Evidence of a link between fall-related anxiety and high-risk patterns of visual search in older adults during adaptive locomotion.

Abstract

BACKGROUND: Older adults deemed to be at a high-risk of falling will often display visual search behaviours likely to impair movement planning when negotiating environmental hazards. It has been proposed that these behaviours may be underpinned by fall-related anxiety. Thus, the aim of this study was to explore the effects of fall-related anxiety on visual search and stepping behaviours during adaptive gait. METHODS: Forty-four community-dwelling older adults (mean age = 74.61; standard deviation = 6.83) walked along a path and stepped into two raised targets. All participants completed walks at ground level, while participants deemed to be at a low risk of falling (n=24) also completed walks under conditions designed to induce fall-related anxiety (walkway elevated 0.6m). Participants' movement kinematics and gaze behaviour were measured. RESULTS: During ground trials, 'High-risk' participants visually prioritised the immediate walkway areas, at the expense of previewing future stepping constraints. This reduced planning appeared to negatively impact safety, with greater stepping errors observed for future constraints. When completing walks on the elevated walkway, 'Low-risk' participants similarly prioritised immediate walkway areas, at the expense of planning future stepping actions. These behaviours were associated with greater attention directed towards consciously processing walking movements. CONCLUSIONS: These findings provide evidence of a link between heightened fall-related anxiety and 'high-risk' visual search behaviours associated with greater stepping errors. This information enhances our understanding of why high-risk older adults are less able to safely navigate environmental constraints.