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Lower-Limb Factors Associated with Balance and Falls in Older Adults: A Systematic Review and Clinical Synthesis

Christopher Neville PT, PhD, Hung Nguyen PhD, Kim Ross DC, PhD, Mariana Wingood PT, DPT, GCS, CEEAA, Elizabeth Walker Peterson PhD, OTR/L, James E. Dewitt DPM, Jonathan Moore DPM, MS, MA, Michael J. King DPM, Levan Atanelov MD, MS, Josh White DPM, CPed, and Bijan Najafi PhD
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Background

Despite sufficient evidence to suggest that lower-limb–related factors may contribute to fall risk in older adults, lower-limb and footwear influences on fall risk have not been systematically summarized for readers and clinicians. The purpose of this study was to systematically review and synethesize the literature related to lower-limb, foot, and footwear factors that may increase the risk of falling among community-dwelling older adults.

Methods

We searched PubMed, Embase, PsycINFO, CINAHL, Web of Science, Cochrane Library, and AgeLine. To describe the trajectory toward increasing risk of falls, we examined those articles that linked age-related changes in the lower limb or footwear to prospective falls or linked them to evidenced-based fall risk factors, such as gait and balance impairment.

Results

This systematic review consisted of 81 articles that met the review criteria, and the results reflect a narrative review of the appraised literature for eight pathways of lower-limb–related influences on fall risk in older adults. Six of the eight pathways support a direct link to fall risk. Two other pathways link to the intermediate factors but lack studies that provide evidence of a direct link.

Conclusions

This review provides strong guidance to advance understanding and assist with managing the link between lower-limb factors and falls in older adults. Due to the lack of literature in specific areas, some recommendations were based on observational studies and should be applied with caution until further research can be completed.

Department of Physical Therapy Education, Upstate Medical University, Syracuse, NY.

Interdisciplinary Consortium on Advanced Motion Performance, Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX.

Canadian Memorial Chiropractic College, Toronto, ON, Canada.

Department of Rehabilitation and Movement Sciences, University of Vermont, Burlington, VT.

Department of Occupational Therapy, University of Illinois at Chicago, Chicago, IL.

Advanced Foot and Ankle Associates, Wyoming, MI.

Cumberland Foot and Ankle Centers of Kentucky, Somerset, KY.

Upperline Healthcare, Nashville, TN.

Steady Strides: Fall Prevention and Stroke Rehabilitation Medical Institute; Johns Hopkins Physical Medicine and Rehabilitation, Baltimore, MD.

SafeStep, Orthotic Holdings Inc, Ronkonkoma, NY.

Corresponding author: Christopher Neville, PT, PhD, Department of Physical Therapy Education, Upstate Medical University, 750 E Adams St, Syracuse, NY 13210. (E-mail: nevillec@upstate.edu)