Stair-descent Phenotypes in Community-dwelling Older Adults Determined Using High-level Balance Tasks

Overview

Journal Aging Clin Exp Res

Publisher Springer

Date 2025 Jan 29

PMID 39878920

Authors

Takahiro Tanaka

Kimitaka Hase

Kimihiko Mori

Masanori Wakida

Yasuaki Arima

Takanari Kubo

Meguru Taguchi

Affiliations

Soon will be listed here.

Abstract

Background: Falls on stairs are a major cause of severe injuries among older adults, with stair descent posing significantly greater risks than ascent. Variations in stair descent phenotypes may reflect differences in physical function and biomechanical stability, and their identification may prevent falls.

Aims: This study aims to classify stair descent phenotypes in older adults and investigate the biomechanical and physical functional differences between these phenotypes using hierarchical cluster analysis.

Methods: Eighty-two older adults participated in this study. Stair descent was measured using a three-dimensional motion analysis system. Physical function was assessed using measures of muscle strength, walking speed, the Timed Up and Go Test (TUG), and the Community Balance and Mobility Scale (CB&M).

Results: Hierarchical cluster analysis was performed on kinematic data obtained during stair descent. Three phenotypes were identified: neutral (N-type; 24%), extension (E-type; 52%), and rotation (R-type; 23%). There were no significant differences in lower limb muscle strength or walking speed among the different types, and TUG scores showed no differences in terms of mobility or balance abilities. However, CB&M scores were significantly lower for E-type and R-type compared to N-type. Sub-analyses revealed that while there were no differences in the mobility factor of CB&M between E-type and R-type, the strength factors were significantly lower compared to those for N-type.

Discussion: These results suggest that E-type and R-type stair-descent patterns may be influenced by declines in standing balance ability and muscle strength.

Conclusions: These findings may inform fall-prevention training programs related to stair descent among older adults.

References

Takacs J, Krowchuk N, Goldsmith C, Hunt M . Factor Analysis of the Community Balance and Mobility Scale in Individuals with Knee Osteoarthritis. Physiother Res Int. 2016; 22(4). DOI: 10.1002/pri.1675. View

Bulea T, Kobetic R, Audu M, Schnellenberger J, Pinault G, Triolo R . Forward stair descent with hybrid neuroprosthesis after paralysis: Single case study demonstrating feasibility. J Rehabil Res Dev. 2014; 51(7):1077-94. PMC: 4667789. DOI: 10.1682/JRRD.2013.12.0257. View

Adkin A, Frank J, Carpenter M, Peysar G . Postural control is scaled to level of postural threat. Gait Posture. 2000; 12(2):87-93. DOI: 10.1016/s0966-6362(00)00057-6. View

Oba N, Sasagawa S, Yamamoto A, Nakazawa K . Difference in Postural Control during Quiet Standing between Young Children and Adults: Assessment with Center of Mass Acceleration. PLoS One. 2015; 10(10):e0140235. PMC: 4598130. DOI: 10.1371/journal.pone.0140235. View

Huang C, Okada K, Matsushita E, Uno C, Satake S, Martins B . The association of social frailty with intrinsic capacity in community-dwelling older adults: a prospective cohort study. BMC Geriatr. 2021; 21(1):515. PMC: 8475329. DOI: 10.1186/s12877-021-02466-6. View

Wu G, Siegler S, Allard P, Kirtley C, Leardini A, Rosenbaum D . ISB recommendation on definitions of joint coordinate system of various joints for the reporting of human joint motion--part I: ankle, hip, and spine. International Society of Biomechanics. J Biomech. 2002; 35(4):543-8. DOI: 10.1016/s0021-9290(01)00222-6. View

Tateuchi H, Akiyama H, Goto K, So K, Kuroda Y, Ichihashi N . Clinical phenotypes based on clinical prognostic factors in patients with secondary hip osteoarthritis: preliminary findings from a prospective cohort study. Clin Rheumatol. 2020; 39(7):2207-2217. DOI: 10.1007/s10067-020-04988-7. View

Hamel K, Cavanagh P . Stair performance in people aged 75 and older. J Am Geriatr Soc. 2004; 52(4):563-7. DOI: 10.1111/j.1532-5415.2004.52162.x. View

Dalmaijer E, Nord C, Astle D . Statistical power for cluster analysis. BMC Bioinformatics. 2022; 23(1):205. PMC: 9158113. DOI: 10.1186/s12859-022-04675-1. View

10.

Saywell N, Taylor D, Boocock M . During step descent, older adults exhibit decreased knee range of motion and increased vastus lateralis muscle activity. Gait Posture. 2012; 36(3):490-4. DOI: 10.1016/j.gaitpost.2012.05.007. View

11.

Fujiwara Y, Suzuki H, Yasunaga M, Sugiyama M, Ijuin M, Sakuma N . Brief screening tool for mild cognitive impairment in older Japanese: validation of the Japanese version of the Montreal Cognitive Assessment. Geriatr Gerontol Int. 2010; 10(3):225-32. DOI: 10.1111/j.1447-0594.2010.00585.x. View

12.

Mulroy S, Gronley J, Weiss W, Newsam C, Perry J . Use of cluster analysis for gait pattern classification of patients in the early and late recovery phases following stroke. Gait Posture. 2003; 18(1):114-25. DOI: 10.1016/s0966-6362(02)00165-0. View

13.

Balasubramanian C . The community balance and mobility scale alleviates the ceiling effects observed in the currently used gait and balance assessments for the community-dwelling older adults. J Geriatr Phys Ther. 2014; 38(2):78-89. DOI: 10.1519/JPT.0000000000000024. View

14.

Boye N, Mattace-Raso F, Van der Velde N, Van Lieshout E, de Vries O, Hartholt K . Circumstances leading to injurious falls in older men and women in the Netherlands. Injury. 2014; 45(8):1224-30. DOI: 10.1016/j.injury.2014.03.021. View

15.

Andriacchi T, Andersson G, Fermier R, Stern D, Galante J . A study of lower-limb mechanics during stair-climbing. J Bone Joint Surg Am. 1980; 62(5):749-57. View

16.

Verghese J, Holtzer R, Lipton R, Wang C . Quantitative gait markers and incident fall risk in older adults. J Gerontol A Biol Sci Med Sci. 2009; 64(8):896-901. PMC: 2709543. DOI: 10.1093/gerona/glp033. View

17.

Park K, Cynn H, Choung S . Musculoskeletal predictors of movement quality for the forward step-down test in asymptomatic women. J Orthop Sports Phys Ther. 2013; 43(7):504-10. DOI: 10.2519/jospt.2013.4073. View

18.

Masud T, Morris R . Epidemiology of falls. Age Ageing. 2002; 30 Suppl 4:3-7. DOI: 10.1093/ageing/30.suppl_4.3. View

19.

Krebs D, Wong D, Jevsevar D, Riley P, Hodge W . Trunk kinematics during locomotor activities. Phys Ther. 1992; 72(7):505-14. DOI: 10.1093/ptj/72.7.505. View

20.

Barry E, Galvin R, Keogh C, Horgan F, Fahey T . Is the Timed Up and Go test a useful predictor of risk of falls in community dwelling older adults: a systematic review and meta-analysis. BMC Geriatr. 2014; 14:14. PMC: 3924230. DOI: 10.1186/1471-2318-14-14. View