Deficient limb support is a major contributor to age differences in falling.

Abstract

Older adults are more likely than young to fall upon a loss of balance, yet the factors responsible for this difference are not well understood. This study investigated whether age-related differences in movement stability, limb support, and protective stepping contribute to the greater likelihood of falling among older adults. Sixty young and 41 older, safety-harnessed, healthy adults were exposed to a novel and unexpected forward slip during a sit-to-stand task. More older than young adults fell (76% vs. 30%). Falls in both age groups were related to lesser stability and lower hip height at first step touchdown, with 97.1% of slip outcomes correctly classified based on these variables. Decreases in hip height at touchdown had over 20 times greater effect on the odds of falling than equivalent decreases in stability. Three age differences placed older adults at greater risk of falling: older adults had lower and more slowly rising hips at slip onset, they were less likely to respond to slipping with ample limb support, and they placed their stepping foot less posterior to their center of mass. The first two differences, each associated with deficient limb support, reduced hip ascent and increased hip descent. The third difference resulted in lesser stability at step touchdown. These results suggest that deficient limb support in normal movement patterns and in the reactive response to a perturbation is a major contributor to the high incidence of falls in older adults. Improving proactive and reactive limb support should be a focus of fall prevention efforts.