A life course approach to balance ability

Balance ability is a crucial component of everyday life, underlying physical movement at all stages in life. Despite this, balance is an overlooked aspect of physical health and ageing, with minimal evidence of how factors throughout life are associated with balance ability. This PhD thesis used a life course approach to investigate how factors across life contribute to standing balance in mid and later life, and to examine associations between balance ability and subsequent falls risk. Data from the MRC National Survey of Health and Development (NSHD) were used. NSHD is a nationally representative sample of 5362 males and females, born in England, Scotland and Wales in March 1946 and followed up to 24 times across life. One-legged balance time with eyes closed was assessed at ages 53, 60-64 and 69 (n=3111 individuals with a balance time at one or more age). Analytical methods included multilevel models, structural equation models, linear and logistic regressions and receiver-operating characteristic analyses. In adulthood, disadvantaged socioeconomic position, poor health and adverse health related behaviours were associated with poorer balance ability (Chapter 3). In childhood, disadvantaged socioeconomic position, lower cognitive ability, slower coordination and early or late attainment of motor milestones were associated with poorer balance ability (Chapter 3, 4). Across several domains, higher cognitive ability in midlife was associated with better balance ability (Chapter 5). The association between verbal memory and subsequent balance ability was unidirectional, with some evidence of more complex bidirectional associations with search speed (Chapter 6). Most factors across life demonstrated changing patterns of association with balance with age. Finally, balance ability was associated with subsequent falls, although the one-legged stand did not appear to be a sensitive prognostic indicator of fall risk (Chapter 7). Better understanding of the socioeconomic, cognitive, behavioural and health pathways across life which relate to subsequent balance ability, identified in this thesis, provides an opportunity to intervene earlier in life to minimise, prevent or delay balance impairment or decline