Prediction of Balance Perturbations and Falls on Stairs in Older People Using a Biomechanical Profiling Approach: A 12-Month Longitudinal Study

Abstract

Background Stair falls are a major health problem for older people, but presently there are no specific screening tools for stair fall prediction. The purpose of the present study was to investigate whether stair fallers could be differentiated from non-fallers by biomechanical risk factors or physical/psychological parameters and to establish the biomechanical stepping profile posing the greatest risk for a stair fall. Methods Eighty-seven older adults (age: 72.1±5.2 y) negotiated an instrumented seven-step staircase and performed a range of physical/psychological tasks. K-means clustering was used to profile the overall stair negotiation behaviour with biomechanical parameters indicative of fall risk as input. Falls and events of balance perturbation (combined “hazardous events”) were then monitored during a 12-month follow-up. Cox-regression analysis was performed to examine if physical/psychological parameters or biomechanical outcome measures could predict future hazardous events. Kaplan-Meier survival curves were obtained to identify the stepping strategy posing a risk for a hazardous event. Results Physical/psychological parameters did not predict hazardous events and the commonly used Fall Risk Assessment Tool (FRAT) classified only 1/17 stair fallers at risk for a fall. Single biomechanical risk factors could not predict hazardous events on stairs either. On the contrary, two particular clusters identified by the stepping profiling method in stair ascent were linked with hazardous events. Conclusion This highlights the potential of the stepping profiling method to predict stair fall risk in older adults against the limited predictability of single parameter approaches currently used as screening tools.

Systematic review of candidate prognostic factors for falling in older adults identified from motion analysis of challenging walking tasks

“…The details of the study designs and populations of risk studies are reported in Table 1 . Two older adult performance studies assessed fall risk prospectively [ 1 , 25 ], by following subjects for one year to determine whether they fall, after they performed the challenging walking task. Six studies assessed fall risk retrospectively [ 2 , 10 , 20 , 24 , 58 , 62 , 80 ], by asking subjects at the time of the walking measurement whether they had fallen in the previous months.…”

“…Walking, approaching or crossing speed was assessed in 5 risk studies with stairs, 1 risk study with perturbations and 5 risk studies with obstacles. Stair studies reported speed in number of steps per second [ 1 , 2 , 10 ] and two studies reported the total stair ascent or descent time [ 57 , 58 ]. The perturbation study reported speed in meters per second [ 63 ].…”

Systematic review of candidate prognostic factors for falling in older adults identified from motion analysis of challenging walking tasks

“…To be able to compare studies in a meta-analysis, relevant motion analysis parameters should be assessed in a uniform way in future. Based on the findings, the following outcome parameters are suggested: - Assessment of foot clearance : During stair ascent mainly tripping occurs, while during stair descent loss of control of CoM or slipping are main causes for falls (Ackermans et al, 2021). The included stair climbing studies reported significantly increased foot clearance with age and significantly increased foot clearance variability with age and fall risk (Begg and Sparrow, 2000; Zietz et al, 2011; Ackermans et al, 2019; Francksen et al, 2020).…”

“…The included stair climbing studies reported significantly increased foot clearance with age and significantly increased foot clearance variability with age and fall risk (Begg and Sparrow, 2000;Zietz et al, 2011;Ackermans et al, 2019;Francksen et al, 2020). In stair descent older adults ascended with reduced foot contact on the shorter step, which may cause an increased slip risk (Ackermans et al, 2019(Ackermans et al, , 2021Francksen et al, 2022). Therefore, the percentage of foot length on the stair should be assessed.…”

Nutrition Strategies Promoting Healthy Aging: From Improvement of Cardiovascular and Brain Health to Prevention of Age-Associated Diseases

“…Morbidity and mortality continuously increase with age [ 1 ]. There are several conditions that affect an older adult’s life, such as sensory decline (decrease or loss of hearing, poor eyesight), cardiovascular diseases, diabetes mellitus, depression, dementia, sarcopenia [ 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 ], gait and balance abnormalities and falls [ 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 ], and chronic obstructive pulmonary disease [ 21 ]. These diseases share several risk factors.…”