Lower-Limb Factors Associated with Balance and Falls in Older Adults A Systematic Review and Clinical Synthesis

Background: Despite sufficient evidence to suggest that lower-limb-related factors may contribute to fall risk in older adults, lower-limb and footwear influences on fall risk have not been systematically summarized for readers and clinicians. The purpose of this study was to systematically review and synethesize the literature related to lower-limb, foot, and footwear factors that may increase the risk of falling among community-dwelling older adults. Methods: We searched PubMed, Embase, PsycINFO, CINAHL, Web of Science, Cochrane Library, and AgeLine. To describe the trajectory toward increasing risk of falls, we examined those articles that linked age-related changes in the lower limb or footwear to prospective falls or linked them to evidenced-based fall risk factors, such as gait and balance impairment. Results: This systematic review consisted of 81 articles that met the review criteria, and the results reflect a narrative review of the appraised literature for eight pathways of lower-limb- related influences on fall risk in older adults. Six of the eight pathways support a direct link to fall risk. Two other pathways link to the intermediate factors but lack studies that provide evidence of a direct link. Conclusions: This review provides strong guidance to advance understanding and assist with managing the link between lower-limb factors and falls in older adults. Due to the lack of literature in specific areas, some recommendations were based on observational studies and should be applied with caution until further research can be completed.