtitle":[],"editor":[{"given":"Masaki","family":"Mogi","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2024,4,25]]},"references-count":52,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2024,4,25]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0302678","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,4,25]]}}}