Effect Of Covid-19 Lockdown On Home Stair Falls And Consequences For Stair Negotiating Biomechanics In Older Adults

Wharton, E (2026) Effect Of Covid-19 Lockdown On Home Stair Falls And Consequences For Stair Negotiating Biomechanics In Older Adults. Doctoral thesis, Liverpool John Moores University.

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Abstract

Falls on stairs represent a leading cause of injury, loss of independence, and mortality among older adults, yet little is known about how individual, behavioural, and environmental factors interact to shape stair fall risk in real-world home contexts. This thesis adopts a multi-method approach to investigate the biomechanics, perceptions, and experiences of stair use among older adults, with a particular focus on the unique conditions created by the COVID-19 pandemic.

Study 1 employed a survey of older adults (n = 164) to examine the incidence and consequences of stair falls during the UK COVID-19 lockdown. Findings indicated an increase in home stair falls and near-falls during confinement. A higher injury severity was observed in older adults of increased age and higher risk of falling for those living alone. Reduced physical activity were identified during the lockdowns and may be contributing factors to increased stair falls. Study 2 used home visits combining interviews and environmental stair assessments to explore older adults’ perceptions of stair safety in relation to objective staircase conditions. A disconnect emerged between perceived and actual safety, as all stair fallers rated their stairs as safe despite 40% of staircases failing to meet British Standards for staircase rise and going. Behavioural and décor choices, such as leaving objects on steps or patterned stair coverings, were identified as modifiers of risk. Participants frequently reported reactive changes in behaviour following a fall, and strong emotional attachment to their home. Study 3 examined stepping biomechanics under different handrail use conditions in older adults with and without a history of stair falls/near-falls. No significant improvements in stability were found; instead, handrail use increased CoM acceleration variability during lowering, suggesting reduced movement consistency. Handrail benefits may depend on individual caution and real-world conditions, warranting further investigation outside of controlled settings.

In summary, the findings revealed that stair fall risk in older adults arises from a complex interplay of individual characteristics, environmental hazards, and behavioural factors, all of which were amplified during the COVID-19 pandemic due to increased exposure to home stairs, reduced physical activity, and social isolation. This thesis highlights the urgent need for multifaceted fall prevention strategies that go beyond physical impairments to address behavioural training, hazard awareness, and home adaptations. Recommendations are made for research (e.g., use of real-world wearable monitoring and larger, more diverse samples), practice (e.g., integrating stair-specific questions into fall risk assessments, training in safe handrail use), and policy (e.g., strengthening housing regulations and investing in affordable home adaptations). Collectively, these measures are essential for supporting safe stair use, preventing falls, and enabling older adults to maintain independence in their homes.

Item Type:	Thesis (Doctoral)
Uncontrolled Keywords:	stair negotiation; Community living; Health inequalities; older adult
Subjects:	R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine R Medicine > RC Internal medicine > RC1200 Sports Medicine
Divisions:	Sport and Exercise Sciences
Date of acceptance:	26 February 2026
Date of first compliant Open Access:	1 April 2026
Date Deposited:	01 Apr 2026 13:22
Last Modified:	01 Apr 2026 13:33
DOI or ID number:	10.24377/LJMU.t.00028166
Supervisors:	O'Brien, T, Foster, R, Giebel, C and Maganaris, C
URI:	https://researchonline.ljmu.ac.uk/id/eprint/28166

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