# Association of Fall-Risk Factors and Margin of Stability While Tripping in Community-Dwelling Older Adults: Experimental Pilot Study

## TL;DR

This study explores how balance stability changes during tripping in older adults and how it relates to fall risk, using a pilot experiment to assess feasibility and initial results.

## Contribution

The study introduces a tripping paradigm to measure margin of stability (MoS) as a potential dynamic fall-risk indicator in older adults.

## Key findings

- Perturbations significantly disrupted MoS during tripping, with recovery steps showing progressive stabilization.
- The second recovery step had the highest predictive accuracy for fall-risk differentiation under slow walking conditions.
- Perceived safety concerns limited full participation, highlighting the importance of comfort in experimental protocols.

## Abstract

Falls are a leading cause of injury among older adults, often resulting from dynamic balance disturbances. It is influenced by a complex interplay of intrinsic and extrinsic fall-risk factors. To identify individual fall risks, it is important to understand the underlying associations.

This study aimed to build an experimental setup modeling selected factors leading to a loss of balance, measured by the margin of stability (MoS) in an ecologically valid real-world example (tripping). Additionally, these analyses aimed to assess the feasibility and safety of the protocol and to explore the use of the MoS as part of a prototypical dynamic fall-risk model to differentiate between fall-risk groups.

Nineteen community-dwelling older adults (mean age of 71, SD 3.67 y; n=7, 37% women) completed the tripping protocol involving perturbations under various conditions. Clinical assessments were used to identify relevant fall-related intrinsic fall-risk factors. MoS was measured using an 8-camera motion capture system. Receiver operating characteristic analyses determined the ability of MoS to distinguish between low and high fall-risk groups.

Approximately one-quarter of participants discontinued before or at the start of the tripping scenario because of discomfort or fear of perturbations, indicating that perceived safety is an important feasibility factor. Perturbations significantly disrupted MoS, with a median MoS of −106.05 (IQR –181.40 to –41.50) mm during the perturbed step compared to 114 (IQR 81.20-155.20) mm in the preperturbation step. Recovery steps showed progressive stabilization, with the second recovery step achieving a median MoS of 88.45 (IQR 47.50-137.80) mm. The second recovery step exhibited the highest predictive accuracy for fall-risk differentiation, with area under the curve values reaching 82.3% during slow walking with a series of right-sided perturbations. In contrast, fast walking with random perturbations yielded lower area under the curve values (64.9%). Slow walking conditions generally demonstrated the clearest separation between fall-risk groups.

This pilot and feasibility study demonstrates the applicability of a tripping paradigm to perturb MoS in older adults and provides preliminary insights into its association with fall-risk indices. While the protocol proved safe and feasible for fit older adults, perceived safety limited full participation. The findings are exploratory and intended to guide the design of larger prospective studies rather than to establish predictive conclusions. These data suggest that MoS during controlled tripping may help differentiate fall-risk strata, but confirmation will require adequately powered studies in more diverse and frailer older populations—and across multiple real-world scenarios—before any clinical implementation can be considered.