Abstract
Introduction
Falling is a significant public health issue in older people, with 30 to 60% of people aged 65 years or older having a fall each year, and 10 to 20% of these falls result in significant injuries such as hip fracture, hospitalisation or death. Footwear is one of many issues that can impact a person’s stability and fall risk. Footwear and its condition or imbalance can impact balance in older people. This Thesis aims to examine; 1) Is there a significant difference in physical performance for older people when activity is performed shod compared to barefoot? and 2) Does footwear degradation (wear) in older people's footwear influence physical performance?
Methods
The Footwear and Falls Study in Older People was a single-centre, repeated measures study with a randomised cross-over design for the barefoot or shod conditions. Community-dwelling older people (over 65 for NZ European/Pākehā participants and over 55 for Māori and Pacific participants) were included, each having at least one risk factor for falling. The shoe condition was assessed using the total asymmetry score (TAS) for the forefoot and hindfoot, and the heel drop was calculated. Each participant completed the Calf Raise Senior (CRS), Timed Up and Go (TUG), and Five Times Sit to Stand (5xSTS) in both the barefoot and shod states, with the CRS being the primary outcome measure. Paired t-tests were used to compare barefoot versus shod performance. Linear regression models were used to define the relationship between shoe asymmetry (using the forefoot and hindfoot TAS and heel drop) and physical performance while controlling for Fear of Falling and the Frail Scale score.
Results
Thirty-six older adults (mean age 77 years, SD 5.6) participated in the study. Of these, 72% were female, and 81% were of New Zealand European / Pākehā ethnicity.
There was no statistically significant difference between barefoot and shod physical performance in the CRS and TUG. However, the 5xSTS did show a statistically significant difference (Mean difference -1.5, 95% CI -3.1;-0.0, p-value <0.05).
All three footwear measurements showed no correlation with physical performance. Specifically for the primary outcome of CRS, each of the three shoe measures (when controlled for Fear of Falling and Frail Scale score) did not affect the physical performance. However, being Pre-frail/Frail or having a high Fear of Falling score was associated with reduced performance (except for the left forefoot with a high fear of falling, p 0.052). For the TUG and 5xSTS, there were no statistically significant results.
Conclusions and Implications
The Footwear and Falls Study in Older People showed a statistically significant difference between the barefoot and shod physical performance in the 5xSTS but showed no correlation between footwear imbalance and physical performance. This is the first study (to the best of our knowledge) that explores the imbalance of an older person’s footwear and their physical performance in relation to fall risk.