title: Footwear style and risk of falls in older adults.
abstract: OBJECTIVE
  To determine how the risk of a fall in an older adult varies in relation to style of footwear worn.
  
  
  METHODS
  Nested case-control study.
  
  
  METHODS
  Group Health Cooperative, a large health maintenance organization in Washington state.
  
  
  METHODS
  A total of 1,371 adults aged 65 and older were monitored for falls over a 2-year period; 327 qualifying fall cases were compared with 327 controls matched on age and sex.
  
  
  METHODS
  Standardized in-person examinations before fall occurrence, interviews about fall risk factors after the fall occurred, and direct examination of footwear were conducted. Questions for controls referred to the last time they engaged in an activity broadly similar to what the case was doing at the time of the fall.
  
  
  RESULTS
  Athletic and canvas shoes (sneakers) were the styles of footwear associated with lowest risk of a fall. Going barefoot or in stocking feet was associated with sharply increased risk, even after controlling for measures of health status (adjusted odds ratio=11.2, 95% confidence interval (CI)=2.4-51.8). Relative to athletic/canvas shoes, other footwear was associated with a 1.3-fold increase in the risk of a fall (95% CI=0.9-1.9), varying somewhat by style.
  
  
  CONCLUSIONS
  Contrary to findings from gait-laboratory studies, athletic shoes were associated with relatively low risk of a fall in older adults during everyday activities. Fall risk was markedly increased when participants were not wearing shoes.
authors.affiliation: Department of Epidemiology, University of Washington, Seattle 98195, USA. koepsell@u.washington.edu
authors.forename: Thomas D
authors.initials: TD
authors.lastname: Koepsell
authors.forename: Marsha E
authors.initials: ME
authors.lastname: Wolf
authors.forename: David M
authors.initials: DM
authors.lastname: Buchner
authors.forename: Walter A
authors.initials: WA
authors.lastname: Kukull
authors.forename: Andrea Z
authors.initials: AZ
authors.lastname: LaCroix
authors.forename: Allan F
authors.initials: AF
authors.lastname: Tencer
authors.forename: Cara L
authors.initials: CL
authors.lastname: Frankenfeld
authors.forename: Milda
authors.initials: M
authors.lastname: Tautvydas
authors.forename: Eric B
authors.initials: EB
authors.lastname: Larson
mesh_terms: D000058:Accidental Falls / Q000706:statistics & numerical data*; D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D001696:Biomechanical Phenomena; D016022:Case-Control Studies; D015986:Confounding Factors, Epidemiologic; D004867:Equipment Design; D005260:Female; D005684:Gait; D015577:Geriatric Assessment; D018737:Hand Strength; D006279:Health Maintenance Organizations; D006304:Health Status; D006801:Humans; D008297:Male; D016017:Odds Ratio; D011159:Population Surveillance; D004856:Postural Balance; D018570:Risk Assessment; D012307:Risk Factors; D012775:Shoes / Q000009:adverse effects* / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D016138:Walking; D014861:Washington / Q000453:epidemiology