Abstract
This opportune case study describes visual and stepping behaviours of an 87 year old female (P8), both prior to, and following two falls. Before falling, when asked to walk along a path containing two stepping guides positioned before and after an obstacle, P8 generally visually fixated the first stepping guide until after foot contact inside it. However, after falling P8 consistently looked away from the stepping guide before completing the step into it in order to fixate the upcoming obstacle in her path. The timing of gaze redirection away from the target (in relation to foot contact inside it) correlated with absolute stepping error. No differences in eyesight, cognitive function, or balance were found between pre- and post-fall recordings. However, P8 did report large increases in fall-related anxiety and reduced balance confidence, supporting previously suggested links between anxiety/increased fear or falling and maladaptive visual/stepping behaviours. The results represent a novel insight into how psychological and related behavioural factors can change in older adults following a fall, and provide a possible partial rationalisation for why recent fallers are more likely to fall again in the following 12 months. These findings highlight novel possibilities for falls prevention and rehabilitation.
Highlights
Walking safely through our cluttered world requires visual identification of hazards in our path, so that we can plan and execute appropriate stepping actions safely to avoid falling
The detrimental effects of fear of falling (FOF) in OA has received much attention in the literature since 1982, when Murphy and Isaacs [3] described FOF as a serious disabling condition that often occurs in older adults (OA) following a fall
Whereas OA without FOF will continue to visually fixate stepping guides until after foot contact, OA with FOF will look away from a stepping guide prematurely i.e. before completing the step in to it, in order to fixate the hazard in the path [8]
Summary
Walking safely through our cluttered world requires visual identification of hazards in our path, so that we can plan and execute appropriate stepping actions safely to avoid falling. The authors suggested that anxiety regarding future stepping hazards compels OA to fixate them earlier This suggestion is supported by the finding that increased anxiety is associated with inducing an attentional bias, so that individuals allocate their attention towards environmental features that are perceived as being more threatening [9]. Previous research has demonstrated a causal link between the premature transferral of gaze from a stepping guide and reduced stepping accuracy inside it, along with increased variability of foot placement [10]. This finding led the authors to suggest that maladaptive visual behaviours are likely to be associated with an increased risk of falling [10]
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