Older Adults’ Perceptions of Fall-resisting Skills Training and their Stability: a Pilot Study for a Randomised Controlled Trial

Introduction

Training fall-resisting skills can prevent falls in older adults. These skills include proactive gait adaptability, gait robustness, and reactive gait recovery, which allow people to effectively avoid, resist, and recover from balance threats, respectively.This pilot study guided the design of an RCT of fall-resisting skills training by investigating older adults’ perceptions of the training and their own stability. The aims were 1) explore older adults’ perceptions of stability during walking perturbations related to gait researcher observations; 2) investigate how task unpredictability affects anxiety during walking perturbations; and 3) check the feasibility of fall-resisting skill tasks.

Method

Eleven healthy older adults (73.5±5.5y) performed assessment and training tasks for each fall-resisting skill. For aim 1, participants experienced walking perturbations of increasing magnitude. Their self-reported perceptions of stability after each perturbation were compared to gait researcher observations. For aim 2, participants experienced large walking perturbations progressing from single to multiple directions, to adding auditory dual tasks. Anxiety was assessed with a 7-point Likert scale. Feasibility of each fall-resisting skill task was assessed with a 7-point Likert scale and open-ended questions on participants’ enjoyment, tension, and anxiety.

Results

Participants’ perception of stability did not consistently match gait researcher observations, with participants reporting instability early, at perturbation levels typically insufficient to induce instability. During large walking perturbations, participants’ anxiety scores started at 2.1±1.3 (1=low, 7=high) and progressively decreased with increasingly unpredictable perturbations. Overall, participants reported high enjoyment, and low anxiety and tension in all tasks. 

Conclusions

Older adults' perceptions of their own stability cannot be relied upon for evaluating or progressing training difficulty. Fall-resisting skill tasks are feasible, and gradually increasing types of perturbations do not increase anxiety, given they are introduced in this order (i.e., repetition reduces anxiety), supporting their use in the future RCT.