A review of stairway falls and stair negotiation: Lessons learned and future needs to reduce injury

- Stairway falls are common across the lifespan and often injurious.
- Mechanics of stair use are well described for healthy young and older adults.
- Literature suggests changes to stair design and user behaviors could be beneficial.
- Further study needed on sensory-motor mechanisms of stair use and strategies for balance recovery.
- Instrumented studies in ecological environments also needed.

Stairways are a common location for falls, and they result in a disproportionate risk of death or severe injury. Stairway falls are a significant problem across the lifespan and are often coincident with risky behaviors during stair use. The mechanics of successful stair negotiation for healthy young and older adults have been well described. These studies imply that current stair design does not offer an optimal universal design to meet the needs of older adults or people with health conditions. In addition, impaired stair negotiation associates with more than impaired strength, including functional impairments of cognitive load, sensory function and central motor coordination. Identification of behavioral strategies or stairway environments that assist or hinder recovery from a loss of balance on stairs remains incomplete. Therefore, future studies should investigate the mechanisms of balance recovery on stairs as well as the effectiveness of environmental interventions to mitigate stairway falls and injuries. Potential areas for evaluation may include modifying stair dimensions, surfaces, handrails, visual cues, and removing distractors of attention. Studies should also evaluate combinatorial interventions on person-related factors, such as behavioral interventions to decrease risky behaviors during stair use as well as interventions on cognitive, sensory, and motor functions relevant to stair use. Moreover, future studies should take advantage of new technologies to record stair use outside the laboratory in order to identify people or locations at risk for stairway falls. Such studies would inform the potential for broad-spectrum programs that decrease the risk of stairway falls and injuries.