title: Even low alcohol concentrations affect obstacle avoidance reactions in healthy senior individuals.
abstract: BACKGROUND
  Alcohol is a commonly used social drug and driving under influence is a well-established risk factor for traffic accidents1. To improve road safety, legal limits are set for blood alcohol concentration (BAC) and driving, usually at 0.05% (most European countries) or 0.08% (most US states, Canada and UK). In contrast, for walking there are no legal limits, yet there are numerous accounts of people stumbling and falling after drinking. Alcohol, even at these low concentrations, affects brain function and increases fall risk. An increased fall risk has been associated with impaired obstacle avoidance skills. Low level BACs are likely to affect obstacle avoidance reactions during gait, since the brain areas that are presumably involved in these reactions have been shown to be influenced by alcohol. Therefore we investigated the effect of low to moderate alcohol consumption on such reactions.Thirteen healthy senior individuals (mean(SD) age: 61.5(4.4) years, 9 male) were subjected to an obstacle avoidance task on a treadmill after low alcohol consumption. Fast stepping adjustments were required to successfully avoid suddenly appearing obstacles. Response times and amplitudes of the m. biceps femoris, a prime mover, as well as avoidance failure rates were assessed.
  
  
  RESULTS
  After the first alcoholic drink, 12 of the 13 participants already had slower responses. Without exception, all participants' biceps femoris response times were delayed after the final alcoholic drink (avg ± sd:180 ± 20 ms; p < 0.001) compared to when participants were sober (156 ± 16 ms). Biceps femoris response times were significantly delayed from BACs of 0.035% onwards and were strongly associated with increasing levels of BAC (r = 0.6; p < 0.001). These delays had important behavioural consequences. Chances of hitting the obstacle were doubled with increased BACs.
  
  
  CONCLUSIONS
  The present results clearly show that even with BACs considered to be safe for driving, obstacle avoidance reactions are inadequate, late, and too small. This is likely to contribute to an increased fall risk. Therefore we suggest that many of the alcohol-related falls are the result of the disruptive effects of alcohol on the online corrections of the ongoing gait pattern when walking under challenging conditions.
authors.affiliation: Department of Research, Development & Education, Sint Maartenskliniek, Nijmegen, The Netherlands. j.hegeman@maartenskliniek.nl.
authors.forename: Judith
authors.initials: J
authors.lastname: Hegeman
authors.forename: Vivian
authors.initials: V
authors.lastname: Weerdesteyn
authors.forename: Bart Jf
authors.initials: BJ
authors.lastname: van den Bemt
authors.forename: Bart
authors.initials: B
authors.lastname: Nienhuis
authors.forename: Jacques
authors.initials: J
authors.lastname: van Limbeek
authors.forename: Jacques
authors.initials: J
authors.lastname: Duysens