Evidence of a Link Between Fall-Related Anxiety and High-Risk Patterns of Visual Search in Older Adults During Adaptive Locomotion

Background: Older adults deemed to be at a high risk of falling will often display visual search behaviors likely to impair movement planning when negotiating environmental hazards. It has been proposed that these behaviors 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 behaviors 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, whereas 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 0.6 m). Participants' movement kinematics and gaze behavior were measured.

Results: During ground trials, "high-risk" participants visually prioritized the immediate walkway areas 1-2 steps ahead, at the expense of previewing future stepping constraints. This reduced planning appeared to negatively affect safety, with greater stepping errors observed for future constraints. When completing walks on the elevated walkway, "low-risk" participants similarly prioritized immediate walkway areas, at the expense of planning future stepping actions. These behaviors were associated with greater attention directed toward consciously processing walking movements.

Conclusions: These findings provide evidence of a link between heightened fall-related anxiety and "high-risk" visual search behaviors associated with greater stepping errors. This information enhances our understanding of why high-risk older adults are less able to safely navigate environmental constraints.