Activity tool 2. On the stairs and outdoors, keep a firm footing!

Used with permission from the Régie Régionale de la santé et des services sociaux de Montréal Centre, Programme Intégré d'Équilibre Dynamique (PIED).

• Page 1. Activity
• Page 2. Buyer’s Guide - Practical items for the outdoors
• Page 3. Checklist: On the stairs and outdoors, keep a firm footing!
• Page 4. Illustration "On the stairs and outdoors, keep a firm footing!"
• Page 5. Information for Facilitators

Information for Facilitators

Stairs

Walking up and down stairs: a complex activity

In the United States, the Consumer Product Safety Commission determined in the 1970s that stairs were the most dangerous consumer product (Archea, 1985). The risk of injury on stairs increases with age, and women living alone seem at the highest risk (Startzell et al., 2000). Stair-related falls and injuries occur much more often when walking down the stairs (Tinetti, Speechley & Ginter, 1988).

The authors think that perceptual errors caused by architectural defects account for a large number of falls (Startzell et al., 2000). Changes in the perceptual functions of seniors may be another cause. Negotiating a staircase involves a number of systems: visual, proprioceptive, vestibular, cardiac and musculo-skeletal (Startzell et al, 2000).

When using stairs, our brain apparently records, from the first steps, the height of the stairs and space available for our feet (Achea, Collings & Stahl, 1979). In the middle of the staircase, visual points of reference are used less, and proprioception is the sense used most, as our brain assumes that all of the steps are the same. Proprioception may also play an important role in placing the foot on the first stair when walking down a staircase (Startzell et al., 2000).

Bi-focal glasses can negatively affect stair safety because they can create visual distortions (Startzell et al., 2000).

Stair Behaviour

Seniors consider negotiating a staircase to be one of the five most complex daily activities they deal with (Williamson & Fried in Startzell et al., 2000).

Compared to younger people, seniors are more cautious on stairs. Nevertheless, almost one-half of seniors admit to one or more unsafe behaviours (Startzell et al., 2000):

• Using stairs while wearing only socks or unsafe footwear
• Not holding the handrail
• Leaving objects on the stairs

Carrying objects on stairs has also been identified as a behaviour frequently associated with falls on stairs (Startzell et al., 2000).

Use of a handrail improves stair safety in a number of ways (Startzell et al., 2000):

• As a pivot point for changing direction on the stairs
• To reduce the load on lower limbs
• As a reference point for orientation
• To prevent falls in cases where a person loses balance

Safe stairs

For information, the following chart presents the major structural elements to consider in order to make stairs safer (Pauls, 1998).

Keeping balanced, a task that demands attention

For a long time, people thought that good posture was such a well-learned task that it was automatic (Dault, Geurts, Mulder & Duysens, 2001). And yet, in recent years, researchers have shown that it is more difficult, especially for seniors, to keep their balance when performing a task that demands attention (Marsh & Geel, 2001; Melzer, Benjuya & Kalanski, 2001; Ranking, Woollacott, Shumway-Cook & Brown, 2000; Redfern, Jennings, Martin & Furman, 2001; Shumway-Cook, Woollacott, Kerns & Baldwin, 1997).

Furthermore, it has been proven that seniors more readily lose their balance when mobile visual elements enter their field of vision (Borger, Whitney, Redfern & Furman, 1999). This suggests that as we grow older, keeping our balance demands an increasing amount of attention (Shumway-Cook & Woollacott, 2000) and that seniors may be at greater risk of falling when they move during multiple-task situations (Marsh & Geel, 2000).

And yet, in daily life, seniors are constantly confronted with dual task situations, often in environmental conditions that challenge the sensorial systems involved in balance. For example: walking on an uneven sidewalk and turning their heads as a bus passes by, or walking in a poorly lit garage while searching their pockets for keys. Transitional areas, such as vestibules and entrance ways, are locations where these complex situations are likely to occur (Reinsch, MacRae, Lachenbruch & Tobis, 1992).

Sources

Achea, J., Collings, B. & Stahl, F. (1979). Guidelines for stair safety. Vol. Series 120. Washington: U.S. Government Printing Office.

Archea, J. (1985). Environmental factors associated with stair accidents by the elderly. Clinics in Geriatric Medicine, 1(3): 1555-569.

Borger, LL., Whitney, SL., Redfern, MS. & Furman, JM. (1999). The influence of dynamic visual environments on postural sway in the elderly. J Vestib Res, 9(3):197-205.

Dault, MC., Geurts, AC., Mulder, TW. & Duysens, J. (2001). Postural control and cognitive task performance in healthy participants while balancing on different support-surface configurations. Gait Posture, 14(3): 248-55.

Marsh, AP. & Geel, SE. (2000). The effect of age on the attentional demands of postural control. Gait Posture, 12(2): 105-113.

Melzer, I., Benjuya, N. & Kaplanski, J. (2001). Age-related changes of postural control: effect of cognitive task. Gerontology, 47(4): 189-94.

Pauls, J. (1998). Benefit-cost analysis and housing affordability: The case of stairway usability, safety, design and related requirements and guidelines for new and existing homes. Pacific Rim Conference of Building Officials. Convention proceedings, Hawaii.

Rankin, JK., Woollacott, MH., Shumway-Cook, A. & Brown, LA. (2000). Cognitive influence on postural stability: a neuromuscular analysis in young and older adults. J. Gerontol A Biol Med Sci 55(3): M112-9.

Reinsch, S., MacRae, P., Lachenbruch, PA & Tobis, JS. (1992). Why do healthy older adults fall ? Behavioral and environmental risk: Physical & Occupational therapy in Geriatrics, 11 (1): 1-14.

Shumway-Cook, A. & Woollacott, M. (2000). Attentional demands and postural control: the effect of sensory context. J. Gerontol A Biol. Sci Med Sci, 55(1): M10-M16.

Shumway-Cook, A., Woollacott, M., Kerns, KA. & Baldwin, M. (1997). The effect of two types of cognitive tasks on postural stability in older adults with and without a history of falls. J Gerontol. A Biol Sci Med Sci: 52(4): M232-M240.

Startzell, JK., Owens, DA., Mulfinger, LM. & Cavanagh, PR. (2000). Stair negotiation in older people:  a review. J Am Geriatr Soc, 48(5): 567-80.

Tinetti, M., Speechley, M. & Ginter, S. (1988). Risk factors for falls among elderly persons living in the community. N Engl J Med, 319: 1701-1707.

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