The association between choice stepping reaction time and falls in older adults--a path analysis model

Pijnappels, Mirjam; Delbaere, Kim; Sturnieks, Daina L.; Lord, Stephen R. · 2009 · OpenAlex-citations

DOI: 10.1093/ageing/afp200

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Summary

This study investigates the underlying mechanisms linking choice stepping reaction time (CSRT) to fall risk in older adults. While previous research established that CSRT—a functional test requiring rapid stepping onto randomly illuminated targets—effectively discriminates between fallers and non-fallers, the specific physiological and cognitive pathways mediating this relationship remained unclear. The authors aimed to determine whether the association between poor CSRT performance and multiple falls is direct or mediated by underlying impairments in physiological and cognitive functions. The study involved 294 retirement-village residents aged 62 to 95 years. Participants underwent assessments of CSRT, physiological performance (including visual contrast sensitivity, proprioception, quadriceps strength, simple reaction time, and postural sway), and cognitive processing (measured via the Trail Making Test). Fall incidence was tracked prospectively over one year, with participants classified as multiple fallers if they experienced two or more falls. Statistical analysis utilized path modeling to examine direct and indirect associations between these variables and fall outcomes. Results indicated that 27% of participants were multiple fallers, who exhibited significantly slower CSRT and impaired performance across all physiological and cognitive tests compared to non-fallers. Path analysis revealed that the association between CSRT and multiple falls was entirely mediated by simple reaction time and balance (postural sway), with no direct effect of CSRT on falls. These two primary mediators were, in turn, influenced by indirect physiological pathways (quadriceps strength and visual contrast sensitivity) and cognitive pathways (processing speed). The final model explained 17% of the variance in multiple falls. An alternative model positing that CSRT directly causes falls was rejected due to poor fit, confirming that CSRT is an outcome of underlying impairments rather than a direct cause of falling. The findings demonstrate that CSRT serves as a composite indicator of integrated physiological and cognitive deficits rather than an independent risk factor. Specifically, impaired balance and slow reaction time are the primary drivers linking poor stepping performance to falls, supported by weaker muscle strength, reduced visual acuity, and slower cognitive processing. These results have clinical implications for fall prevention, suggesting that interventions targeting strength, balance, and cognitive processing may improve functional stepping performance and reduce fall risk. The study highlights the multifactorial nature of falls and validates the use of path analysis to elucidate the complex interrelationships between functional measures and health outcomes in aging populations.

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• perception reaction time