Falls are the most frequent cause of fatal injury to older Americans, and non-fatal falls, which are also common, can curtail mobility and quality of life for older adults. The choice of footwear for adults aged 65 and older may be an important factor in preventing these falls, according to new research by investigators at the Harborview Injury Prevention & Research Center and Group Health Cooperative of Puget Sound.
“Footwear Style and Risk of Falls in Older Adults” is published in the September issue of the Journal of the American Geriatrics Society. The study involved monitoring 1,371 Group Health Cooperative enrollees aged 65 and older over a two-year period.
A total of 327 qualifying falls occurred during this period, with most falls taking place inside or near the home.
Fallers were asked to call a telephone hotline as soon as possible after their falls. After a telephone screening, two-person field teams visited the faller to gather information on the circumstances of the fall, including the type of shoes worn at the time. A control group was asked a similar set of questions, apart from questions about a fall, including such topics as sociodemographics, health status, mobility, and footwear habits.
Footwear was divided into several categories based on shoe design and the kinds of activities for which of different styles are commonly worn. In one analysis, for example, five categories were compared: athletic/canvas shoes, lace-up oxfords, loafers/flats, other shoe styles (including boots, high heels, sandals and slippers), and going shoeless (barefoot or stocking feet).
Athletic and canvas shoes (also known as sneakers) — the styles of footwear most commonly worn by this sample of older adults — were associated with the lowest risk of falling, while older adults going shoeless had the highest risk. Compared to athletic and canvas shoes, other footwear was associated with a 30 percent greater risk of a fall.
Athletic shoes and canvas shoes have a relatively wide rubber or crepe sole, low heel height, and a large area of contact between the shoe sole and the walking surface. While being barefoot has been associated with good balance performance in the laboratory, walking without shoes leaves the foot more vulnerable to painful injury, and stocking feet provide a poor coefficient of friction and thus are more prone to slipping.
“Falls among older adults can lead to hip and other fractures, head injuries, hospitalization, or limited mobility and quality of life,” says Dr. Thomas Koepsell, a University of Washington (UW) professor of epidemiology, and the study’s principal investigator. “Our research indicates that the risk of a fall varies significantly depending on the type of footwear an older person chooses. This information may be useful to older adults in their decisions about what kinds of shoes to buy and wear.”
In addition to Koepsell, the study was conducted by Marsha Wolf, Ph.D., formerly of the Harborview Injury Prevention & Research Center (HIPRC); Dr. David Buchner of the National Center for Chronic Disease Prevention and Health Promotion at the Centers for Disease Control and Prevention; Walter Kukull, Ph.D., a UW professor of epidemiology; Andrea LaCroix, Ph.D., a UW professor of epidemiology affiliated with Group Health Cooperative; Allan Tencer, Ph.D., a UW professor of orthopaedics and sports medicine; Cara Frankenfeld, M.S., formerly of the HIPRC; Milda Tautvydas, M.F.A, of the HIPRC; and Dr. Eric Larson of the Center for Health Studies at Group Health Cooperative.