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Do barefeet, socks only, and house slippers cause more seniors at home to fall?

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When it applies to senior health, which causes more falls in the home, walking barefoot, wearing slippers, shoes, or wearing socks? Institute for Aging Research study says going barefoot in home may contribute to elderly falls. As summer continues, elderly people may want to think twice about taking their shoes off when they get home. Going barefoot in the home, or wearing slippers or socks with no shoes, may contribute to falls among the elderly, according to a new study from the Institute for Aging Research of Hebrew SeniorLife (Hebrew SeniorLife Institute for Aging Research, an affiliate of Harvard Medical School, is a nonprofit, non-sectarian organization founded in 1903 devoted to innovative research, health care, education and housing that improves the lives of seniors.) The study, "Footwear and falls in the home among older individuals in the MOBILIZE Boston Study," is published online since July 20, 2010 in the journal Footwear Science. http://www.tandfonline.com/doi/full/10.1080/19424280.2010.491074#.U7rr1LEVFwE

The researchers found that nearly 52 percent of the participants who reported a fall were either barefoot, wearing socks without shoes, or wearing slippers at the time of their fall. These people also reported more serious injuries, including fractures, sprains, dislocations, and pulled or torn muscles, ligaments or tendons, as a result of their fall.

"Our findings show that older people going barefoot, wearing only socks, or wearing slippers may be at considerably increased risk of falls in their homes," says senior author Marian T. Hannan, D.Sc., M.P.H., according to a June 23, 2010 news release, "Institute for Aging Research study says going barefoot in home may contribute to elderly falls." Hannan at the time of the news release is mentioned as co-director of the Musculoskeletal Research Center at the Institute for Aging Research. "Therefore, older people should wear shoes at home whenever possible to minimize their risk of falling."

Study participants underwent a comprehensive baseline falls assessment, including a home visit and clinic examination. During the assessment, they were asked what type of shoe they usually wear. Options included athletic shoes (sneakers), flat-sole canvas shoes, oxfords or other tied shoes, loafers, sandals, pumps, slippers, socks or stockings only, or barefoot. Participants were followed for an average of 27.5 months and were asked to record each day whether they had fallen; those reporting falls were asked about the shoes they were wearing when they fell.

Of those who reported falling, more than 18 percent were barefoot when they fell. Nearly 27 percent were wearing slippers and 7 percent were wearing socks only

"On the basis of this and other studies," says Dr. Hannan, according to the news release. Hannan is an associate professor of medicine at Harvard Medical School. "We suggest that advice about wearing shoes whenever possible be included in fall prevention programs. More research is needed on the design of acceptable and comfortable footwear that provides optimal safety for older people."

Prevention of falls among older adults is a major clinical and public health concern. Previous studies have shown that more than 20 percent of elderly people do not wear shoes around the home. For those who did, slippers were by far the most common shoe type. Studies also show that fall risk is markedly increased when older people are barefoot or in stocking feet, while others report that balance is adversely affected when people are barefoot.

"Recommendations such as wearing well-fitting, low-heeled shoes with slip-resistant soles seem sensible," says Dr. Hannan. "But there's only limited data to support this advice. Designing an optimal shoe type for seniors will need to take into account such issues as foot problems and the ease of putting them on and taking them off."

The study, which was funded by the National Institutes of Health, was part of MOBILIZE Boston (Maintenance of Balance, Independent Living, Intellect and Zest in the Elderly), a long-term cohort study based at the Institute for Aging Research. The study is determining causes of falls in older adults in order to develop new ways to prevent falls from occurring. MOBILIZE Boston is directed by principal investigator Lewis A. Lipsitz, M.D., director of the Institute for Aging Research, professor of medicine at Harvard Medical School, and a leading authority on falls.

According to the Centers for Disease Control and Prevention, more than one third of adults 65 and older fall each year in the United States

Thirty percent of these individuals suffer moderate to severe injuries, including hip fractures and traumatic brain injuries. Experts say that many falls are due to preventable factors such as muscle weakness, improper footwear, and medications.

Scientists at the Institute for Aging Research of Hebrew SeniorLife seek to transform the human experience of aging by conducting research that will ensure a life of health, dignity and productivity into advanced age. The Institute carries out rigorous medical and social studies that discover the mechanisms of age-related disease and disability; lead to the prevention, treatment and cure of disease; advance the standard of care for older people; and inform public decision-making. Founded in 1903, Hebrew SeniorLife, an affiliate of Harvard Medical School, is a nonprofit, non-sectarian organization devoted to innovative research, health care, education and housing that improves the lives of seniors.

Early humans wore 'shoes' 30,000 years ago

Early humans wore 'shoes' 30,000 years ago, says a research team from Washington University in St. Louis. Those high-tech, air-filled, light-as-a-feather sneakers on your feet are a far cry from the leather slabs our ancestors wore for protection and support.

But believe it or not, our modern day Nikes and Reeboks are direct descendents of the first supportive footwear that new research suggests came into use in western Eurasia between 26,000 and 30,000 years ago. Erik Trinkaus, professor of anthropology at Washington University in St. Louis, derived those dates by analyzing anatomical evidence of early modern humans, which suggests a reduction in the strength of the smaller toes in Upper Paleolithic humans while there was little change in leg strength. His research, "Anatomical evidence for the antiquity of human footwear use," is published online published in the October 2005 issue of the Journal of Archaeological Science.

Also see, "Anatomical evidence for the antiquity of human footwear: Tianyuan and Sunghir," published online in 2008 in the Journal of Archaeological Science. Trinkaus argues that early humans living in far northern climates began to put insulation on their feet around 500,000 years ago. While archaeological evidence suggests that footwear was in use by at least the middle Upper Paleolithic in portions of Europe, the frequency of use and the actual mechanical protection provided by that footwear was unclear.

Use of protective footwear has been difficult to document because in most cases the footwear does not survive the test of time. Lacking such physical evidence, Trinkaus analyzed the foot bones of western Eurasian Middle Paleolithic and middle Upper Paleolithic humans. In doing so, he found the anatomy of their feet began to change starting around 26,000 years ago.

"I discovered that the bones of the little toes of humans from that time frame were much less strongly built than those of their ancestors while their leg bones remained large and strong," Trinkaus said, according to an August 17, 2005 news release, Early humans wore 'shoes' 30,000 years ago. "The most logical cause would be the introduction of supportive footwear."

During barefoot walking, the smaller toes flex for traction, keeping the toe bones strong. Supportive footwear lessens the roll of the little toes, thus weakening them.

Sedentary lifestyle and not caloric intake may be to blame for increased obesity in the US, according to a new analysis of data from the National Health and Nutrition Examination Survey

A study, "Obesity, Abdominal Obesity, Physical Activity, and Caloric Intake in U.S. Adults: 1988-2010," published online since March 11, 2014 in the American Journal of Medicine (Elsevier Health Sciences ) reveals that in the past 20 years there has been a sharp decrease in physical exercise and an increase in average body mass index (BMI), while caloric intake has remained steady. Investigators theorized that a nationwide drop in leisure-time physical activity, especially among young women, may be responsible for the upward trend in obesity rates. Sedentary lifestyle and not caloric intake may be to blame for increased obesity in the US.

Total daily calorie, fat, carbohydrate, and protein consumption have not changed significantly over the last 20 years, yet the obesity rate among Americans is continuing to rise. Less exercise, not more calories, is responsible for expanding waistlines. Seems when it comes to unhealthy food choices added to less fitness and physical exercise, expanding waistlines may be more about an accumulation of expanding waste lines, if referring to lack of exercise figuratively.

Lack of leisure-time physical activity raises obesity risk

Lack of leisure-time physical activity linked to increased obesity, particularly in young women, reports the American Journal of Medicine. Sedentary lifestyle and not caloric intake may be to blame for increased obesity in the US, according to a new analysis of data from the National Health and Nutrition Examination Survey (NHANES).

By analyzing NHANES data from the last 20 years, researchers from Stanford University discovered that the number of US adult women who reported no physical activity jumped from 19.1% in 1994 to 51.7% in 2010. For men, the number increased from 11.4% in 1994 to 43.5% in 2010. During the period, average BMI has increased across the board, with the most dramatic rise found among young women ages 18-39.

"These changes have occurred in the context of substantial increases in the proportion of adults reporting no leisure-time physical activity, but in the absence of any significant population-level changes in average daily caloric intake," explains lead investigator Uri Ladabaum, MD, MS, according to the July 7, 2014 news release, "Less exercise, not more calories, responsible for expanding waistlines." Ladabaum is an Associate Professor of Medicine (Gastroenterology and Hepatology), Stanford University School of Medicine. "At the population level, we found a significant association between the level of leisure-time physical activity, but not daily caloric intake, and the increases in both BMI and waist circumference."

The study looked at the escalation of obesity in terms of both exercise and caloric intake

While investigators did not examine what types of foods were consumed, they did observe that total daily calorie, fat, carbohydrate, and protein consumption have not changed significantly over the last 20 years, yet the obesity rate among Americans is continuing to rise. Researchers also tracked the rise in abdominal obesity, which is an independent indicator of mortality even among people with normal BMIs.

Abdominal obesity is defined by waist circumference of 88 cm (34.65 in) or greater for women and 102 cm (40.16 in) or greater for men. Data showed that average waist circumference increased by 0.37% per year for women and 0.27% per year for men. Just like the rise in average BMIs, the group most affected by increased rates of abdominal obesity was women.

"The prevalence of abdominal obesity has increased among normal-weight women and overweight women and men," observes Dr. Ladabaum, according to the news release. "It remains controversial whether overweight alone increases mortality risk, but the trends in abdominal obesity among the overweight are concerning in light of the risks associated with increased waist circumference independent of BMI."

When Ladabaum et al grouped respondents to the most recent NHANES survey by race/ethnicity and age, they found that more than 50% of the workforce-aged adults in eight demographic subgroups reported no leisure-time physical activity

There are differences between the 1994 survey results and those collected in 2010 (albeit, with slightly different survey methods). According to the data, women, and black and Mexican-American women in particular, showed the greatest decreases in reported exercise.

While increased caloric intake is often blamed for rising rates of obesity, no association between these was found in this study. In contrast, an association was found between the trends over time for lack of physical activity and high BMI numbers.

"Our findings do not support the popular notion that the increase of obesity in the United States can be attributed primarily to sustained increase over time in the average daily caloric intake of Americans," concludes Dr. Ladabaum, according to the news release. "Although the overall trends in obesity in the United States are well appreciated and obesity prevalence may be stabilizing, our analyses highlight troublesome trends in younger adults, in women, and in abdominal obesity prevalence, as well as persistent racial/ethnic disparities."

There is no easy answer in our ongoing battle against obesity, but identifying the link between the drop in physical activity and increased BMIs, as well as the groups particularly affected, can assist public health officials to develop targeted, effective interventions. In an accompanying commentary Pamela Powers Hannley, MPH, Managing Editor, the American Journal of Medicine, notes, "If we as a country truly want to take control of our health and our health care costs, the Ladabaum et al paper should be our clarion call. From encouraging communities to provide safe places for physical activity to ensuring ample supply of healthy food to empowering Americans to take control of their health, we must launch a concerted comprehensive effort to control obesity."

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