Factors associated with balance impairments in the community-dwelling elderly in urban China

**Background:** Balance performance is a critical indicator of functional status in the elderly, predicting poor health outcomes, reduced independence, and increased healthcare needs. Maintenance of balance relies on visual, vestibular, somatosensory, muscle, and skeletal systems, all of which decline with age. Despite the importance, large-scale studies identifying factors associated with balance impairments in community-dwelling elderly are limited. This study aimed to identify independent factors contributing to impairments in overall balance, three domains (static balance, postural stability, dynamic balance), and 16 individual balance items in the urban Chinese elderly.

**Methods:** A total of 1984 community-dwelling Chinese elderly (aged 60-97 years, 47.4% male) from urban Shanghai were enrolled. Data on demographics (gender, age, education, income, BMI), lifestyle (exercise frequency, smoking), and health status (vision, hearing, somesthesis, chronic diseases including cerebrovascular disease, hypertension, diabetes, etc.) were collected via face-to-face interviews. Balance performance was assessed by trained investigators using the X16 balance testing scale, which includes 4 items for static balance, 4 for postural stability, and 8 for dynamic balance. Ordinal logistic regression was used for overall balance and domain scores; binary logistic regression was used for individual items. Multivariable models were built using stepwise selection (entry p<0.10, stay p<0.05).

**Key Results:** - **Overall balance:** Age was a strong risk factor, with ORs increasing from 1.26 (age 65- years) to 3.20 (age 85-97 years) (all P<0.01). Overweight/obesity (BMI ≥24.0 kg/m²) increased risk (OR=1.26, P<0.001). Regular exercise (1-7 times/week) reduced risk (ORs 0.63-0.73, all P<0.001). Vision impairment (able only <1 m: OR=1.59), moderate hearing impairment (OR=1.54), somesthesis dysfunction (mild: OR=1.59, moderate: OR=4.85, severe: OR=13.26, all P<0.001), and cerebrovascular disease (OR=1.45, P=0.001) were all associated with increased risk. - **Static balance:** Age (ORs 1.28-1.87 from age 70- to 85-97), lower education (OR=1.35), underweight (OR=1.29, not significant), exercise (ORs 0.59-0.72), vision (1- m: OR=1.16, 0- m: OR=1.46), hearing (moderate: OR=1.26, severe: OR=1.44), somesthesis (mild: OR=1.16, moderate: OR=1.98, severe: OR=4.26), hypertension (OR=1.13) were significant. - **Postural stability:** Age (ORs 1.28-3.01), overweight/obesity (OR=1.24), exercise (ORs 0.70-0.80), vision (1- m: OR=1.14, 0- m: OR=1.24), hearing (moderate: OR=1.30), somesthesis (mild: OR=1.68, moderate: OR=3.19, severe: OR=8.58), cerebrovascular disease (OR=1.57), linguistic incompetence (OR=1.42) were significant. - **Dynamic balance:** Age (ORs 1.17-2.58), overweight/obesity (OR=1.24), exercise (4-7 times/week: ORs 0.70-0.81), vision (1- m: OR=1.27, 0- m: OR=1.39), hearing (moderate: OR=1.46), somesthesis (mild: OR=1.39, moderate: OR=3.24, severe: OR=6.08), cerebrovascular disease (OR=1.30), linguistic incompetence (OR=1.51) were significant. - **Individual items:** Age was associated with 15 of 16 items (except item I1: standing with feet together). Overweight/obesity was associated with all 4 postural stability items and 7 of 8 dynamic balance items. Somesthesis dysfunction was associated with all 16 items (ORs up to 170.76 for postural stability). Regular exercise (≥1 time/week) reduced risk for 15 items. Cerebrovascular disease was associated with all postural stability items and 3 dynamic balance items.

**Clinical Implications:** This large cross-sectional study identifies key modifiable and non-modifiable factors associated with balance impairments in urban Chinese elderly. The strong association of somatosensory dysfunction (particularly severe: ORs up to 13.26 for overall balance, 170.76 for postural stability items) suggests that interventions targeting proprioceptive training may be highly effective. The protective effect of regular exercise (even 1 time/week reduced risk) supports exercise promotion as a public health strategy. Overweight/obesity and sensory impairments (vision, hearing) are also important modifiable targets. The graded effect of age emphasizes the need for early and continuous balance screening and intervention. Causality cannot be inferred due to cross-sectional design, and future studies should explore detailed exercise parameters (mode, intensity, duration) and occupations. Nonetheless, these findings provide evidence for targeted prevention programs to reduce fall risk and improve quality of life in aging populations.