Concern About Falls Elicits Changes in Gait Parameters in Conditions of Postural Threat in Older People

Background. Previous studies have indicated that gait patterns in older people may be affected by concern about falling. The aim of this study was to examine the effects of concern about falling and physiological falls risk on gait performance using a paradigm in which concern about falling was experimentally induced. Methods. Forty-four community-living older adults (17 men, 27 women) with a mean age of 76.8 (standard deviation = 5.2) years walked at self-selected speeds on the floor and on a 60-cm elevated walkway in normal and dim lighting conditions. Temporal and spatial gait parameters, muscle activity, measures of physiological arousal, physiological falls risk, and concern about falls were assessed. Results. Physiological falls risk was associated with slower walking speeds in all conditions including the optimal (floor) condition (p = .029). In the elevated walkway conditions, concern about falls (both self-report and as indicated by physiological arousal) was increased and participants walked more slowly, took shorter steps, decreased their cadence, and spent more time in double support (p <.005). Disproportionately large reductions in walking speed were evident in participants with greater concern about falling (p = .018). Conclusions. These findings suggest that walking performance is influenced by both physiological and psychological factors. Physiological falls risk appears to determine walking speed under optimal conditions, whereas concern about falling elicits greater (possibly excessive) gait adjustments under conditions of postural threat.