Data for this study came from the January 2021 National Poll on Healthy Aging (NPHA), a nationally representative survey of U.S. adults aged 50–80 (n = 2023, completion rate = 78%). Respondents were selected from the Ipsos web-enabled KnowledgePanel® in which panel participants are randomly recruited through address-based sampling, and households are provided with access to the internet and laptop computers if needed to complete surveys. The poll asked older adults about their experiences related to activities, function, and falls since March 2020 (i.e., the start of the United States coronavirus pandemic).

Our main outcomes of interest were measures capturing physical function and falls. Two indicators of physical function were assessed: worsened mobility and physical conditioning. Mobility was defined for respondents as “a person's ability to move around on one's own – by walking, using assistive devices such as a cane or walker, or by using transportation.” Physical conditioning was defined for respondents as “a person's flexibility, muscle strength, endurance, and ability to do physical activity.” Respondents were asked whether, since March 2020, each of mobility and physical conditioning had changed, if at all, with three response options: improved, worsened, and no change. Binary indicators for each of worsened mobility and worsened physical conditioning were developed from respondent answers.

Additionally, two fall-related outcomes were assessed: (1) falls, defined for respondents as “where a person ends up on the ground or a lower level due to a loss of balance, slip, or trip” and (2) worsened fear of falling. For the first measure, respondents were asked, “Since March 2020, how many times have you fallen?” with response options of 0, 1, 2–3, and ≥4 times. A binary indicator was created to categorize individuals as having fallen (≥1 fall) or not fallen (0 falls). For the second measure, respondents were asked, “Are you afraid of falling?” with response options of yes, very afraid of falling; yes, somewhat afraid of falling; and no, not afraid of falling. For those who answered yes (either very or somewhat afraid of falling), an additional question was asked: “How has your fear of falling changed since March 2020?” with response options of more fearful of falling, less fearful of falling, and no change in fear of falling.

Several measures of health behaviors and physical function (hereafter, “function”) were also assessed. Respondents were asked “Since March 2020, how often have you done moderate or more vigorous physical activity for at least 30 minutes?” Response options were as follows: every day or nearly every day, several times a week, about once a week, every 2–3 weeks, once a month or less, and never. Examples of moderate physical activities included brisk walking, housework, or mowing the lawn. Participants were then asked, “How has the amount of moderate or more vigorous physical activity you do changed since March 2020, if at all?” Respondents were also asked “How has the amount of time you spend on your feet standing or walking on a typical day changed since March 2020, if at all?” Response options for both questions were as follows: more active, less active, or no change. Two dichotomous indicators were created to categorize individuals into those with reduced versus not reduced physical activity and with reduced versus not reduced daily time spent on their feet. To assess social isolation, respondents were asked “In the past year, how often have you felt isolated from others?” Response options were as follows: hardly ever, some of the time, often. A dichotomous indicator was created to categorize individuals into those who felt frequent social isolation (some of the time or often) versus hardly ever.

Sociodemographic and health characteristics included age (continuous), gender, race/ethnicity (non-Hispanic White, non-Hispanic Black, Hispanic, and non-Hispanic Other), education (high school or less, some college, bachelor's degree or higher), total annual household income (<$30,000, $30,000–$59,999, $60,000–$99,999, ≥$100,000), marital status (married/partnered, not married/not partnered), and health status (poor, fair, good, very good, or excellent).

In analyses, overall sociodemographic and health characteristics were first described. Next, t-tests for continuous and chi-square tests for binary or categorical variables were used to compare these measures by physical activity (hereafter, “activity”) levels, daily time spent on one's feet, mobility, and physical conditioning (hereafter, “conditioning”).

Given conceptual and empirical understandings of disablement and injury (Figure 1), we hypothesized that reduced activity and greater social isolation would be associated with worsened function. In turn, we expected that decreased function would increase injury risk and fear of injury. To test these hypotheses, four logistic regression models were estimated. For the first and second models, logistic regression models were separately estimated, regressing each of worsened mobility and worsened conditioning on reduced activity, less daily time spent on one's feet, and social isolation. For the third and fourth models, logistic regression models were separately estimated, regressing each of having a fall and worsened fear of falling on worsened mobility, worsened conditioning, and social isolation. All models were adjusted for sociodemographic and health characteristics. Results for adults aged 65–80 are provided in Tables S1–S3.

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