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Saturday, February 09, 2008

Falls prevention in the elderly: Latest research

Although footwear has been linked to falls in older people, it remains unclear as to which shoe features are beneficial or detrimental to balance in older people. A systematic investigate to discover how footwear features affect balance and stepping in older people was undertaken. The subjects were tested for postural sway, maximal balance range, coordinated stability and choice-stepping reaction time in a standard shoe and seven other shoes that differed from the standard shoe in one feature only, namely: elevated heel (4.5 cm), soft sole, hard sole, flared sole, bevelled heel, high heel-collar and tread sole. Repeated-measures ANOVA with simple contrasts revealed significantly increased sway in the elevated heel versus the standard shoe condition (p < 0.05). A footwear performance index based on the sum of z-scores across three tests (sway, coordinated stability and choice-stepping reaction time) normalized to the standard condition indicated that the elevated heel was most detrimental to balance (p < 0.05) whereas a high heel-collar and a hard sole showed trends towards being beneficial. The researchers concluded an elevated heel of only 4.5 cm height significantly impaired balance in older people but acknowledged the potential benefits of wearing shoes with a hard sole or a high heel-collar on balance in older people warranted further research in ambulatory tasks. Some characteristics of footwear influence balance in older people but the relationship between footwear and falls is still unclear. Another study undertaken by the same group was to determine the relationships between footwear characteristics and the risk of indoor and outdoor falls in older people. Footwear characteristics (shoe type, heel height, heel counter height, heel width, critical tipping angle, method of fixation, heel counter stiffness, sole rigidity and flexion point, tread pattern and sole hardness) were assessed in 176 people (56 men and 120 women) aged 62-96 (mean age 80.1, SD 6.4) residing in a retirement village. Falls were recorded over a 12-month follow-up period and comparisons made between fallers and non-fallers. Analysis of the results revealed 50 participants (29%) fell indoors and 36 (21%) fell outdoors. After controlling for age, gender, demographic characteristics, medication use, physiological falls risk factors and foot problems, those who fell indoors were more likely to go barefoot or wear socks inside the home (OR = 13.74; 95% CI 3.88-48.61, p < 0.01). However, there were no significant differences in indoor or outdoor footwear characteristics between fallers and non-fallers. Five indoor fallers (10%) and three outdoor fallers (8%) stated that their shoes contributed to their fall. The researchers concluded footwear characteristics were not significantly associated with falls either inside or outside the home. Risk of falling indoors was however associated with going barefoot or wearing socks. Older people at risk of falling should therefore be advised to wear shoes indoors where possible. In a previous study of footwear and hip fractures, older people who suffered a trip-related fracture were more likely to be wearing shoes without any method of fixation (ie: laces, buckles, etc).

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