Advancing age progressively affects obstacle avoidance skills in the elderly

The ability to adequately avoid obstacles while walking is an important skill that allows safe locomotion over uneven terrain. The high proportion of falls in the elderly that is associated to tripping over obstacles potentially illustrates an age-related deterioration of this locomotor skill. Some studies have compared young and old adults, but very little is known about the changes occurring within different age groups of elderly. In the present study, obstacle avoidance performance was studied in 25 young (20-37 years) and 99 older adults (65-88 years). The participants walked on a treadmill at a speed of 3 km/h. An obstacle was dropped 30 times in front of the left foot at various phases in the step cycle. Success rates (successful avoidance) were calculated and related to the time available between obstacle appearance and the estimated instant of foot contact with the obstacle (available response times or ARTs ranging from 200 to more than 350 ms). In addition, latencies of avoidance reactions, the choice of avoidance strategies (long or short step strategy, LSS or SSS), and three spatial parameters related to obstacle avoidance (toe distance, foot clearance, and heel distance) were determined for each participant. Compared to the young, the older adults had lower success rates, especially at short ARTs. Furthermore, they had longer reaction times, more LSS reactions, smaller toe and heel distances, and larger foot clearances. Within the group of elderly, only the 65-69 year olds were not different from young adults with respect to success rate, despite marked changes in the other parameters measured. In particular, even this younger group of elderly showed a dramatic reduction in the amount of SSS trials compared to young adults. Overall, age was a significant predictor of success rates, reaction times, and toe distances. These parameters deteriorated with advancing age. Finally, avoidance success rates at short ARTs were considerably worse in elderly participants who sustained recurrent falls in the six-month period prior to the assessment compared to those who sustained no or only one fall. An exercise program has been shown to improve avoidance success rates, especially at short ARTs, but the training effects on the determinants of success still need to be assessed.