Abstract
BACKGROUND: Environmental hazards (e.g., pedestrian traffic) cause falls and testing environment impacts gait in older adults. However, most fall risk evaluations do not assess real-world moving hazard avoidance. AIMS: This study examined the effect of fall history in older adults on acceleration profiles before, during, and after a near collision with a moving hazard, in laboratory and real-world settings. METHODS: Older adults with (n = 14) and without a fall history (n = 15) performed a collision avoidance walking task with a sudden moving hazard in real-world and laboratory settings. Gait acceleration and video data of participants' first-person views were recorded. Four mixed effects multilevel models analyzed the magnitude and variability of mean and peak anteroposterior and mediolateral acceleration while walking before, during, and after the moving hazard in both environments. RESULTS: In the real-world environment, older adults without a fall history increased their mean anteroposterior acceleration after the moving hazard (p = 0.046), but those with a fall history did not (p > 0.05). Older adults without a fall history exhibited more intersubject variability than those with a fall history in mean (p < 0.001) and peak anteroposterior (p = 0.015) acceleration across environments and epochs. Older adults without a fall history exhibited a slower peak mediolateral reaction during the moving hazard (p = 0.014) than those with a fall history. CONCLUSIONS: These results suggest that compared to older adults with a fall history, older adults without a fall history are more adaptable and able to respond last-minute to unexpected hazards. Older adults with a fall history exhibited more homogenous responses.