Measurements of stepping accuracy in a multitarget stepping task as a potential indicator of fall risk in elderly individuals

Elderly individuals who are at high risk for a fall generally exhibit increased gait variability, a decline in visuomotor control of foot movement, and cognitive impairment, particularly in executive functions. A new walking test, a multitarget stepping task, was developed in the present study to identify elderly individuals with impaired stepping performance on a walkway requiring the involvement of executive functions to find a footfall target. Thirty-one high-risk (82.7 ± 6.4 years) and 87 low-risk (80.7 ± 7.9 years) elderly individuals performed the multitarget stepping task on 2 days with a 2-week interval. For the multitarget stepping task, they walked while stepping on squares with an assigned color as a footfall target continuously along the 15 lines while avoiding other colors (distracters). Two types of failure were measured: (a) failure to step precisely on the target (stepping failure) and (b) failure to avoid distracters (avoidance failure). The two groups' performance was compared. A logistic regression analysis was also performed to determine whether the measurements were independently associated with falling. The high-risk groups showed a significantly higher rate in stepping (64.5 vs 25.3% of participants in the group) and avoidance (54.8 vs 17.2%) failure than the low-risk groups. The test-retest analyses showed good agreement for both measurements. A logistic regression analysis demonstrated that the stepping failure was independently associated with falling (odds ratio = 19.365, 95% confidence interval = 3.28-113.95; p < .001). Measurements of stepping accuracy while performing the multitarget stepping task, particularly precise stepping failure, could contribute to identifying high-risk elderly individuals.