Falls are a leading cause of injury, loss of independence, and premature mortality among older adults, and they place a substantial burden on individuals, caregivers, and healthcare systems.
Objective
This cross-sectional study aimed to determine the contribution of vibration and proprioception sense, isometric muscle strength, static balance, reaction time and postural stability to falls in females aged 65 and over.
Methods
In this cross-sectional study, 92 females (aged ≥65 years) were evaluated for vibration sense, proprioception, isometric muscle strength, static balance, reaction time, and postural stability. The number of falls within the past year was recorded. Statistical analyses were performed using IBM SPSS v27.0, with non-normally distributed variables compared using the Mann–Whitney U test and independent contributors to falls identified by multiple linear regression with backward stepwise elimination.
Results
Fallers demonstrated reduced vibration sense, larger ankle joint reposition errors, weaker dorsiflexor and plantarflexor strength, and slower dorsiflexion and plantarflexion reaction times (all p < 0.001); no group differences were seen for invertor/evertor strength, static balance duration, or postural sway (p > 0.05). In multivariable regression, greater plantarflexion joint reposition error (β = 0.454, p < 0.001), poorer vibration sense (β = −0.214, p = 0.005), reduced plantarflexor strength (β = -0.149, p = 0.040) and longer plantarflexion reaction time (β = 0.232, p = 0.003) independently predicted number of falls (VIF < 2.2).
Conclusion
Impaired vibration sense, greater plantar flexion proprioceptive error, reduced plantar flexor strength, and slower plantarflexion reaction time were independently associated with more falls. Targeted interventions to enhance proprioceptive function, muscle strength, and neuromuscular response may be essential for fall prevention and promoting safer, more independent aging.
GerlandP. What's beneath the future: world population prospects. In: Semaine data-SHS. Aix-en-Provence, France: Aix‑Marseille Université, 2023, pp.1–76.
2.
SadaqaMNémethZMakaiA, et al.Effectiveness of exercise interventions on fall prevention in ambulatory community-dwelling older adults: a systematic review with narrative synthesis. Front Public Health2023; 11: 1209319.
3.
KalacheAFuDYoshidaS, et al.World Health Organisation global report on falls prevention in older age. Geneva, Switzerland: World Health Organization, 2007.
4.
HorakFB. Postural orientation and equilibrium: what do we need to know about neural control of balance to prevent falls?Age Ageing2006; 35: ii7–ii11.
5.
ToosizadehNEhsaniHMiramonteM, et al.Proprioceptive impairments in high fall risk older adults: the effect of mechanical calf vibration on postural balance. Biomed Eng Online2018; 17: 1–14.
6.
FerlincAFabianiEVelnarT, et al.The importance and role of proprioception in the elderly: a short review. Materia Socio MEDica2019; 31: 19.
7.
SturnieksiDLMenantJLordSR. Balance and ageing. In: The biology of ageing. London, UK: CRC Press, 2022, pp.223–234.
8.
RibeiroFOliveiraJ. Aging effects on joint proprioception: the role of physical activity in proprioception preservation. Eur Rev Aging Phys Act2007; 4: 71–76.
9.
LordSRMenzHBTiedemannA. A physiological profile approach to falls risk assessment and prevention. Phys Ther2003; 83: 237–252.
10.
NariciMVMaganarisCN. Plasticity of the muscle-tendon complex with disuse and aging. Exerc Sport Sci Rev2007; 35: 126–134.
11.
IwasakiSYamasobaT. Dizziness and imbalance in the elderly: age-related decline in the vestibular system. Aging Dis2015; 6: 38.
12.
NakamuraKOshikiRKobayashiR, et al.Postural sway velocity predicts osteoporotic fracture in community-dwelling elderly Japanese women: the muramatsu study. Age Ageing2011; 40: 132–135.
13.
SmithRESheltonADSawickiGS, et al.The effects of plantarflexor weakness and reduced tendon stiffness with aging on gait stability. PLoS One2024; 19: e0302021.
14.
CattagniTHarnieJJubeauM, et al.Neural and muscular factors both contribute to plantar-flexor muscle weakness in older fallers. Exp Gerontol2018; 112: 127–134.
15.
SlugaSPKozincŽ. Sensorimotor and proprioceptive exercise programs to improve balance in older adults: a systematic review with meta-analysis. Eur J Transl Myol2024; 34: 1.
16.
AndreH-ICarnideFBorjaE, et al.Calf-raise senior: a new test for assessment of plantar flexor muscle strength in older adults: protocol, validity, and reliability. Clin Interv Aging2016; 11: 1661–1674.
17.
KolbaşıENvan der HulstEGSpildoorenJ, et al.Does sensory integration influence gait parameters in healthy older adults? Insights from a systematic review with meta-analysis. J Clin Med2025; 14: 4545.
18.
PiirtolaMEraP. Force platform measurements as predictors of falls among older people: a review. Gerontology2006; 52: 1–16.
19.
QuijouxFVienne-JumeauABertin-HugaultF, et al.Center of pressure displacement characteristics differentiate fall risk in older people: a systematic review with meta-analysis. Ageing Res Rev2020; 62: 101117.
20.
PapaliaGFPapaliaRDiaz BalzaniLA, et al.The effects of physical exercise on balance and prevention of falls in older people: a systematic review and meta-analysis. J Clin Med2020; 9: 2595.
21.
SalisFCostaggiuDMandasA. Mini-mental state examination: optimal cut-off levels for mild and severe cognitive impairment. Geriatrics2023; 8: 12.
22.
SaglamMArikanHSavciS, et al.International physical activity questionnaire: reliability and validity of the turkish version. Percept Mot Skills2010; 111: 278–284.
23.
SousaASGuedesDCFélixJ, et al. Physical activity, readiness, and cardiovascular risk stratification in the polytechnics communities of the northern region of Portugal integrated in mobility as a service concept. In: Healthcare. Basel, Switzerland: MDPI, 2023, p.3145.
24.
DeshpandeNMetterEJFerrucciL. Validity of clinically derived cumulative somatosensory impairment index. Arch Phys Med Rehabil2010; 91: 226–232.
25.
ChattopadhyaySGoswamiSSenguptaN, et al.Can the 128-hz tuning fork be an alternative to the biothesiometer for diabetic peripheral neuropathy screening? A cross-sectional study in a tertiary hospital in east India. BMJ Open2024; 14: e082193.
26.
AlshahraniMSReddyRS. Relationship between kinesiophobia and ankle joint position sense and postural control in individuals with chronic ankle instability—a cross-sectional study. Int J Environ Res Public Health2022; 19: 2792.
27.
DeshpandeNConnellyDMCulhamEG, et al.Reliability and validity of ankle proprioceptive measures. Arch Phys Med Rehabil2003; 84: 883–889.
28.
Romero-FrancoNJiménez-ReyesPGonzález-HernándezJM, et al.Assessing the concurrent validity and reliability of an iPhone application for the measurement of range of motion and joint position sense in knee and ankle joints of young adults. Phys Ther Sport2020; 44: 136–142.
29.
AlfuthMHahmMM. Reliability, comparability, and validity of foot inversion and eversion strength measurements using a hand-held dynamometer. Int J Sports Phys Ther2016; 11: 72.
30.
ChamorroCArmijo-OlivoSDe la FuenteC, et al.Absolute reliability and concurrent validity of hand held dynamometry and isokinetic dynamometry in the hip, knee and ankle joint: systematic review and meta-analysis. Open Med2017; 12: 359–375.
31.
PantaBK. A study to associate the Flamingo Test and the Stork Test in measuring static balance on healthy adults. Foot Ankle Online J2015; 8: 1–4.
32.
GoldbergACasbyAWasielewskiM. Minimum detectable change for single-leg-stance-time in older adults. Gait Posture2011; 33: 737–739.
33.
AdamsK. Exercise, Cognition, and the Aging Process among Active, Competitive, and Sedentary Middle-Aged and Older Adults. 2017.
34.
ErisFUzunRHazirA, et al.Comparison of some anthropometric features and balance ability of basketball and volleyball athletes. Eur J Mol Clin Med2023; 10: 1–8.
35.
MiçooğullarıMYükselİAngınS. Efficacy of scapulothoracic exercises on proprioception and postural stability in cranio-cervico-mandibular malalignment: a randomized, double-blind, controlled trial. J Back Musculoskelet Rehabil2024; 37: 883–896.
36.
KooTKLiMY. A guideline of selecting and reporting intraclass correlation coefficients for reliability research. J Chiropr Med2016; 15: 155–163.
37.
KasugaSCrevecoeurFCrossKP, et al.Integration of proprioceptive and visual feedback during online control of reaching. J Neurophysiol2022; 127: 354–372.
38.
ShadrachJLGomez-FrittelliJKaltschmidtJA. Proprioception revisited: where do we stand?Curr Opin Physiol2021; 21: 23–28.
39.
TomatsuSKimGKubotaS, et al.Presynaptic gating of monkey proprioceptive signals for proper motor action. Nat Commun2023; 14: 6537.
40.
WinterLHuangQSerticJV, et al.The effectiveness of proprioceptive training for improving motor performance and motor dysfunction: a systematic review. Front Rehabil Sci2022; 3: 830166.
41.
GobleDJCoxonJPVan ImpeA, et al.The neural basis of central proprioceptive processing in older versus younger adults: an important sensory role for right putamen. Hum Brain Mapp2012; 33: 895–908.
42.
RöijezonUClarkNCTreleavenJ. Proprioception in musculoskeletal rehabilitation. Part 1: basic science and principles of assessment and clinical interventions. Man Ther2015; 20: 368–377.
43.
BalohRWYingSHJacobsonKM. A longitudinal study of gait and balance dysfunction in normal older people. Arch Neurol2003; 60: 835–839.
44.
WangQFuH. Relationship between proprioception and balance control among Chinese senior older adults. Front Physiol2022; 13: 1078087.
45.
WangQLiLMaoM, et al.The relationships of postural stability with muscle strength and proprioception are different among older adults over and under 75 years of age. J Exerc Sci Fit2022; 20: 328–334.
46.
PolFForghanySHosseiniSM, et al.Structural and functional foot and ankle characteristics associated with falls in older people. Gait Posture2021; 88: 78–83.
47.
KingGWStylianouAPKludingPM, et al.Effects of age and localized muscle fatigue on ankle plantar flexor torque development. J Geriatr Phys Ther2012; 35: 8–14.
48.
SpinkMJFotoohabadiMRWeeE, et al.Foot and ankle strength, range of motion, posture, and deformity are associated with balance and functional ability in older adults. Arch Phys Med Rehabil2011; 92: 68–75.
49.
WillemseLWoutersEJBrontsHM, et al.The effect of interventions anticipated to improve plantar intrinsic foot muscle strength on fall-related dynamic function in adults: a systematic review. J Foot Ankle Res2022; 15: 3.
50.
BokS-KLeeTHLeeSS. The effects of changes of ankle strength and range of motion according to aging on balance. Ann Rehabil Med2013; 37: 10.
51.
FlemingBEWilsonDRPendergastDR. A portable, easily performed muscle power test and its association with falls by elderly persons. Arch Phys Med Rehabil1991; 72: 886–889.
52.
PollockRDProvanSMartinFC, et al.The effects of whole body vibration on balance, joint position sense and cutaneous sensation. Eur J Appl Physiol2011; 111: 3069–3077.
53.
ShafferSWHarrisonAL. Aging of the somatosensory system: a translational perspective. Phys Ther2007; 87: 193–207.
54.
CitakerSGunduzAGGucluMB, et al.Relationship between foot sensation and standing balance in patients with multiple sclerosis. Gait Posture2011; 34: 275–278.
55.
PerrySD. Evaluation of age-related plantar-surface insensitivity and onset age of advanced insensitivity in older adults using vibratory and touch sensation tests. Neurosci Lett2006; 392: 62–67.
56.
DeshpandeNMetterEJLauretaniF, et al.Activity restriction induced by fear of falling and objective and subjective measures of physical function: a prospective cohort study. J Am Geriatr Soc2008; 56: 615–620.
57.
MenzHBLordSRFitzpatrickRC. Acceleration patterns of the head and pelvis when walking on level and irregular surfaces. Gait Posture2003; 18: 35–46.
58.
GilmanS. Joint position sense and vibration sense: anatomical organisation and assessment. J Neurol Neurosurg Psychiatry2002; 73: 473–477.
59.
LordSRSturnieksDL. The physiology of falling: assessment and prevention strategies for older people. J Sci Med Sport2005; 8: 35–42.
60.
KolevVFalkensteinMYordanovaJ. Motor-response generation as a source of aging-related behavioural slowing in choice-reaction tasks. Neurobiol Aging2006; 27: 1719–1730.
61.
WatanabeTSaitoKIshidaK, et al.Coordination of plantar flexor muscles during bipedal and unipedal stances in young and elderly adults. Exp Brain Res2018; 236: 1229–1239.
62.
FozardJLVercruyssenMReynoldsSL, et al.Age differences and changes in reaction time: the Baltimore longitudinal study of aging. J Gerontol1994; 49: P179–P189.
63.
ChaoY-YZhaPYangK, et al.Association between physical function and perceived stress among US Chinese older adults. Am J Aging Sci Res2020; 1: 12.
64.
SinghNBTaylorWRMadiganML, et al.The spectral content of postural sway during quiet stance: influences of age, vision and somatosensory inputs. J Electromyogr Kinesiol2012; 22: 131–136.
65.
GhahramaniMStirlingDNaghdyF, et al.Body postural sway analysis in older people with different fall histories. Med Biol Eng Comput2019; 57: 533–542.
66.
LajoieYGallagherS. Predicting falls within the elderly community: comparison of postural sway, reaction time, the Berg balance scale and the Activities-specific Balance Confidence (ABC) scale for comparing fallers and non-fallers. Arch Gerontol Geriatr2004; 38: 11–26.
67.
PizzigalliLCremascoMMMulassoA, et al.The contribution of postural balance analysis in older adult fallers: a narrative review. J Bodyw Mov Ther2016; 20: 409–417. doi:10.1016/j.jbmt.2015.12.008
