Associations Between Childhood Motor Clumsiness and the Risk of Falls and Stumbles in Older Adults: A Preliminary Investigation from a Lifespan Developmental Perspective
Article information
Abstract
Objectives
This study examined the associations between childhood motor clumsiness and falls and stumbles in older adults from a lifespan developmental perspective.
Methods
A cross-sectional observational study was conducted with 75 community-dwelling older adults aged 65 years and older, recruited from participants in a health event. Childhood motor clumsiness was evaluated using the question “Were you ever told by others that you were clumsy in movement as a child?” Current motor coordination was assessed using eight items related to developmental coordination disorder (DCD). Falls and stumbles, as well as exercise preferences and self-evaluations were also investigated.
Results
The mean age of participants was 78.2 ± 6.0 years. Childhood motor clumsiness was reported in 12 participants (16.0%) and showed significant negative correlations with current and past exercise preferences and self-evaluations (r = −0.32 to −0.43). Falls were reported by 45.5% of the Childhood Motor Clumsiness group and 10.7% of the group without childhood clumsiness, while stumbles were reported by 83.3% and 38.2%, respectively. After adjusting for age and gender, difficulty with organization and tidying was independently associated with falls (OR = 2.63, p = 0.04), and difficulty with distance estimation was independently associated with stumbles (OR = 4.03, p = 0.02).
Conclusions
Childhood motor clumsiness influences lifelong exercise preferences and self-evaluations, and specific DCD characteristics are associated with fall and stumble risks in older adulthood. These findings suggest fall prevention approaches must be developed through a lifespan developmental perspective.
INTRODUCTION
Falls among older adults represent a significant health problem that can lead to fractures and becoming bedridden. Numerous studies and systematic reviews have established the effectiveness of exercise therapy in preventing falls. For example, the Cochrane review by Sherrington et al. demonstrates that multicomponent exercise programs incorporating balance and strength training reduce fall rates by approximately 23% among community-dwelling older adults [1]. However, most fall prevention research has focused on risk factors present during older adulthood, such as muscle weakness, balance dysfunction, and cognitive decline [2,3], with limited examination of risk factors identified through a lifespan developmental perspective. Recently, Tan et al. reported that adverse childhood experiences increase fall risk in middle-aged and older adults by 2.38 times [4], revealing that childhood experiences can influence fall risk in this population decades after the initial exposure. These findings highlight the importance of examining risk factors through a lifespan developmental perspective, rather than limiting falls research to older adulthood alone.
Motor coordination is the ability to perform body movements efficiently and smoothly, and it is foundational to physical activity and activities of daily living [5]. Motor coordination is not a single physical function but a higher-order motor control function that integrates multiple elements, including muscle strength, balance ability, reaction time, and spatial cognition. The motor coordination foundation formed in childhood becomes an important protective mechanism that compensates for age-related decline in individual physical functions, ensuring safety in situations with high fall risk, such as walking on unstable terrain, responding to unexpected perturbations, and performing movements with divided attention [6]. From a lifespan developmental perspective, difficulties in motor coordination during childhood manifest as “motor clumsiness,” which may have long-term effects on fall risk in older adulthood. Motor clumsiness is a core characteristic of developmental coordination disorder (DCD) [7] and often manifests as childhood experiences of being told by others that one has poor motor skills [8]. The characteristics of DCD include not only fine and gross motor clumsiness but also various problems in planning, organization, executive function, spatial cognition, and psychosocial factors, despite the absence of intellectual disability [9].
Individuals diagnosed with DCD in childhood participate less in physical activities, with this tendency persisting into adulthood [10]. Additionally, associations have been demonstrated between adult DCD characteristics and balance ability, suggesting that motor clumsiness may influence fall risk in older adults. Furthermore, childhood movement experiences influence lifelong preferences and self-evaluations regarding exercise [11]. Recent large-scale surveys have revealed that adverse childhood experiences such as physical abuse, witnessing domestic violence, and bullying significantly increase fall risk in middle and older adulthood through pain and depressive symptoms [4]. These findings suggest that childhood experiences may have long-term effects on falls risk in older adulthood through various pathways. However, the direct relationship between and fall risk in older adulthood has not been examined.
This study aimed to explore the association between perceived childhood motor clumsiness and experiences of falls and stumbles in older adulthood among community-dwelling older adults, establishing a foundation for future fall prevention research. The research hypotheses were as follows. First, experiences of being told about childhood motor clumsiness and DCD characteristics are associated with experiences of falls and stumbles in older adulthood, increasing the risk of their occurrence. Second, experiences of being told about childhood motor clumsiness are associated with reduced current preferences and self-evaluations regarding exercise among older adults.s.
METHODS
This The study employed a cross-sectional observational design. Community-dwelling older adults were recruited from those who participated in health events in Region A in the Kanto area. The participant inclusion criteria were individuals aged 65 years or older, capable of independent walking, with no physical conditions restricting exercise, and possessing cognitive function sufficient to consent to research participation. The survey included assessments of fall and stumble experiences, evaluations of childhood and current motor clumsiness, evaluations of past and current exercise preferences, and an assessment of physical function.
Fall and stumble experiences were evaluated through self-report by the following questions: “Have you experienced falling within the past year?” and “Do you stumble on flat surfaces or stairs?” respectively. Participants were classified into two groups based on the presence or absence of these experiences.
Childhood motor clumsiness was evaluated using a two-point scale (yes/no) for “Were you ever told by others for being clumsy in movement as a child?” It should be noted that this method may be subject to recall bias and subjective interpretation.
Current motor clumsiness was evaluated using eight items related to DCD characteristics: “difficulty writing quickly,” “difficulty reading one’s own handwriting,” “difficulty organizing and tidying things,” “frequency of bumping into, spilling, or breaking things,” “use of leisure time,” “form of sports participation,” “difficulty estimating distances,” and “difficulty making plans,” using a four-point scale (1: never to 4: always). These items are used in DCD assessment scales [12,13] to provide a comprehensive understanding of DCD by capturing its multifaceted disability profile. Each item was treated as an ordinal continuous variable and entered individually as a predictor in logistic regression analyses. In this study, the eight items were classified in accordance with categories proposed based on the International Classification of Functioning, Disability and Health framework [14] : fine motor difficulties (difficulty writing quickly, difficulty reading own handwriting), non-motor difficulties (difficulty with organization/tidying, difficulty estimating distances, difficulty making plans), and effects on activities and participation (frequency of bumping/spilling/breaking, use of leisure time, form of sports participation). No items were classified as gross motor difficulties in the present study.
In this study, motor clumsiness and motor coordination were regarded as the same concept, defined as difficulties in the ability to coordinate multiple body parts efficiently and smoothly. In childhood, this was evaluated through the question “Were you ever told by others for being clumsy in movement as a child?” and in adulthood through the eight items characterizing DCD.
This study used secondary fata from health events, and as such the data are secondary in nature measures were available for all participants. Physical function data (BMI, one-leg standing time) were available for only a subset of participants (n = 30, 40.0%); the reasons for missing data were not recorded in the original dataset. No imputation methods were used for missing data. Each analysis was conducted using available case analysis, and the number of participants included in each analysis is specified in the Results section. For logistic regression analyses, only cases with complete data for all variables in the model were included.
This study was conducted with approval from the Ethics Committee of the University of Tsukuba (approval number: 2139).
Statistical Analysis
Statistical analysis included descriptive statistics, correlation analysis (Spearman correlation coefficient), group comparisons (Fisher’s exact test and Mann–Whitney U test), and multivariate analysis (binary logistic regression). In logistic regression analyses, age and sex were included as covariates as established confounders for falls and stumbles. For DCD-related items, we first conducted univariate analyses (Mann-Whitney U test, Table 4) to identify items associated with fall and stumble experiences. Items showing significant or near-significant associations (p ≤ 0.05) in univariate analyses were then entered individually (one per model) into separate logistic regression models, adjusting for age and sex. This approach was chosen to avoid multicollinearity among DCD items and to minimize the number of covariates given the small sample size and limited number of events, thereby reducing the risk of overfitting. However, it should be noted that the highly skewed sex distribution (90.3% female) may lead to unstable estimates for the sex covariate. Statistical software (SPSS version 28.0) was used to perform the analyses, with a significance level set at p ≤ 0.05. Effect sizes were evaluated using Cohen’s criteria (small: r = 0.1, medium: r = 0.3, large: r = 0.5) [15].
Comparison of DCD-related difficulties between participants with and without fall and stumble experiences
RESULTS
Participant Characteristics
The 75 participants had a mean age of 78.2 ± 6.0 years. There were 65 females and seven males (three non-respondents). Physical function data showed a Body Mass Index of 22.8 ± 2.9 kg/m² (n = 30) and one-leg standing time with eyes open of 22.0 ± 17.1 seconds (n = 30) (Table 1). For the childhood motor clumsiness question, 68 participants responded (7 non-respondents), with 12 participants reporting having been told they were clumsy and 56 participants reporting no such experience. Among those reporting childhood motor clumsiness, fall experience data were available for 11 participants (1 non-respondent) and stumble experience data for all 12 participants. Among those reporting no childhood motor clumsiness, fall experience data were available for all 56 participants and stumble experience data for 55 participants (1 non-respondent). The analyses included 67 participants for fall experience, 67 for stumble experience, 68 for correlation analyses, and 67 for logistic regression analyses.
Characteristics of the study participants
Associations Between Reported Childhood Motor Clumsiness and Exercise Preferences and Self-Evaluations
Spearman correlation analysis revealed significant negative correlations between reported childhood motor clumsiness and exercise preferences and self-evaluations (Table 2). For current exercise preferences, r = −0.35 (p = 0.003); for current exercise self-evaluation, r = −0.43 (p < .001); for past exercise preferences, r = −0.32 (p = 0.009); and for past exercise self-evaluation, r = −0.43 (p < 0.001). These results suggest that being told about motor clumsiness in childhood influences exercise preferences and self-evaluations throughout the lifespan.
Relationships between reported childhood motor clumsiness and exercise preferences and self-evaluations
Associations Between Reported Childhood Motor Clumsiness and Falls and Stumbles
Childhood motor clumsiness was reported in 12 participants (16.0%) and absent in 56 participants (74.7%), with seven participants not responding (9.3%) (Table 3). Regarding falls, five out of 11 participants (45.5%) in the group reporting childhood motor clumsiness and six out of 56 participants (10.7%) in the group not reporting it experienced falls, with Fisher’s exact test showing an odds ratio of 1.50 (95% CI: 0.41–5.54, p = 0.73). For stumbles, 10 out of 12 participants (83.3%) in the group reporting childhood motor clumsiness and 21 out of 55 participants (38.2%) in the group not reporting it experienced stumbles, with an odds ratio of 2.64 (95% CI: 0.52–13.3, p = 0.31). Although no statistically significant differences were found, the stumble experience results suggest a substantial association with reported childhood motor clumsiness, evidenced by an approximately 2.6 times higher risk. However, the confidence intervals were wide, requiring verification with larger sample sizes.
Associations between childhood motor clumsiness and fall and stumble experiences
Associations Between DCD-Related Items and Fall and Stumble Experiences
Analysis of the eight items related to the characteristics of DCD showed that “Do you find it difficult to find or organize things in your room?” showed a statistical tendency for an association with fall experience (p = 0.05), and “Do you find it difficult to estimate distances when parking or passing through objects?” was significantly associated with stumble experience (p = 0.02) (Table 4). Logistic regression adjusted for age and gender revealed that difficulty with organization and tidying was independently associated with fall experience (odds ratio = 2.63, 95% CI: 1.05–6.56, p = 0.04), and difficulty with distance estimation was independently associated with stumble experience (odds ratio = 4.03, 95% CI: 1.27–12.7, p = 0.02) (Table 5). These results suggest that these two items may be independently associated with fall risk even after accounting for the influence of confounding factors such as age and gender.
Multivariable logistic regression analysis for factors associated with fall and stumble experiences
DISCUSSION
This This study examined the association between childhood motor clumsiness and current motor coordination difficulties with experiences of falls and stumbles in older adulthood among community-dwelling older adults. Our key findings were that reported childhood clumsiness was associated with exercise preferences and self-evaluations, and that DCD characteristics of “difficulty with organization and tidying” and “difficulty with distance estimation” were independently associated with falls and stumbles.
Associations Between Childhood Motor Coordination Difficulties and Exercise Preferences and Self-Evaluations
Moderate significant negative correlations were found between reported childhood motor clumsiness and current and past exercise preferences and self-evaluations. These results suggest that childhood motor clumsiness may be associated negative attitudes toward exercise throughout the lifespan. However, as this is a cross-sectional study based on retrospective self-report, causal relationships cannot be inferred.
Longitudinal studies have reported that children diagnosed with DCD have lower exercise participation rates and reduced physical activity levels in adulthood [16], consistent with the present findings. Therefore, negative attitudes toward exercise may be associated with decreased physical activity, resulting in muscle weakness and deterioration of balance, which can potentially increase the risk of falls and stumbles. The knowledge gained from childhood situations suggests that the association between reported childhood motor clumsiness and fall/stumble risk may not be limited to older adulthood but may also extend to middle and younger adulthood. A large-scale survey performed by Peeters et al. reported fall prevalence rates of 8.7% in women aged 40–44 years and 29.9% in those aged 60–64 years, and 14.7% in men aged 45–49 years and 15.7% in those aged 60–64 years [17], indicating that fall experience is not limited to older adulthood. Middle adulthood is a transitional period when changes in physical function gradually begin to appear. Childhood tendencies may be associated with continued physical inactivity in middle adulthood, which may be associated with accelerated age-related changes in muscle strength and balance.
Associations Between DCD Characteristics and Fall and Stumble Experiences
This study showed that difficulty with organization and tidying was independently associated with falls, and difficulty with distance estimation was independently associated with stumbles. In DCD assessment, difficulty with organization and tidying is an important indicator of executive function [18]. Declines in executive function are associated with reduced adaptation to environmental changes and risk prediction ability, leading to increased risk of falls [19]. Meanwhile, difficulty with distance estimation is an important aspect of visuospatial cognitive ability [18], which may be associated with poor obstacle avoidance during walking and poor recognition of steps, potentially increasing the risk of stumbling [20]. These findings provide new perspectives for fall and stumble prevention. Conventional strategies for preventing falls have focused on maintaining and improving physical function; however, if developmental characteristics persisting from childhood are involved, falls and stumbles may not be prevented simply by enhancing physical function.
The present findings highlight that fall and stumble prevention is not merely a problem of older adulthood. Rather, preventing falls and stumbles is a continuous challenge from childhood through adulthood, making the early identification of DCD characteristics and the construction of lifelong support that considers these characteristics important issues.
Study Limitations
This study has several limitations. First, being a cross-sectional study, causal relationships cannot be inferred from the data. Prospective cohort studies are needed to clarify the effects of childhood motor clumsiness on the risk of falls in older adulthood. Second, the small sample size, particularly the small number of males (9.7%), constrains the generalizability of the results. Additionally, the high proportion of missing physical function data (60% for BMI and one-leg standing time) limits the interpretation of analyses involving these variables. Even for items that did not achieve statistical significance (Fisher’s exact test), the odds ratios suggested substantial associations—requiring verification with larger sample sizes. Third, the evaluation of childhood motor clumsiness was based on recall of a single item (“Were you ever told for being clumsy in movement as a child?”), presenting challenges in measurement validity. Fourth, the logistic regression models adjusted only for age, sex, and one DCD-related item. Given the small number of events and highly skewed sex distribution, there is a possibility of overfitting and unstable estimates. Verification with larger samples is needed.
CONCLUSIONS
Childhood motor clumsiness is associated with lifelong exercise preferences and self-evaluations, and specific characteristics of DCD are associated with the risk of falls and stumbles in older adulthood. These findings suggest that fall prevention approaches must be developed through a lifespan developmental perspective. Practical implications include the potential value of screening older adults for DCD-related characteristics and providing early support for children with motor clumsiness. However, it should be noted that the findings reflect associations based on retrospective self-report, not verified diagnoses or prospective data.
Notes
ACKNOWLEDGEMENTS
We extend our heartfelt thanks to all participants who kindly took part in this research. This work was supported by JSPS KAKENHI Grant Number 23K10564. We thank Andrew Hunt, PhD, from Edanz (https://jp.edanz.com/ac) for editing a draft of this manuscript.
Informed Consent Statement
Informed consent was obtained from all participants involved in the study.
Conflicts of Interest
The authors declare no conflict of interest.