Abstract
Age-related hearing loss (ARHL) and impaired gait both independently heighten the risk of accidental falls among older adults. However, the combined impact of these factors remains unclear. We analyzed the data of 786 community-dwelling Japanese older adults. Hearing was evaluated at frequencies of 1.0 and 4.0 kHz, with participants categorized into ARHL (> 25 dB) and non-ARHL groups. Gait was also assessed, defining slow gait (SG) as speeds one standard deviation below the age- and sex-specific mean. Participants were divided into four groups based on their ARHL and SG statuses and were monitored annually for 8 years to track falls and related injuries. Throughout the follow-up, incidents included 328 single falls (9.6/100 person-years), 117 multiple falls (2.8/100 person-years), 249 minor injuries from falls (6.7/100 person-years), and 55 fractures due to falls (1.3/100 person-years). Cox proportional hazard regression models showed that participants without ARHL but with SG faced a significantly increased risk of frequent falls. Furthermore, ARHL combined with SG significantly raised the risk of both single and frequent falls, and increased the incidence of both minor and severe fall-related injuries, including fractures. In contrast, no significant association was found between ARHL alone and fall-related incidents. These findings suggest that the previously reported risk associated with hearing loss in fall incidents predominantly relates to gait impairment. The co-occurrence of ARHL and SG significantly escalates the risk of falls and related injuries, highlighting the critical need for routine gait monitoring.
Keywords: Age-related hearing loss, Slow gait, Falls, Fall-related injuries, Longitudinal study
Introduction
Hearing is an essential sense that significantly influences daily activities, including balance and mobility. It enables us to accurately locate objects and respond to events in our surroundings. Moreover, hearing is vital for perceiving our movement through space, enhancing our awareness of body position and motion [1–4]. When compromised, commonly referred to as hearing loss, it can disrupt the sensory input necessary for maintaining stability and proper posture, potentially increasing the risk of falls among older adults [1, 5].
Indeed, falls are more common among older adults with age-related hearing loss (ARHL), and their risk of falling is higher compared to those without ARHL [6, 7]. For instance, there is a 1.4-fold increase in the odds of reporting a fall over the past 12 months for every 10-dB increase in hearing loss [8]. Additionally, minor fall-related injuries are 1.6 times more frequent among individuals with hearing loss than among those without [9]. These findings highlight the link between hearing loss and falls in older adults, supported by a limited number of longitudinal studies [6, 10, 11].
One plausible hypothesis for the connection between hearing loss and falls is that hearing acts as a sensory anchor, akin to visual fixation or light touch, enabling us to sense our surroundings and maintain balance [1, 12]; falls occur when this function is impaired. Research demonstrates that sound cues improve center of pressure displacement in individuals with normal hearing and those using hearing aids due to hearing loss; however, these effects are not observed in individuals with hearing impairments who do not wear hearing aids and those with significant hearing loss [4, 13–15]. Furthermore, recent laboratory-based studies have shown that auditory deprivation increases step-length variability when approaching obstacles and alters foot clearance during obstacle negotiation, emphasizing the critical role of auditory information in adjusting movement and stabilizing during locomotion [5].
While sound perception is critical for maintaining balance during movement and is associated with fall risk, from a fall prevention perspective, older adults with ARHL may not be at high risk of falling if their mobility remains intact [16–19]. Previous studies have indicated that ARHL can impair lower-extremity functions, leading to slower gait speeds and increased stride length variability [19–22], suggesting that mobility issues are prevalent in individuals with ARHL [23]. Therefore, there may be a synergistic effect underlying the association between ARHL and falls. Supporting this notion, research has shown that ARHL is not merely associated with falls [24], and older adults with moderate ARHL were more likely to report falls in the previous year, especially as their gait speed diminished [21]. However, these associations have primarily been observed in cross-sectional studies, and the impact on fall-related injuries remains largely unexplored. Understanding the interaction between ARHL, slow gait (SG), and fall risk can help identify individuals at a higher risk of severe fall-related injuries and elucidate the mechanisms contributing to increased fall risk in ARHL.
This study aimed to explore the role of SG in the previously reported risk of hearing loss in fall incidents. To this end, utilizing longitudinal data from a cohort study, we assessed the combined effects of incidents of single falls, multiple falls, injuries due to falls, and fractures resulting from falls. We hypothesized that the simultaneous presence of ARHL and SG is associated with a higher risk for each fall outcome. Conversely, ARHL alone (i.e., those with ARHL without SG) may not significantly contribute to multiple and injurious falls because these individuals often maintain sufficient locomotor function to prevent or recover from losing balance.
Methods
Participants
The Otassha Study, initiated in 2011, targets older adults in Itabashi Ward, an urban area of Tokyo, to study healthy aging [25–27]. We invited all residents aged 65–84 years, registered in the Basic Resident Register of Itabashi Ward and residing within the study area as of October 2011, excluding those previously surveyed or institutionalized. We conducted health surveys and annual follow-ups, recruiting new participants at age 65. This study focuses on participants who were followed for 8 years, starting from either 2013 or 2014 as the baseline when the auditory test was introduced. Participants in 2014 were either new or had skipped the 2013 assessment. This study was approved by the Tokyo Metropolitan Institute of Gerontology Ethics Board, and all participants provided informed consent upon enrollment. Our research adheres to the STROBE guidelines.
The inclusion criteria were as follows: (1) ability to walk independently, (2) completion of both auditory and gait assessments, and (3) at least one follow-up during the study period. The exclusion criteria included (1) presence of a serious or acute disease, (2) history of substance abuse, (3) dementia or significant cognitive impairment, as indicated by an MMSE score below 24 [28], (4) unstable psychiatric illness, and (5) presence of an eye disease in one or both eyes that interferes with daily activities.
Gait assessment
In the 2013 assessment, participants were instructed by a skilled examiner to walk a 16-m straight pathway on a level surface at their usual pace, performing the task twice. To accurately measure gait speed and eliminate variability due to starting and stopping, only the middle 10 m of the walk were considered, excluding the initial and final 3 m to avoid acceleration and deceleration effects. The average gait speed calculated from two consecutive trials was recorded as the gait parameter. For the 2014 assessment, a similar protocol was adopted but shortened to an 11-m walk, with participants asked to walk at their usual pace twice. Again, only the central 5 m were used for calculating gait speed to negate start and stop influences. The average of two trials was taken as the measure of gait speed, just as in 2013. Consistency between both test setups was confirmed, with a high intraclass correlation coefficient (> 0.9) noted in 40 older adults.
Auditory assessment
The evaluation was conducted in a sound-isolation room by a skilled examiner who measured air conduction hearing thresholds for both ears following established protocols. Participants underwent auditory acuity assessments at frequencies of 1.0 and 4.0 kHz using the automated testing mode of the audiometer (AA-58 model, RION Co., Ltd., Tokyo, Japan). The pure-tone average (PTA), representing the average hearing threshold levels at these frequencies, was determined for the better-hearing ear at both 1.0 kHz and 4.0 kHz. Typically, the PTA is calculated using average hearing thresholds at frequencies of 0.5, 1.0, 2.0, and 4.0 kHz in the better-hearing ear. However, high-reliability coefficients (Cronbach’s alpha of 0.972) have been established for PTA calculated at both the standard range of 0.5 to 4.0 kHz and the narrower range of 1.0 and 4.0 kHz [20]. According to the World Health Organization’s definitions, a PTA greater than 25 dB, indicative of mild to severe hearing loss, was identified and classified as ARHL [29] that increases the risk of falls [6, 8].
Falls and falls-related injuries
During the 8-year follow-up period, prospective non-injurious and injurious falls were monitored at each annual assessment. Consensus defines a fall as an incident where an individual unintentionally comes to rest on the ground, floor, or another lower level, excluding events such as bicycle accidents and sudden cardiovascular or central nervous system occurrences [30]. Additionally, we gathered data on 1-year retrospective fall incidence during the baseline assessment. Our fall assessments documented the number of falls, acknowledging that individuals who have fallen only once in the past 12 months may have different underlying mechanisms compared to those who have experienced multiple falls. Participants who reported falls were further evaluated for injuries sustained during these events, categorized either as minor injuries without fractures (e.g., grazes and bruises) or as fractures resulting from falls. The total duration of observation was recorded for each participant, and any fall-related incidents during the 8-year period were classified accordingly.
Covariates
Participants were interviewed regarding relevant sociodemographic and clinical variables at baseline to assess the association between the combined effects of ARHL, SG, and falls. These variables included age, sex, body mass index; number of medications; number of comorbidities, including hypertension, hyperlipidemia, cerebrovascular disease, heart disease, diabetes, kidney disease, and lung disease; the presence of osteoarthritis and osteoporosis; lower frequency of going outdoors (going out every few days or less) as a measure of poor daily physical activity; depression tendency assessed by the Zung Self-Rating Depression Scale (SDS); and hearing aid use. The year of baseline (i.e., 2013 or 2014) was also included as a covariate to control for potential variations in methods used to measure walking speed.
Data analyses
SG is defined as a gait speed that is one standard deviation below the mean gait speed, specific to age and sex, based on previous studies assessing pathological aging [31]. Participants were then categorized into one of four groups: non-ARHL without SG, non-ARHL with SG, ARHL without SG, and ARHL with SG, according to their ARHL and gait speed statuses. Comparisons of baseline characteristics among these groups were made using the chi-square test for categorical variables and analysis of variance for continuous variables. Multivariable Cox proportional hazards regression analyses were conducted to assess the risk, measured as adjusted hazard ratios (aHR), for incidents of a single fall, recurrent or multiple falls, fall-related injuries, and fractures due to falls across the four groups. These analyses were adjusted for the previously mentioned covariates and the baseline experience of the respective outcome variable (e.g., aHRs of single falls were adjusted for baseline single fall experience). Three models were assessed: Model 1 adjusted for age, sex, and the year of baseline; Model 2, which included adjustments from Model 1 plus sociodemographic and clinical variables; and Model 3, which further included adjustments for the baseline experience of the respective outcome variable. Time to event was calculated from the baseline to the assessment visit at which each outcome was observed. The proportional hazard assumption for the model was tested using methods based on scaled Schoenfeld residuals. All statistical analyses, except for the proportional hazards assumption assessed by SAS 9.1 (SAS Institute, Cary, NC, USA), were performed using IBM SPSS Statistics (version 27.0; IBM, Armonk, NY, USA), with the significance level set at p < 0.05.
Results
Out of the 996 individuals assessed at baseline, 791 joined the study in 2013, and 205 in 2014. Exclusion criteria led to the removal of 100 participants from the 2013 cohort due to cognitive impairment, incomplete assessments, and lack of follow-up after baseline. Similarly, 52 participants from the 2014 cohort were excluded for similar reasons. Consequently, the analysis included 786 participants (mean age [SD], 72.9 [5.6] years; 59.2% women; 633 from 2013 and 153 from 2014).
Table 1 presents the cut-off values for gait speed that define SG. By applying these cut-off values, this study identified 97 older adults, constituting 12.3% of the sample, as having SG. Table 2 details the characteristics of the participants and highlights differences among the four groups, stratified by the presence of ARHL (non-ARHL and ARHL) and gait speed (non-SG and SG). A total of 446 (56.7%) participants experienced hearing loss. Those with ARHL were older, had a higher prevalence of hearing aid usage, and lower MMSE scores compared to those without ARHL. Participants with SG exhibited a higher prevalence of polypharmacy, more comorbidities, a lower frequency of going outdoors, and higher SDS scores. They also experienced single and multiple falls at a higher rate and sustained injuries due to falls at baseline. The group with both ARHL and SG had a significantly higher prevalence of osteoporosis.
Table 1.
Gait speed cut-off values (m/s) for defining slow gait in this study
| Age group (y) | Men | Women |
|---|---|---|
| 65–69 | 1.18 | 1.21 |
| 70–74 | 1.18 | 1.13 |
| 75–79 | 1.10 | 1.07 |
| 80 or older | 1.05 | 0.93 |
Table 2.
Baseline characteristics of participants stratified by hearing loss and gait speed
| Non-ARHL without SG (n = 301) |
Non-ARHL with SG (n = 39) |
ARHL without SG (n = 388) |
ARHL with SG (n = 58) |
p-value | |
|---|---|---|---|---|---|
| Female, n (%) | 164 (54.5) | 13 (33.3) | 164 (42.3) | 21 (36.2) | p < 0.001 |
| Age, years | 70.7 (4.6) | 70.9 (5.7) | 74.5 (5.6) | 75.7 (5.9) | p < 0.001 |
| Body mass index | 22.7 (3.2) | 23.0 (2.9) | 22.9 (3.0) | 23.2 (3.5) | 0.711 |
| Five plus medications, n (%) | 52 (17.3) | 13 (33.3) | 111 (28.6) | 31 (53.4) | p < 0.001 |
| Number of comorbidities | 1.0 (1.0) | 1.2 (1.1) | 1.1 (1.1) | 1.5 (1.2) | 0.010 |
| Hypertension, n (%) | 124 (41.2) | 21 (53.8) | 158 (40.7) | 39 (67.2) | 0.001 |
| Hyperlipidemia, n (%) | 108 (35.9) | 11 (28.2) | 128 (33.0) | 18 (31.0) | 0.696 |
| Cerebrovascular disorders, n (%) | 15 (5.0) | 4 (10.3) | 25 (6.4) | 8 (13.8) | 0.072 |
| Heart disease, n (%) | 33 (11.0) | 6 (15.4) | 65 (16.8) | 10 (17.2) | 0.172 |
| Diabetes mellitus, n (%) | 27 (9.0) | 4 (10.3) | 49 (12.6) | 13 (22.4) | 0.030 |
| Chronic kidney disease, n (%) | 2 (0.7) | 0 (0.0) | 3 (0.8) | 1 (1.7) | 0.790 |
| COPD, n (%) | 0 (0.0) | 1 (2.6) | 4 (1.0) | 0 (0.0) | 0.136 |
| Osteoarthritis, n (%) | 39 (13.0) | 8 (20.5) | 35 (9.0) | 3 (5.2) | 0.038 |
| Osteoporosis, n (%) | 40 (13.3) | 7 (17.9) | 51 (13.1) | 11 (19.0) | 0.560 |
| Infrequent going out, n (%) | 28 (9.3) | 9 (23.1) | 49 (12.6) | 19 (32.8) | p < 0.001 |
| SDS score | 31.4 (7.7) | 35.2 (8.5) | 32.0 (8.0) | 36.2 (8.8) | p < 0.001 |
| MMSE score | 29.0 (1.3) | 28.4 (1.4) | 28.3 (1.6) | 27.8 (1.6) | p < 0.001 |
| Hearing aids, n (%) | 1 (0.3) | 0 (0.0) | 20 (5.2) | 3 (5.2) | 0.001 |
| Gait speed, m/s | 1.44 (0.17) | 0.98 (0.24) | 1.40 (0.19) | 0.92 (0.19) | p < 0.001 |
| Single fall at baseline, n (%) | 48 (15.9) | 12 (30.8) | 68 (17.5) | 18 (31.0) | 0.010 |
| Multiple falls at baseline, n (%) | 10 (3.3) | 6 (15.4) | 22 (5.7) | 9 (15.5) | p < 0.001 |
| Fall-related minor injuries, n (%) | 31 (10.3) | 9 (23.1) | 37 (9.5) | 8 (13.8) | 0.061 |
| Fall-related fractures, n (%) | 4 (1.3) | 1 (2.6) | 7 (1.8) | 4 (6.9) | 0.051 |
ARHL, age-related hearing loss; SG, slow gait; COPD, chronic obstructive pulmonary disease; infrequent going out, going out every few days or less; SDS, Zung self-rating depression scale; MMSE, Mini-Mental State Examination
The mean follow-up duration was 4.3 years for single falls, 5.3 years for multiple falls, 4.7 years for minor injuries, and 5.5 years for injuries with fractures (with a range of 1–8 years for all outcomes). During the follow-up, 41.7% and 14.9% of the sample fell at least once or multiple times, respectively, with an overall incidence rate of 9.6 per 100 person-years and 2.8 per 100 person-years. Additionally, 31.7% and 7.0% of the sample experienced minor injuries or injuries with fractures due to falls, with overall incidence rates of 6.7 per 100 person-years and 1.3 per 100 person-years, respectively.
Figure 1 and Table 3 depict the joint association of ARHL and SG with fall-related outcomes, including at least one incident of falling, multiple falls, minor injuries due to falls, and fractures resulting from falls. The Cox proportional hazards regression model, adjusted for sociodemographic and clinical variables, revealed that the presence of both ARHL and SG was significantly associated with a higher risk of at least one falling incident (aHR: 1.57, 95% confidence interval [CI]: 1.01–2.43). However, this association was less pronounced when further adjusted for the experience of a single fall at baseline. Additionally, while a significantly higher risk of multiple falls was observed in those with SG (both non-ARHL with SG and ARHL with SG), the association in individuals with SG but without ARHL was weakened when adjusted for covariates (aHR: 2.09, 95% CI: 0.98–4.45). In contrast, the association in individuals with both ARHL and SG remained unchanged (aHR: 2.96, 95% CI: 1.52–5.78). Regarding fall-related injuries, only the combination of ARHL and SG significantly increased the risk of minor fall-related injuries (aHR: 1.82, 95% CI: 1.10–3.01) and fractures resulting from falls (aHR: 2.98, 95% CI: 1.15–7.70). No significant association was observed between fall-related outcomes and ARHL without SG.
Fig. 1.
Cumulative Hazard Ratio for Incidents of Fall and Fall-related Injuries. A, Single fall; B, Multiple falls; C, Minor injuries resulting from falls; D, Fractures resulting from falls. Assessments were carried out annually over a period of 8 years, specifically from day 365 to day 2920. Below the figure, the number of individuals at risk of experiencing each event is displayed. The results were adjusted for age, sex, baseline year, sociodemographic and clinical variables, and the baseline experience of the respective outcome variable. ARHL, age-related hearing loss; SG, slow gait
Table 3.
Cox proportional hazard regression analysis of the association of incidents of fall and fall-related injuries
| Model 1 | Model 2 | Model 3 | ||||
|---|---|---|---|---|---|---|
| HR(95%CI) | P-value | HR(95%CI) | P-value | HR(95%CI) | P-value | |
| Single fall | ||||||
| Non-ARHL with SG | 1.28 (0.78–2.10) | 0.330 | 1.11 (0.67–1.84) | 0.691 | 1.05 (0.63–1.75) | 0.848 |
| ARHL without SG | 1.04 (0.81–1.33) | 0.790 | 1.04 (0.81–1.34) | 0.768 | 1.05 (0.82–1.36) | 0.685 |
| ARHL with SG | 1.78 (1.17–2.71) | 0.007 | 1.57 (1.01–2.43) | 0.047 | 1.53 (0.98–2.37) | 0.059 |
| Multiple falls | ||||||
| Non-ARHL with SG | 2.46 (1.17–5.16) | 0.018 | 2.13 (0.99–4.56) | 0.052 | 2.09 (0.98–4.45) | 0.057 |
| ARHL without SG | 1.34 (0.85–2.10) | 0.207 | 1.34 (0.84–2.12) | 0.216 | 1.38 (0.87–2.19) | 0.176 |
| ARHL with SG | 3.40 (1.81–6.41) | p < 0.001 | 3.20 (1.64–6.24) | 0.001 | 2.96 (1.52–5.78) | 0.001 |
| Fall-related minor injuries | ||||||
| Non-ARHL with SG | 1.50 (0.86–2.59) | 0.151 | 1.40 (0.80–2.46) | 0.235 | 1.37 (0.78–2.39) | 0.275 |
| ARHL without SG | 1.09 (0.81–1.45) | 0.580 | 1.09 (0.81–1.46) | 0.571 | 1.10 (0.82–1.48) | 0.511 |
| ARHL with SG | 1.86 (1.15–3.03) | 0.012 | 1.82 (1.10–3.01) | 0.020 | 1.82 (1.10–3.01) | 0.021 |
| Fall-related fractures | ||||||
| Non-ARHL with SG | 2.61 (0.94–7.22) | 0.065 | 2.22 (0.78–6.34) | 0.135 | 2.23 (0.78–6.35) | 0.134 |
| ARHL without SG | 1.27 (0.65–2.46) | 0.486 | 1.16 (0.59–2.29) | 0.660 | 1.16 (0.59–2.29) | 0.665 |
| ARHL with SG | 3.83 (1.59–9.27) | 0.003 | 3.12 (1.23–7.90) | 0.017 | 2.98 (1.15–7.70) | 0.024 |
Non-ARHL without SG were used as the reference group. Model 1 includes age, sex, and the year of baseline. Model 2 includes body mass index, number of medications, number of comorbidities, the presence of osteoarthritis and osteoporosis, lower frequency of going outdoors, SDS score, and hearing aid use, and is adjusted for the same covariates as Model 1. Model 3 includes the baseline experience of the respective outcome variable and is adjusted for the same covariates as Model 2. ARHL, age-related hearing loss; SG, slow gait
Discussion
This longitudinal study demonstrated that ARHL alone was not independently associated with falls or related injuries. More importantly, these risks increased when SG was also present, aligning with our hypothesis. This not only corroborates findings from previous cross-sectional studies but also suggests that the impact of ARHL on fall risk intensifies when combined with SG [21]. The findings indicate that the exacerbation of fall risk associated with ARHL may be due to a decline in locomotor function, which normally compensates for impaired spatial awareness. This study provides valuable insights into the mechanisms underlying the increased fall risk among older adults with ARHL.
Our results indicate that gait performance can either exacerbate or mitigate the effects of ARHL on fall risks, offering new perspectives on the role of ARHL in fall dynamics. Beyond the previously mentioned anchor effect, the connection between hearing loss and falls can be attributed to several probable causes: (i) concurrent vestibular disorders increasing fall risk, (ii) diminished cognitive capacity for balance due to the cognitive load imposed by hearing loss, and (iii) a decline in auditory perception leading to reduced spatial awareness [32]. Adequate gait performance may indicate either the absence of significant vestibular pathology that impacts fall risk or a conservation of cognitive resources essential for maintaining balance. These protective factors help prevent balance deficits and subsequent falls. As hypothesized, effective lower-limb function might also prevent falls in situations prone to such incidents.
These assumptions extend to the increased risk of fall-related injuries. Our findings suggest that the concurrent presence of ARHL and SG increases the risk of fractures from falls, in addition to minor injuries. In contrast, neither ARHL nor SG alone were linked to injurious falls. This suggests that the combination of ARHL and SG might prevent individuals from achieving a protective landing position (e.g., successful defensive positioning and stepping actions) during a fall, leading to more severe injuries, such as fractures. Given that individuals with hearing loss often exhibit poor movement coordination [14, 33, 34], SG alone may not necessarily lead to postural instability that results in injuries. Rather, it is the synergistic effect of both factors that likely contributes to the observed injuries from falls.
Fall-related mortality is increasing, particularly among individuals aged 75 years and older [35], a demographic where hearing loss is highly prevalent [36]. A prior study showed that older adults who reported significant hearing trouble or were deaf faced a higher risk of death, predominantly due to serious fall-related injuries, with notably shorter survival times [37]. Given these findings, enhancing gait performance to prevent serious fall-related injuries among those with ARHL could be crucial for promoting healthy longevity.
In this study, hearing aids did not demonstrate a preventive effect on falls, nor did they reduce the combined synergistic impact of ARHL and SG. This finding aligns with previous studies indicating that hearing aids do not alter the risk of falls among older adults with ARHL [9, 38, 39]. However, some studies suggest that hearing aids can improve balance function [14, 40], potentially delaying injurious falls among this population [41]. These conflicting results highlight that factors such as physical functioning, severity of hearing loss, and duration of hearing aid use might play a role in the relationship between hearing aid use and fall risk.
The strength of this study lies in its prospective design, exploring the effect of the combination of ARHL and SG on the incidence of falls and related injuries for the first time. However, there are several limitations. This study may have underestimated fall experiences since it relied on participants’ recall over the past year for each assessment, although this was less likely for multiple falls and fall-related fractures. Additionally, baseline covariates might not adequately control the main outcomes as they could change during follow-up. Our study did not examine time-varying confounding factors associated with ARHL or SG that could influence fall incidents. It also focused only on ARHL and SG statuses at baseline without considering their previous conditions and subsequent changes. Moreover, our sample comprised relatively high-functioning community-based volunteers, particularly in terms of gait speed [31], which might introduce potential bias. The definition of SG as a speed one standard deviation below the age and sex-specific mean [31], differs from the guideline-recommended speed of < 0.8 m/s based on its predictive ability and simplicity [7]. Indeed, a previous cohort study indicated that 30% of participants had gait speeds faster than 1.0 m/s before experiencing falls [42], suggesting that the risk increases prior to reaching the well-known slow gait threshold of 1.0 m/s [43]. Although our methodology for defining slow gait is not significantly flawed, differences in definitions might affect the results. Further studies using different cohorts are needed to validate our findings.
Conclusion
Our findings underscore that the simultaneous presence of ARHL and SG significantly increases the risk of multiple falls and fall-induced fractures, as well as minor injuries, compared to when these risk factors are present separately. Moreover, our results reveal that ARHL alone is not associated with an increased risk of falls, suggesting that the impact of ARHL on fall risk is not substantial in the absence of impaired gait performance. Therefore, monitoring gait performance is crucial for assessing fall risk in individuals with ARHL.
Funding
This study was supported by JSPS KAKENHI (24700774, 16K01853, 20K12751, and 20H04115), Health and Labor Sciences Research Grant (H23-Choju-Ippan-002), Health and Labour Sciences Research Grants (39–64 and 40–72) from the Ministry of Health, Labour and Welfare of Japan, and Research Funding for Longevity Sciences (28–30 and 29–42) from the National Center for Geriatrics and Gerontology (NCGG).
Data availability
The data supporting this study’s findings is available from the authors upon request. Requests for access to the data should be addressed to Dr. Ryota Sakurai (r_sakurai@hotmail.co.jp).
Declarations
Conflict of interest
The authors declare no competing interests.
Footnotes
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
The data supporting this study’s findings is available from the authors upon request. Requests for access to the data should be addressed to Dr. Ryota Sakurai (r_sakurai@hotmail.co.jp).