Association of In-Lab and Free-Living Mobility Measures With Falls and Fear of Falling in Underactive Older People

Falls in older adults have significant consequences—a single fall can lead to serious injury, psychological trauma, activity restriction, and increased mortality. This study describes differences in mobility-related characteristics of underactive (<150 minutes/week of physical activity), racially diverse, older adults (65–84 years) classified by self-reported fall status (0, 1, 2+ falls in previous 12mo) and fear of falling (yes/no). We analyzed baseline data from 105 individuals (mean age=72.1 years; 73% female; 64% white, 29% Black, 12% Asian) who participated in a trial of a physical activity smartphone intervention for older people. Total minutes of daily stepping and medium-to-brisk (≥75 steps/min) and brisk (≥100) cadence bouts in free-living conditions was gathered over 3 days via ActivPal activity monitor. Gait speed was determined from a 4-meter walk test for those pretested prior to COVID-19 mandates (n=60). Of the median 81.8 minutes spent stepping daily, very few minutes involved moderate-to-brisk (14.0) or brisk cadence (10.1). Groups classified by fall status (non-fallers n=74, 1x fallers n=18, repeat fallers n=13) differed significantly in daily minutes spent in medium-to-brisk (p=0.04) and brisk cadence (p=0.02), but not in 4-meter gait speed or total minutes stepping. Individuals who reported fear of falling versus those with no fear did not differ significantly on any mobility-related parameters. Four-meter gait speed was significantly negatively correlated with both cadence measures (p=0.02) but not total minutes stepping. This study indicates that faster walking behaviors in everyday activity may be a useful target for intervention to prevent falls in underactive older adults.