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Background. Cognitive impairment has been shown to predict falls risk in older adults. The ability to step accurately is necessary to safely traverse challenging terrain conditions such as uneven or slippery surfaces. However, it is unclear how well persons with cognitive impairment can step accurately to avoid such hazards and what specific aspects of cognition predict stepping ability in different patient populations. Methods. Healthy older adults (NC), patients with Mild Cognitive Impairment with only memory impairment (MCI-EF) or memory and executive function impairments (MCI+EF) and early Alzheimer's patients (AD) were timed as they performed a stepping accuracy test with increasing cognitive demand (Walking Trail-Making Test; W-TMT), which required stepping on instrumented targets with either increasing sequential numbers (W-TMT A) or alternating sequential numbers and letters (W-TMT B). Results. After accounting for age and baseline walking speed, the AD and MCI+EF groups were significantly slower than the NC and MCI-EF groups on the task with the highest cognitive demand, W-TMT B (interaction effect F = 6.781, p < .0001). No group differences were noted on the W-TMT A task that was less cognitively demanding. Neuropsychological measures of executive functioning were associated with slower W-TMT B performance, whereas memory, visual attention and visual spatial skills were not (adjusted [R.sup.2] = 0.42). Conclusions. Executive function is important for stepping performance, particularly under more complex environmental conditions. Key Words: Gait--Cognition Dementia--Executive functioning.

Background. Stooping, crouching, and kneeling (SCK) are fundamental components of daily living tasks, and nearly a quarter of older adults report a lot of difficulty or inability to perform these movements. This study examined characteristics associated with SCK difficulty to explore underlying mechanisms and remediation strategies. Methods. One hundred eighty-four older adults with no, low, or high SCK difficulty underwent a comprehensive laboratory visit at the University of Michigan. Results. Twenty-one percent of participants (n = 39) reported a lot of difficulty or inability to stoop, crouch, or kneel. Characteristics independently associated with increasing SCK difficulty were self-reported leg joint limitations, (odds ratio [OR] = 3.84; 95% confidence interval [CI], 1.64-9.01), Activities-specific Balance Confidence Scale score (OR = 0.97; 95% CI, 0.95-0.99), and knee extension strength (OR = 0.72; 95% CI, 0.55-0.94). Conclusions. Increasing SCK difficulty is associated with balance confidence as well as leg limitations. Remediation of SCK difficulty will likely require a program that encompasses both behavioral and physical issues. Key Words: Stooping difficulty--Crouching difficulty--Kneeling difficulty.

Background. Impaired vision, cognition, and divided attention performance predict falls. Requiring both visual and cognitive input, the ability to step accurately is necessary to safely traverse challenging terrain conditions such as uneven or slippery surfaces. We compared healthy young and older adults in the time taken to step accurately under conditions of increasing cognitive and visual demand. Methods. Healthy Young (n = 42, mean age 21) and Older (n = 37, mean age 70) participants were required to step accurately on an instrumented walkway under conditions of increasing visual and cognitive demand. Based on the paper-and-pencil neuropsychological test, the Trail Making Test (P-TMT) A and B, participants stepped on instrumented targets with increasing sequential numbers (Walking Trail Making Test A [W-TMT A]) and increasing sequential numbers and letters (Walking Trail Making Test B [W-TMT B]), under conditions of Low as well as Normal lighting. Results. W-TMT performance time increased with increased age (Older vs Young), decreased light (Low vs Normal), and increased cognitive demand (Trails B vs Trails A). W-TMT performance time was disproportionately increased in Low light and in the Older group under the highest cognitive demand (W-TMT B) conditions. Paired W-TMT A-B differences were three times higher in the Older group than in the Young group. In the Older group, the correlation between W-TMT results and P-TMT B was particularly strong (p < .001). Conclusions. The time to perform a stepping accuracy task, such as may be required to avoid environmental hazards, increases under reduced lighting and with increased cognitive demand, the latter disproportionately so in older adults.

Background. Controlling the flexing trunk is critical in recovering from a loss of balance and avoiding a fall. To investigate the relationship between trunk control and balance in older adults, we measured trunk repositioning accuracy in young and balance-impaired and unimpaired older adults. Methods. Young adults (N = 8, mean age 24.3 years) and two groups of community-dwelling older adults defined by unipedal stance time (UST)--a balance-unimpaired group (UST > 30 seconds, N = 7, mean age 73.9 years) and a balance-impaired group (UST < 5 seconds, N = 8, mean age 79.6 years)--were tested in standing trunk control ability by reproducing a ~30[degrees] trunk flexion angle under three visual-surface conditions: eyes opened and closed on the floor, and eyes opened on foam. Errors in reproducing the angle were defined as trunk repositioning errors (TREs). Clinical measures related to balance, trunk extensor strength, and self-reported disability were obtained. Results. TREs were significantly greater in the balance-impaired group than in the other groups, even when controlling for trunk extensor strength and body mass. In older adults, there were significant correlations between TREs and three clinical measures of balance and fall risk, UST and maximum step length (0.65 to 0.75), and Timed Up & Go score (0.55), and between TREs and age (0.63~0.76). In each group TREs were similar under the three visual-surface conditions. Test-retest reliability for TREs was good to excellent (intraclass correlation coefficients [greater than or equal to] 0.74). Conclusions. Older balance-impaired adults have larger TREs, and thus poorer trunk control, than do balance-unimpaired older individuals. TREs are reliable and valid measures of underlying balance impairment in older adults, and may eventually prove to be useful in predicting the ability to recover from losses of balance and to avoid falls.

Background. We quantified age-related decreases in the ability of female participants to generate whole leg movements about the hip. Methods. We measured maximum hip strength and hip velocity in 12 young and 12 older healthy women. Both capabilities could help fall prevention by contributing to fast leg movements. We also measured maximum velocities as a function of isotonic load. Results. Young participants produced 107.6 [+ or -] 25.4 N-m (mean [+ or -] SD) isometric torque in flexion and 109.3 [+ or -] 22.3 N-m in extension. Older participants produced 22% and 31% lower torques, respectively (p < .001). Young participants generated maximum velocities of 362.8 [+ or -] 51.5 [degrees]/s in flexion and 371.5 [+ or -] 54.2 [degrees]/s in extension. Older participants produced 16% lower velocities in both directions (p < .001). Older participants also produced lower velocities as a function of load (p < .001), and lower maximum power (p < .001). Conclusion. Both maximum strength and velocity contribute to reduced ability to move the leg quickly with age.

Background. Measures of maximal oxygen uptake (V[O.sub.2max]) are limited in disabled older adults, and measures of submaximal oxygen uptake (V[O.sub.2]) may better predict functional mobility limitations. These measures may include oxygen-uptake kinetics at the onset of submaximal exercise or during recovery. We sought to determine whether the lag in oxygen uptake at the beginning of exercise (oxygen deficit) and excess oxygen uptake above rest following exercise (excess postexercise oxygen consumption) (a) predict physical performance in impaired older adults with decreased aerobic function, and (b) predict physical performance better than peak V[O.sub.2]. Methods. Two groups of community-dwelling volunteers aged 65 or older were recruited according to their performance on a maximal graded exercise test. Using the Social Security Administration criterion of disability of a peak V[O.sub.2] [less than or equal to] 18 ml/kg/min, we compared the performance of an impaired aerobic capacity group at a peak V[O.sub.2] < 18 ml/kg/min (Impaired, n = 20, mean [+ or -] SEM age 82 [+ or -] 1 years) with an unimpaired group at Peak V[O.sub.2] > 18 (Unimpaired, n = 21, mean [+ or -] SEM age 76 [+ or -] 1 years). Results. The mean [+ or -] SEM peak V[O.sub.2] was 58% lower in the Impaired (14 [+ or -] 1 ml/kg/min) than the Unimpaired (24 [+ or -] 1 ml/kg/min) adults. The time constant for oxygen deficit, [tc.sub.deficit], was more than twice as high in the Impaired than the Unimpaired (p < .05), and the time constant for excess postexercise oxygen consumption, [tc.sub.EPOC], tended to be higher in the Impaired than the Unimpaired (by 43%, p = .09). Measures of submaximal oxygen-uptake kinetics were as strong or more strongly predictive of functional mobility performance than peak V[O.sub.2] in both Unimpaired and Impaired older adults. The major predictor of functional performance for the Unimpaired was a measure of oxygen deficit accruing during exercise ([tc.sub.deficit]), and for the Impaired, it was a measure of oxygen debt during recovery, [tc.sub.EPOC]. Conclusions. Measurement of submaximal oxygen-uptake kinetics may provide a more practical and relevant assessment of deconditioning in frail older adults, and may eventually supplant maximal (peak) oxygen uptake as a predictor of functional disability in older adults.

Background. Toe flexor muscle strength determines the anterior limit of the functional base of support, thereby affecting a standing individual's maximum forward reach or lean capacity. We developed a method for measuring toe flexor muscle strength in order to test the null hypotheses that it is neither affected by age nor gender. Methods. Gender-balanced groups of 20 healthy young adults (YA) (average age 22.8 years) and 20 healthy older adults (OA) (average age 73.2 years) participated in the study. Toe flexor isometric muscle strength, calculated as the maximum volitional moment developed simultaneously in the sagittal plane by the toe flexor muscles about a reference axis through the first metatarsophalangeal joint, was measured in three trials while subjects reached forward as far as possible while standing on a force plate. Results. Significant age (p < .005) and gender (p < .0005) differences were found in maximum toe flexor muscle strength. OA were 28.9% less strong than the YA [mean (SD) 13.5 (5.7) Nm and 19.0 (6.8) Nm, respectively]. The men developed 39.1% greater strength than the women [20.2 (7.1) Nm and 12.3 (3.7) Nm, respectively]. However, when normalized by body size (body weight x height), the gender difference in strength no longer reached statistical significance. Across all subjects, the anterior limit of the functional base of support was significantly correlated with toe flexor strength (coefficient of determination: 0.84). Conclusions. Toe flexor muscle strength decreased significantly with age. This decrement underlies the known age-related reduction in the functional base of support.

Background. Previous work has found that healthy older men were significantly less able than young male adults to recover balance by taking a single rapid step upon sudden release from forward leans. In light of the higher rates of falls and fall-related injuries among older women compared to older men, we hypothesized that healthy older women would perform more poorly than either female young adults or older men in this test of abilities to recover balance rapidly. Methods. Ten young (mean age 25.0 years) and 10 older (73.7 years) healthy women were released from forward leans and instructed to regain standing balance by taking a single step forward. The lean angle was incrementally increased from its smallest value, approximately 14 [degrees], until the subject failed to regain balance as instructed. Lower extremity kinematics were measured, and findings were compared with those of the earlier study of healthy young and old men. Results. Five of the 10 older women could not recover balance with a single step after release from the smallest of the imposed forward leans. For the 5 older women who succeeded in recovering as instructed from at least one lean, the mean maximum lean angle was significantly smaller than that for young women (16.2 [degrees] vs 30.7 [degrees], p < .001) or older men (16.2 [degrees] vs 23.9 [degrees], p = .014). In contrast, there was no significant difference in mean maximum lean angle between female and male young adults. Conclusions. Healthy older women, compared to either young women or older men, were significantly less able to recover balance by taking a single rapid step during a forward fall. The decreased abilities of older women appeared to result from limitations in the maximum speeds at which they moved their swing foot during recovery.

Background. Falls may occur when an unexpected turn must be made quickly, in order to avoid colliding with an object in the gait path. Little is known about abilities, particularly about abilities of old adults, to turn suddenly. Methods. Twenty young and 20 old (mean age 73.8) healthy and physically active adults, while walking straight ahead, were cued to make approximately a 90 [degrees] turn without advance knowledge of where the turn was to be made or whether it would be to the right or left. Subjects were given available response times (ART), the times between the cue to turn, and potential crossing of a specified forward limit line, of 375,450,600, and 750 ms. The rate of success (RS) in completing the turns as prescribed was determined. Regression analyses were used to estimate the additional ART that would be needed for other groups to achieve the same RS as did the young male subject group. Results. For all ART, old subjects had a lower rate of success in completing the turns as prescribed than the young. At an ART of 375 ms, mean RS was 36% for the young and 6% for the old. The regression analyses suggested that, for RS from 30 to 95%, old adults needed 112 ms longer than young of corresponding gender to succeed as well. Females needed on the order of 50 ms longer ART than males of corresponding age. Conclusions. There are significant age and gender differences among healthy and physically active adults in the available response times they need when walking for successfully making sudden turns.

Background. Earlier studies showed that healthy old adults have substantially reduced abilities to develop joint torques rapidly. We hypothesized that this age decline would reduce abilities to regain balance once a forward fall is underway. The present study examined whether aging in fact reduces ability to regain balance by taking a single, rapid step upon release from a forward lean. Methods. Ten young (mean age 24.3 yr) and ten old (72.8 yr) healthy males were released from a forward-leaning position and instructed to regain standing balance by taking a single step forward. Lean angle was successively increased until a subject failed to regain balance as instructed. Lower extremity motions and foot-floor reactions were measured during the responses. Total response time was divided into reaction, weight transfer, and step times. Results. At small lean angles, responses of old subjects were similar to those of the young. However, the mean maximum lean angle from which old could regain balance as instructed was significantly smaller than that for young (23.9 vs 32.5 deg, p < .0005). Within each age group, maximum lean angle correlated strongly with weight transfer time and step velocity. Conclusions. Substantial age-related declines in the ability to regain balance by taking a rapid step exist among healthy adults when the time available for recovery is short. The source of the decline seems largely to lie in the decrease with age of maximum response execution speed rather than in the sensory or motor programming processes involved in response initiation.

Background. When balance is disturbed, often only fractions of a second are available in which to make the initial responses needed for its restoration. Abilities to develop joint torques rapidly may be critical to such responses. We undertook this study to quantify age effects among healthy adults in abilities to develop ankle joint torques rapidly. Methods. Ankle dorsiflexion (DF) and plantarflexion (PF) torque development during rapid isometric and during isokinetic (30, 60, 120, 180, and 240 deg/sec) exertions was assessed in 24 healthy young (mean age 23 years) and 24 healthy old adults (mean age 72 years). The effects of age, gender, and torque direction on the times needed to reach given torque magnitudes, maximum rates of isometric torque development (MRTD), and maximum isokinetic torques were examined. Results. The old adults required substantially more time to reach given torque magnitudes than the young adults. For example, the young and old females needed approximately 236 and 337 msec to develop 15 Nm of DF torque, of which 141 and 164 msec were reaction times. Isometric MRTD were 25 to 36% lower in the old than in the young adults. The age declines in isometric torque development time were associated with losses in maximum isometric strength. Maximum isokinetic torques developed by the old were 20 to 40% lower than those of young adults. The percent losses in isokinetic torques with age were independent of joint angular velocity for PF, but increased with velocity for DF. Conclusions. We found substantial age declines in abilities of healthy old adults to rapidly develop ankle joint torques. The capacities of even healthy old adults to recover balance or to carry out other time-critical actions that require moderate-to-substantial strengths may be considerably degraded by these declines.

Background. Tripping over an obstacle is a common cause of falls in the elderly. An earlier study of abilities to avoid stepping on suddenly appearing obstacles found that, although healthy old adults had a lower rate-of-success than young adults, the magnitude of that difference was not large. The present study inquired whether dividing attention during such a task would differentially affect young and old healthy adults. Methods. Rates-of-success were observed in 16 young and 16 old healthy adults (mean ages 24 and 72 years) in avoiding stepping on a band of light that was suddenly projected across their gait path while they walked at their comfortable gait speed. This virtual obstacle was placed at predicted next-footfall locations to give 350 or 450 msec available response times before footfall. During most of the trials the subjects were asked, in addition to trying not to step on the obstacle, simultaneously to respond vocally as quickly as possible when red lights near the end of the walkway turned on. These attention-dividing reaction time tests were of two types: synchronized, when only red lights lit at intervals synchronized with the appearance of the obstacle. and unsynchronized, when green or yellow lights lit in addition to the red lights, with lighting intervals not synchronized with the appearance of the obstacle. Results. When synchronized and unsynchronized reaction time tests were conducted concurrently with the obstacle avoidance tasks, mean rates-of-success in avoidance decreased significantly in both young and old adults. With available response times of 350 msec, mean success rates decreased from their no-division values in the young adults by 14.7% for synchronized reaction and by 19.9% for unsynchronized reaction, attention-dividing tests. Corresponding mean decreases for the old adults were 32.0 and 35.7%. This age difference in the effects of dividing attention was significant. Conclusion. Both young and old adults had a significantly increased risk of obstacle contact while negotiating obstacles when their attention was divided, but dividing attention degraded obstacle avoidance abilities of the old significantly more than it did in the young. Diminished abilities to respond to physical hazards present in the environment when attention is directed elsewhere may partially account for high rates of falls among the elderly.

Global cognitive impairment in older adults has been associated with a greater risk of falling, and tripping has been implicated a, an important factor in a large percentage of these falls. In order to evaluate the role of specific cognitive domains in tripping and falling, 23 healthy older adults completed basic and complex obstacle avoidance tasks, as well as a battery of neuropsychological tests. Using multiple regression analysis, a select pattern of neuropsychological measures was found to predict the decrement in performanee evident as avoidance task complexity increased. Whereas measures of problem solving, response inhibition, general anxiety, and variability in attention were found to be significant predictors (in that order) of the relative decline in successful obstack avoidance, measures of visuo-spatial discrimination and memory did not.

A study of 24 old and 24 young adults for their ability to avoid an obstacle during walking reveals that younger people have higher mean rates-of-success (RS) than older people whose RS decreases with decreasing available response time (ART). Lower extremity simple reaction time (SRT) tests reveal an 80 ms delay in the SRT of older people compared to that of younger people. A 50 or 100 ms delay in responding to the presence of obstacle reduces the RS of people of any age, indicating that age-related variations in SRT do not predict variations in the ability to avoid obstacles.

Falls associated with tripping over an obstacle can be devastating to elderly individuals, yet little is known about the strategies used for stepping over obstacles by either old or young adults. The gait of gender-matched groups of 24 young and 24 old healthy adults (means ages 22 and 71 years) was studied during a 4 m approach to and while stepping over obstacles of 0,25,51, or 152 mm height and in level obstacle-free walking. Optoelectronic cameras and recorders were used to record approach and obstacle crossing speeds as well as bilateral lower extremity kinematic parameters that described foot placement and movement trajectories relative to the obstacle. The esults showed that age had no effect on minimum swing foot clearance (FC) over an obstacle. For the 25 mm obstacle, mean FC was 64 mm, or approximately three times that used in level gait; FC increased nonlinearly with obstacle height for all subjects. Although no age differences were found in obstacle-free gait, old adults exhibited a significantly more conservative strategy when crossing obstacles, with slower crossing speed, shorter step length, and shorter obstacle-heel strike distance. In addition, the old adults crossed the obstacle so that it was 10% further forward in their obstacle-crossing step. Although all subjects successfully avoided the riskiest form of obstancle contact, tripping, 4/24 healthy old adults stepped on an obstacle, demonstrating an increased risk for obstacle contact with age., The way older and younger people walk and move over obstacles may have a bearing on why older people are more likely to fall, and how to prevent the problem. Gait patterns of healthy young men and women and healthy old men and women were studied as they approached and stepped over obstacles of various heights. A total of 48 volunteers were monitored electronically as they walked along a path with obstacles ranging in height from that of standard door thresholds up to the average curbstone. Each of the volunteers walked the course 42 times. The distance from the foot the person was standing on to the obstacle and the clearance of the foot was the same for all groups. Old adults were more conservative when crossing obstacles than young adults, approaching more slowly and taking more care to have the toes clear the obstacle. Although this increases the risk that the heel will catch on the object, the result would be a less serious stumble instead of a trip. Foot clearance is the most important measure of whether tripping will occur, and all subjects avoided tripping on or kicking the obstacle. Attention and cognition were not measured in this study, and the artificial setting may not reflect what happens when people walk in everyday settings. The results of the study indicate that old adults are more careful when stepping over obstacles than young adults, and are more likely to step on the obstacle, as four of the 24 old adults did. (Consumer Summary produced by Reliance Medical Information, Inc.)

A large number of aged persons need assistance getting in and out of chairs and beds; estimates are that nearly 8 percent of those aged 65 and over who are not living in institutions have such difficulty. These people may be at increased risk for immobility-related diseases and for institutionalization. Though there may be more overt causes for the difficulties that the elderly have in rising, biomechanics are always involved. To gain an understanding of the biomechanics involved in rising from a chair and the difficulties that might occur, 51 adults were classified as either young, old able, or old unable based upon their age and whether they could rise from a chair without the use of the hand-rests. The young group consisted of 17 subjects with an average age of 23 years, the old able group had 23 subjects whose average age was 72 years, and the old unable group consisted of 11 subjects with an average age of 84 years. Subjects were asked to rise from a chair, during which the timing, body segment angles, and hand forces were measured. Compared with the young subjects, the old able subjects spent a greater amount of time in the first of two phases of rising, and they rotated their body segments by a different amount. This was despite the fact that there was no difference in functional ability between the two groups. The old unable group took more time to rise than the old able group, they used different rotations, and they used the force of their hands more as compared with the force of their bodies. These data show that the mechanics of rising from a chair can be quantified in such a way that further analyses of joint strengths and postural stability can be made to determine their contributions to problems in rising. (Consumer Summary produced by Reliance Medical Information, Inc.)

Background. The upper extremities are often used to protect the head and torso from impact with an object or with the ground. We tested the null hypotheses that neither age nor gender would affect the time required for healthy adults to move their upper extremities into a protective posture. Methods. Twenty young (mean age 25 years) and twenty older (mean age 70 years) volunteers, with equal gender representation, performed a seated arm-movement task under three conditions: Condition 1, in which subjects were instructed to raise the hands upon cue as quickly as possible from thigh level to a shoulder height target; Condition 2, in which subjects were instructed as in Condition 1 with the addition of intercepting a swinging pendulum at the prescribed hand target; and Condition 3, in which subjects were instructed as in Condition 2 but were asked to wait as long as possible before initiating hand movement to intercept the pendulum. Arm movements were quantified using standard kinematic techniques. Results. Age (p [is less than] .01) and gender (p [is less than] .05) affected hand movement times. In Conditions 1 and 2, the older women required 20% longer movement times than the other subject groups (335 vs 279 milliseconds; p [is less than] .01). In Condition 3, shorter movement times were achieved by young men (20%; p = .002) and older women (10%; p = .056) as compared with their respective performance in Conditions 1 and 2 because they did not fully decelerate their hands. The other groups slowed their movements in Condition 3. Conclusions. Age, gender, and perceived threat significantly affected movement times. However, even the slowest movement times were well within the time available to deploy the hands in a forward fall to the ground.

Background. Difficulty in rising from a chair is common in older adults and may be assessed by examining the biomechanics of the rise. The purposes of this study were (i) to analyze the biomechanics of rise performance during chair-rise tasks with varying task demand in older adults with varying rise ability and (ii) to determine whether a strength-training program might improve chair-rise success and alter chair-rise biomechanics, particularly under situations of increased task demand. Methods. A training group (n = 16; mean age, 82 years) completed a 12-week strength-training regimen while a control group (n = 14; mean age, 84 years) participated in a seated flexibility program. Outcomes included the ability to complete seven chair-rise tasks, and, if the chair-rise tasks were successful, the biomechanics of these rises. Chair-rise task demand was increased by lowering the seat height, restricting the use of hands, increasing rise speed, and limiting foot support. Results. At baseline, increased chair-rise task demand generally required increased task completion time, increased anterior center of pressure (COP) placement, increased momentum, increased hip flexion, and increased hip and knee torque output. Those unable to rise at 100% knee height without the use of their hands (task NH-100), compared with those able to rise during task NH-100, followed this pattern in requiring increased time, more anterior placement of the COP, and increased hip flexion to rise in the least demanding tasks allowing the use of hands. However, the unable subjects generated less momentum and knee torque in these tasks. At 12 weeks, and compared with baseline and controls, the training group demonstrated changes in chair-rise biomechanics but no significant changes in rise success. The training subjects, as compared with the controls, maintained a more posterior COP, increased their vertical and horizontal momentum, maintained their knees in greater extension, and maintained their knee-torque output. Conclusions. These data demonstrate that subtle yet significant changes can be demonstrated in chair-rise performance as a result of a controlled resistance-training program. These biomechanical changes may represent a shift away from impairment in chair-rise ability, and, although the changes are small, they represent how training may reduce rise difficulty.

Background. In older adults, clinical measures have been used to assess fall risk based on the ability to maintain stance or to complete a functional task. However, in an impending fall situation, a stepping response is often used when strategies to maintain stance are inadequate. We examined how maximal and rapid stepping performance might differ among healthy young, healthy older, and balance-impaired older adults, and how this stepping performance related to other measures of balance and fall risk. Methods. Young (Y; n = 12; mean age, 21 years), unimpaired older (UO; n = 12; mean age, 69 years), and balance-impaired older women (IO; n = 10; mean age, 77 years) were tested in their ability to take a maximal step (Maximum Step Length or MSL) and in their ability to take rapid steps in three directions (front, side, and back), termed the Rapid Step Test (RST). Time to complete the RST and stepping errors occurring during the RST were noted. Results. The IO group, compared with the Y and UO groups, demonstrated significantly poorer balance and higher fall risk, based on performance on tasks such as unipedal stance. Mean MSL was significantly higher (by 16%) in the Y than in the UO group and in the UO (by 30%) than in the IO group. Mean RST time was significantly faster in the Y group versus the UO group (by 24%) and in the UO group versus the IO group (by 15%). Mean RST errors tended to be higher in the UO than in the Y group, but were significantly higher only in the UO versus the IO group. Both MSL and RST time correlated strongly (0.5 to 0.8) with other measures of balance and fall risk including unipedal stance, tandem walk, leg strength, and the Activities-Specific Balance Confidence (ABC) scale. Conclusions. We found substantial declines in the ability of both unimpaired and balance-impaired older adults to step maximally and to step rapidly. Stepping performance is closely related to other measures of balance and fall risk and might be considered in future studies as a predictor of falls and fall-related injuries.