Foot Problems in Older Adults Associations with Incident Falls, Frailty Syndrome, and Sensor-Derived Gait, Balance, and Physical Activity Measures

Abstract

Background: Research on foot problems and frailty is sparse and could advance using wearable sensor-based measures of gait, balance, and physical activity (PA). This study examined the effect of foot problems on the likelihood of falls, frailty syndrome, motor performance, and PA in community-dwelling older adults.

Methods: Arizona Frailty Cohort Study participants (community-dwelling adults aged ≥65 years without baseline cognitive deficit, severe movement disorders, or recent stroke) underwent Fried frailty and foot assessment. Gait, balance (bipedal eyes open and eyes closed), and spontaneous PA over 48 hours were measured using validated wearable sensor technologies.

Results: Of 117 participants, 41 (35%) were nonfrail, 56 (48%) prefrail, and 20 (17%) frail. Prevalence of foot problems (pain, peripheral neuropathy, or deformity) increased significantly as frailty category worsened (any problem: 63% in nonfrail, 80% in prefrail [odds ratio (OR) = 2.0], and 95% in frail [OR = 8.3]; P = .03 for trend) due to associations between foot problems and both weakness and exhaustion. Foot problems were associated with fear of falling but not with fall history or incident falls over 6 months. Foot pain and peripheral neuropathy were associated with lower gait speed and stride length; increased double support time; increased mediolateral sway of center of mass during walking, age adjusted; decreased eyes open sway of center of mass and ankle during quiet standing, age adjusted; and lower percentage walking, percentage standing, and total steps per day.

Conclusions: Foot problems were associated with frailty level and decreased motor performance and PA. Wearable technology is a practical way to screen for deterioration in gait, balance, and PA that may be associated with foot problems. Routine assessment and management of foot problems could promote earlier intervention to retain motor performance and manage fear of falling in older adults, which may ultimately improve healthy aging and reduce risk of frailty.

Figure 1.

Changes in gait and balance parameters as a function of foot problems. Mean ± SE values are given for gait speed (A), center of mass in mediolateral (COM_ML) during walking (B), double support (C), and COM sway with eyes open during quiet standing (D). The percentage change from the no foot problem value is indicated above each bar, which is not the absolute change for those measures whose unit is percentage of time. *P < .05.

Figure 2.

Changes in spontaneous daily physical activities measured over 48 hours as a function of foot problems. Mean ± SE values per 24 hours are given for walking percent time (A), number of steps taken (B),standing percent time (C), and walking bout duration variability (D). The percentage change from the no foot problem value is indicated above each bar, which is not the absolute change for those measures whose unit is percentage of 24 hours. *P<.05.