509
Journal of Back and Musculoskeletal Rehabilitation 28 (2015) 509–516 DOI 10.3233/BMR-140549 IOS Press
Evaluation of stair climbing in elderly people Rüstem Mustafao˘glua, Bayram Unverb,∗ and Vasfi Karatosunc a
Istanbul Physical Therapy and Rehabilitation Research and Training Hospital, Bahçelievler, Istanbul, Turkey Department of Orthopedic Physiotherapy, School of Physiotherapy and Rehabilitation, Dokuz Eylul University, Izmir, Turkey c Department of Orthopaedics and Traumatology, School of Medicine, Dokuz Eylul University, Izmir, Turkey b
Abstract. BACKGROUND: Stair climbing is an important but neglected aspect of independent living. Clinicians should pay attention to the ability to negotiate stairs in elderly and disabled patients. OBJECTIVE: The aim of this study was to determine the effects of age, gender, medication use, cognitive status, lower extremity pathology and pain on the activities of stair negotiation in the elderly population in Turkish society. METHODS: Volunteer elderly people (254) were included the study. Participants were assessed in terms of their medication use, cognitive status, lower extremity pathology and pain and the activity of climbing the stairs. RESULTS: Significant differences were found on the activities of stair negotiation between the elderly with and without lower extremity pathology, with and without lower extremity pain, with and without medication use (p < 0.05). A positive and moderate correlation was found between age and the activity of stair climbing (r = 0.24, p < 0.01). CONCLUSIONS: Activity of stair climbing is affected by age, medication use, the presence of lower extremity pathology and pain. We consider that this information will be helpful for planning an appropriate and effective rehabilitation programme for elderly people for decreasing their risk of falling and increasing their independence level during their activities of daily living. Keywords: Aging, stair negotiation, lower extremity, activities of daily living
1. Introduction The World Health Organization identifies the individuals who were 65 years and over as “elderly” [1]. Average life in Turkey is 69 and the rate of the ones who are older than 65 and over to the total population is 6%. It is foreseen that this rate will reach up to 10% in 2025 [2]. Physiological changes happen in all tissue, organs and system functions with the age [3]. All physiological changes affect adversely the activities of daily living (ADL) [4–6]. The ability to conduct the activities as walking, sit-to-stand and stair negotiation (climbing up and down stairs) is functional activities deter∗ Corresponding author: Bayram Unver, Department of Orthopedic Physiotherapy, School of Physiotherapy and Rehabilitation, Dokuz Eylul University, 35340, Izmir, Turkey. Tel.: +90 2324124928; Fax: +90 2324124946; E-mail: bayram.unver@deu. edu.tr.
mining the independence related to the ADL. The independence level of these activities affects the quality of life and participation to the daily life [7,8]. Disability in ADL became a common problem for elderly adults; they need to get someone’s help in order to make ADL as bathing, going down and climbing up the stairs, walking [9,10]. Along with the loss of functional capacity and abilities, ADL of elderly people are being limited or prevented, their independent functions become more and more semi dependent of entirely dependent and tendency to fall is increasing [8, 11]. Stair climbing is one of the important functional activities of daily living to maintain mobility and independence [12]. The activity of climbing up and down stairs is one of the five activities that elderly people have difficulty at most. Approximately one-third of elderly people live sedentary due to the difficulties they have related to stair negotiation. One out of every three persons with 65 years old and over encounters the risk of fall at least one time per year, and they are taken to
c 2015 – IOS Press and the authors. All rights reserved ISSN 1053-8127/15/$35.00
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R. Mustafao˘glu et al. / Evaluation of stair climbing in elderly people
the hospital as a result of trauma [11,13]. The rate of death from falling increased 36% between the years of 1999–2003. Elderly people encounter the risk of fall in two circumstances at most which are standing or walking (48%) and climbing up and down the stairs (18%) [11]. The falls may cause illness, losses in the function of movement, bedridden and death [6,8,11, 13]. Physical deficiencies (e.g. sit-to-stand, walking, balance etc.) and sociological characteristics (e.g. anthropometric differences, lifestyles, cultural differences and geographic structure, etc.) cause older people have been handled in several studies [1,13–15]. There has been a lot of researches conducted on the activities of sit-to-stand and walking from the activities as walking, sit-to-stand and climbing up and down the stairs which are known as the determinant of independence in daily life, despite the importance of stair climbing and the high prevalence of limitations in this activity, little is known about the actual limitations in climbing stairs perceived by elderly people [3,4,7,9,13]. Stair climbing is an important but neglected aspect of independent living. Clinicians should pay attention to the ability to negotiate stairs in elderly and disabled patients [12,16]. Therefore, the aim of the study is to determine how the activity of climbing up and down the stairs is affected by the age [5,6], gender [4,5], cognitive status [6,10], lower extremity pathology [7,9] and medication use [17] in the elderly population in Turkish society.
be made for old people accepting to attend this study voluntarily. Assessment forms used in this study have been filled by the physiotherapist by interviewing all the participants face-to-face. Inclusion criteria for the study included, (a) have been determined as living in the nursing homes located in Izmir, (b) being at the age of 65 years and over, (c) having the ability to see through both eyes, (d) being cooperate, (e) having no hearing loss. Exclusion criteria were, (a) having deficiencies in the vestibular system, (b) having sensory disorder in both lower extremities, (c) being bedridden, (d) having the acute cardiovascular disease, (e) having limited diarthrosis movement gaps on highest degree and they could not be included into the study [3,6,9,10]. Participants of this study have been divided into two groups; Group I, has a lower extremity pathology (such as osteoarthritis, rheumatoid arthritis, with a history of broken bones in the lower extremities before, avascular necrosis of the hip, total knee and hip replacement) (n = 110, 55 female/55 male) and Group II, has no lower extremity pathology (n = 144, 72 female/ 72 male). The number of male and female in groups was not by chance, they were enrolled intentionally this way. Going Up and Down the Stairs Questionnaire including 15 items for climbing up and down the stairs [7], Standardized Mini Mental State Examination (SMMSE) [18] and Visual Analog Scale [19] were applied to both groups.
2. Methods
2.2. Going Up and Down the Stairs Questionnaire
2.1. Participants The study is a cross-sectional trial, was carried out at the three different Nursing Homes. The study population consisted of 254 volunteer subjects, those aged 65 and over. Subjects were recruited from Zübeyde Hanim Nursing Home in Metropolitan Municipality, Narlidere Resting and Nursing Home and Izmir Nursing and Rehabilitation Center. Subjects accepting face-to-face interview directly, voluntarily, eligible for including to and excluding from the study was chosen for this study by using randomly sampling method among the ones having no lower extremity pathology and having lower extremity pathology based on any pathology before. Informed confirmation form approved by local ethic committee has been taken from the participants with their signature by explaining them the assessment to
Questionnaire consisting of 15 items, formulated in behavioral terms. The items refer to what a patient actually does, and not to what a patient thinks that he/ she can do. Dichotomous response options (YES box marked/NO box not marked) were chosen to facilitate interpretation [7]. The number of answers given as ‘YES’ to the 15 items of the Going Up and Down the Stairs Questionnaire for climbing up and down the stairs indicates the level of constraint and dependency which was used for questioning the activity related to climbing up and down the stairs for elderly people living in the nursing home. If the number of the answer ‘YES’ is high as a result of the questionnaire conducted, it shows that the participant is constraint and depended in terms of the activity related to climbing up and down the stairs.
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2.3. Standardized Mini Mental State Examination (SMMSE)
Table 1 Baseline socio-demographic characteristics of the participants
The SMMSE is used for comprehensive assessments of older adults. It provides a global score of cognitive ability that correlates with function in activities of daily living. The SMMSE measures various domains of cognitive function including orientation to time and place; registration; concentration; short-term recall; naming familiar items; repeating a common expression; and the ability to read and follow written instructions, write a sentence, construct a diagram, and follow a three-step verbal command. Takes approximately 10 minutes to administer, provides a baseline score of cognitive function, and pinpoints specific deficits that can aid in forming a diagnosis. A total score of 30 indicates no impairment. Scores between 26 and 30 are considered normal in the general population. Patients who score between 25 and 20 have mild cognitive impairment and will be experiencing problems with the instrumental activities of daily living, such as shopping, finances, medication use, and meal preparation, but can usually live on their own with support. Those who score between 20 and 10 have moderate cognitive impairment, usually cannot live independently, and are starting to have problems with basic activities, such as grooming, dressing, and using the toilet. Scores between 9 and 0 denote severe cognitive impairment; patients will be having problems with all basic activities, including eating and walking [18]. In this trial, in terms of statistical analyse subjects cognitive function status scores divided into two groups, first was ‘Affected’ group included moderate (10–19 score) and mild (20–25 score) levels and the second was ‘Unaffected’ group included normal (26–30 score) level.
Gender Female Male Age groups 65–74 (year) 75–84 (year) 85 and over (year) Educational status Uneducated Primary school Secondary school High school University Lower extremity pathology Yes No Assistive device User Not user Medication User Not user
2.4. Visual Analog Scale In this study we used Visual Analog Scale to assessed subjects presence or not pain only in the lower extremity. Subjects who have a pain in the lower extremity above the value of 5 in their daily life, these subjects adopted have a pain and subjects who have a pain in the lower extremity under the value of 5 or not have a pain, these subjects adopted have not a pain. During interview participants were asked to bring all their current medicines and full drug history was taken. Hypnotics and anxiolytics, antidepressants central nervous system drugs, analgesics and cardiovascular system drugs were taken into account. And also subjects were asked in terms of usage of assistive device in daily lifes.
Frequency (n)
Percent (%)
127 127
50.0 50.0
101 117 36
39.7 46.1 14.2
32 58 44 72 48
12.6 22.8 17.3 28.3 18.9
110 144
43.3 56.7
89 164
35.0 65.0
199 55
78.4 21.6
2.5. Data analysis All statistical analyses were performed using SPSS for Windows (version 15.0, SPSS Inc., 233 South Wacker Drive, 11th Floor, Chicago, IL, 60606-6307). We used independent samples t test under parametric conditions in order to determine whether there is a statistically differences in terms of the number of answers given as ‘YES’ to the 15 items of the Going Up and Down the Stairs Questionnaire according to the comparison of independent variables such as gender, cognitive status, lower extremity pathology, age, lower extremity pain and use of medication. Statistical analysis between group I and group II in terms of demographic characteristics, lower extremity pain and usage of assistive device and medication were performed by independent samples t test. Pearson correlation analysis was used to identify correlation between the activity of climbing up and down the stairs according to age. A p value of < 0.05 was taken as statistically significant.
3. Results The mean age ± standard deviation of these subjects was 76.57 ± 6.86 years and the gender of 50% (n = 127) of the subjects was female. The number of male and female was enrolled intentionally this way. Baseline socio-demographic characteristics of 254 subjects were listed in Table 1.
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Table 2 Statistical analysis between Group I and Group II in terms of demographic characteristics, lower extremity pain and usage of assistive device and medication
Age (year) Weight (kg) Height (cm) Medication Use, Yes /No Lower Extremity Pain Yes/No Assistive Device Use, Yes/No a Independent
GROUP I (With Lower Extremity Pathology) (n = 110) 77.72 ± 6.97 72.95 ± 13.07 164.13 ± 8.88 93/17 77/33 62/48
GROUP II (Without Lower Extremity Pathology) (n = 144) 75.69 ± 6.67 71.95 ± 12.49 164.40 ± 8.80 106/38 69/75 27/117
p valuea
0.019 0.535 0.807 0.036 0.001 0.001
samples t-test.
Table 3 Distribution of elderly according to their cognitive status SMMSEb score 0–9 score (Serious) 10–19 score (Moderate) 20–25 score (Mild) 26–30 score (Normal) Total b Standardized
Frequency (n) 0 41 79 134 254
Percent (%) 0.0 16.1 31.1 52.8 100.0
Mini Mental State Examination.
Table 2 shows that between group I (n = 110) and group II (n = 144) there were no significant differences in terms of demographic characteristics as height and weight (p > 0.05). However, group I were significantly older than group II. It was found that the number of older adults in group II with having no use of medication, no use assistive device for walking and no lower extremity pain is significantly higher than the number of older adults in group I (p < 0.05). Cognitive status, which assessed by the SMMSE in Table 3. 120 subjects (47.2%) in total have been affected (serious, moderate, and mild) and 134 subjects (52.8%) have not been affected in terms of their cognitive status. Table 4 summarized results as a number and percent given to the 15 items of the Going Up and Down the Stairs Questionnaire for climbing up and down the stairs as ‘YES’ or ‘NO’. Table 5 shows that there were no significant differences in both climbing up and down the stairs affected groups in terms of the gender (p > 0.05). Stair negotiation in terms of cognitive status, subjects as the group of ‘Affected’, and as the group of ‘Unaffected’ it was found that there was no significant difference between these groups in terms of the answers given as ‘YES’ to the 15 items of the inquiry questionnaire for climbing up and down the stairs (p > 0.05). There was statistically significant differences in terms of subjects having lower extremity pathology have more difficulties than the ones having no lower extremity pathology during the climbing up and down the stairs (p
Journal of Back and Musculoskeletal Rehabilitation 28 (2015) 509–516 DOI 10.3233/BMR-140549 IOS Press
Evaluation of stair climbing in elderly people Rüstem Mustafao˘glua, Bayram Unverb,∗ and Vasfi Karatosunc a
Istanbul Physical Therapy and Rehabilitation Research and Training Hospital, Bahçelievler, Istanbul, Turkey Department of Orthopedic Physiotherapy, School of Physiotherapy and Rehabilitation, Dokuz Eylul University, Izmir, Turkey c Department of Orthopaedics and Traumatology, School of Medicine, Dokuz Eylul University, Izmir, Turkey b
Abstract. BACKGROUND: Stair climbing is an important but neglected aspect of independent living. Clinicians should pay attention to the ability to negotiate stairs in elderly and disabled patients. OBJECTIVE: The aim of this study was to determine the effects of age, gender, medication use, cognitive status, lower extremity pathology and pain on the activities of stair negotiation in the elderly population in Turkish society. METHODS: Volunteer elderly people (254) were included the study. Participants were assessed in terms of their medication use, cognitive status, lower extremity pathology and pain and the activity of climbing the stairs. RESULTS: Significant differences were found on the activities of stair negotiation between the elderly with and without lower extremity pathology, with and without lower extremity pain, with and without medication use (p < 0.05). A positive and moderate correlation was found between age and the activity of stair climbing (r = 0.24, p < 0.01). CONCLUSIONS: Activity of stair climbing is affected by age, medication use, the presence of lower extremity pathology and pain. We consider that this information will be helpful for planning an appropriate and effective rehabilitation programme for elderly people for decreasing their risk of falling and increasing their independence level during their activities of daily living. Keywords: Aging, stair negotiation, lower extremity, activities of daily living
1. Introduction The World Health Organization identifies the individuals who were 65 years and over as “elderly” [1]. Average life in Turkey is 69 and the rate of the ones who are older than 65 and over to the total population is 6%. It is foreseen that this rate will reach up to 10% in 2025 [2]. Physiological changes happen in all tissue, organs and system functions with the age [3]. All physiological changes affect adversely the activities of daily living (ADL) [4–6]. The ability to conduct the activities as walking, sit-to-stand and stair negotiation (climbing up and down stairs) is functional activities deter∗ Corresponding author: Bayram Unver, Department of Orthopedic Physiotherapy, School of Physiotherapy and Rehabilitation, Dokuz Eylul University, 35340, Izmir, Turkey. Tel.: +90 2324124928; Fax: +90 2324124946; E-mail: bayram.unver@deu. edu.tr.
mining the independence related to the ADL. The independence level of these activities affects the quality of life and participation to the daily life [7,8]. Disability in ADL became a common problem for elderly adults; they need to get someone’s help in order to make ADL as bathing, going down and climbing up the stairs, walking [9,10]. Along with the loss of functional capacity and abilities, ADL of elderly people are being limited or prevented, their independent functions become more and more semi dependent of entirely dependent and tendency to fall is increasing [8, 11]. Stair climbing is one of the important functional activities of daily living to maintain mobility and independence [12]. The activity of climbing up and down stairs is one of the five activities that elderly people have difficulty at most. Approximately one-third of elderly people live sedentary due to the difficulties they have related to stair negotiation. One out of every three persons with 65 years old and over encounters the risk of fall at least one time per year, and they are taken to
c 2015 – IOS Press and the authors. All rights reserved ISSN 1053-8127/15/$35.00
510
R. Mustafao˘glu et al. / Evaluation of stair climbing in elderly people
the hospital as a result of trauma [11,13]. The rate of death from falling increased 36% between the years of 1999–2003. Elderly people encounter the risk of fall in two circumstances at most which are standing or walking (48%) and climbing up and down the stairs (18%) [11]. The falls may cause illness, losses in the function of movement, bedridden and death [6,8,11, 13]. Physical deficiencies (e.g. sit-to-stand, walking, balance etc.) and sociological characteristics (e.g. anthropometric differences, lifestyles, cultural differences and geographic structure, etc.) cause older people have been handled in several studies [1,13–15]. There has been a lot of researches conducted on the activities of sit-to-stand and walking from the activities as walking, sit-to-stand and climbing up and down the stairs which are known as the determinant of independence in daily life, despite the importance of stair climbing and the high prevalence of limitations in this activity, little is known about the actual limitations in climbing stairs perceived by elderly people [3,4,7,9,13]. Stair climbing is an important but neglected aspect of independent living. Clinicians should pay attention to the ability to negotiate stairs in elderly and disabled patients [12,16]. Therefore, the aim of the study is to determine how the activity of climbing up and down the stairs is affected by the age [5,6], gender [4,5], cognitive status [6,10], lower extremity pathology [7,9] and medication use [17] in the elderly population in Turkish society.
be made for old people accepting to attend this study voluntarily. Assessment forms used in this study have been filled by the physiotherapist by interviewing all the participants face-to-face. Inclusion criteria for the study included, (a) have been determined as living in the nursing homes located in Izmir, (b) being at the age of 65 years and over, (c) having the ability to see through both eyes, (d) being cooperate, (e) having no hearing loss. Exclusion criteria were, (a) having deficiencies in the vestibular system, (b) having sensory disorder in both lower extremities, (c) being bedridden, (d) having the acute cardiovascular disease, (e) having limited diarthrosis movement gaps on highest degree and they could not be included into the study [3,6,9,10]. Participants of this study have been divided into two groups; Group I, has a lower extremity pathology (such as osteoarthritis, rheumatoid arthritis, with a history of broken bones in the lower extremities before, avascular necrosis of the hip, total knee and hip replacement) (n = 110, 55 female/55 male) and Group II, has no lower extremity pathology (n = 144, 72 female/ 72 male). The number of male and female in groups was not by chance, they were enrolled intentionally this way. Going Up and Down the Stairs Questionnaire including 15 items for climbing up and down the stairs [7], Standardized Mini Mental State Examination (SMMSE) [18] and Visual Analog Scale [19] were applied to both groups.
2. Methods
2.2. Going Up and Down the Stairs Questionnaire
2.1. Participants The study is a cross-sectional trial, was carried out at the three different Nursing Homes. The study population consisted of 254 volunteer subjects, those aged 65 and over. Subjects were recruited from Zübeyde Hanim Nursing Home in Metropolitan Municipality, Narlidere Resting and Nursing Home and Izmir Nursing and Rehabilitation Center. Subjects accepting face-to-face interview directly, voluntarily, eligible for including to and excluding from the study was chosen for this study by using randomly sampling method among the ones having no lower extremity pathology and having lower extremity pathology based on any pathology before. Informed confirmation form approved by local ethic committee has been taken from the participants with their signature by explaining them the assessment to
Questionnaire consisting of 15 items, formulated in behavioral terms. The items refer to what a patient actually does, and not to what a patient thinks that he/ she can do. Dichotomous response options (YES box marked/NO box not marked) were chosen to facilitate interpretation [7]. The number of answers given as ‘YES’ to the 15 items of the Going Up and Down the Stairs Questionnaire for climbing up and down the stairs indicates the level of constraint and dependency which was used for questioning the activity related to climbing up and down the stairs for elderly people living in the nursing home. If the number of the answer ‘YES’ is high as a result of the questionnaire conducted, it shows that the participant is constraint and depended in terms of the activity related to climbing up and down the stairs.
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2.3. Standardized Mini Mental State Examination (SMMSE)
Table 1 Baseline socio-demographic characteristics of the participants
The SMMSE is used for comprehensive assessments of older adults. It provides a global score of cognitive ability that correlates with function in activities of daily living. The SMMSE measures various domains of cognitive function including orientation to time and place; registration; concentration; short-term recall; naming familiar items; repeating a common expression; and the ability to read and follow written instructions, write a sentence, construct a diagram, and follow a three-step verbal command. Takes approximately 10 minutes to administer, provides a baseline score of cognitive function, and pinpoints specific deficits that can aid in forming a diagnosis. A total score of 30 indicates no impairment. Scores between 26 and 30 are considered normal in the general population. Patients who score between 25 and 20 have mild cognitive impairment and will be experiencing problems with the instrumental activities of daily living, such as shopping, finances, medication use, and meal preparation, but can usually live on their own with support. Those who score between 20 and 10 have moderate cognitive impairment, usually cannot live independently, and are starting to have problems with basic activities, such as grooming, dressing, and using the toilet. Scores between 9 and 0 denote severe cognitive impairment; patients will be having problems with all basic activities, including eating and walking [18]. In this trial, in terms of statistical analyse subjects cognitive function status scores divided into two groups, first was ‘Affected’ group included moderate (10–19 score) and mild (20–25 score) levels and the second was ‘Unaffected’ group included normal (26–30 score) level.
Gender Female Male Age groups 65–74 (year) 75–84 (year) 85 and over (year) Educational status Uneducated Primary school Secondary school High school University Lower extremity pathology Yes No Assistive device User Not user Medication User Not user
2.4. Visual Analog Scale In this study we used Visual Analog Scale to assessed subjects presence or not pain only in the lower extremity. Subjects who have a pain in the lower extremity above the value of 5 in their daily life, these subjects adopted have a pain and subjects who have a pain in the lower extremity under the value of 5 or not have a pain, these subjects adopted have not a pain. During interview participants were asked to bring all their current medicines and full drug history was taken. Hypnotics and anxiolytics, antidepressants central nervous system drugs, analgesics and cardiovascular system drugs were taken into account. And also subjects were asked in terms of usage of assistive device in daily lifes.
Frequency (n)
Percent (%)
127 127
50.0 50.0
101 117 36
39.7 46.1 14.2
32 58 44 72 48
12.6 22.8 17.3 28.3 18.9
110 144
43.3 56.7
89 164
35.0 65.0
199 55
78.4 21.6
2.5. Data analysis All statistical analyses were performed using SPSS for Windows (version 15.0, SPSS Inc., 233 South Wacker Drive, 11th Floor, Chicago, IL, 60606-6307). We used independent samples t test under parametric conditions in order to determine whether there is a statistically differences in terms of the number of answers given as ‘YES’ to the 15 items of the Going Up and Down the Stairs Questionnaire according to the comparison of independent variables such as gender, cognitive status, lower extremity pathology, age, lower extremity pain and use of medication. Statistical analysis between group I and group II in terms of demographic characteristics, lower extremity pain and usage of assistive device and medication were performed by independent samples t test. Pearson correlation analysis was used to identify correlation between the activity of climbing up and down the stairs according to age. A p value of < 0.05 was taken as statistically significant.
3. Results The mean age ± standard deviation of these subjects was 76.57 ± 6.86 years and the gender of 50% (n = 127) of the subjects was female. The number of male and female was enrolled intentionally this way. Baseline socio-demographic characteristics of 254 subjects were listed in Table 1.
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R. Mustafao˘glu et al. / Evaluation of stair climbing in elderly people
Table 2 Statistical analysis between Group I and Group II in terms of demographic characteristics, lower extremity pain and usage of assistive device and medication
Age (year) Weight (kg) Height (cm) Medication Use, Yes /No Lower Extremity Pain Yes/No Assistive Device Use, Yes/No a Independent
GROUP I (With Lower Extremity Pathology) (n = 110) 77.72 ± 6.97 72.95 ± 13.07 164.13 ± 8.88 93/17 77/33 62/48
GROUP II (Without Lower Extremity Pathology) (n = 144) 75.69 ± 6.67 71.95 ± 12.49 164.40 ± 8.80 106/38 69/75 27/117
p valuea
0.019 0.535 0.807 0.036 0.001 0.001
samples t-test.
Table 3 Distribution of elderly according to their cognitive status SMMSEb score 0–9 score (Serious) 10–19 score (Moderate) 20–25 score (Mild) 26–30 score (Normal) Total b Standardized
Frequency (n) 0 41 79 134 254
Percent (%) 0.0 16.1 31.1 52.8 100.0
Mini Mental State Examination.
Table 2 shows that between group I (n = 110) and group II (n = 144) there were no significant differences in terms of demographic characteristics as height and weight (p > 0.05). However, group I were significantly older than group II. It was found that the number of older adults in group II with having no use of medication, no use assistive device for walking and no lower extremity pain is significantly higher than the number of older adults in group I (p < 0.05). Cognitive status, which assessed by the SMMSE in Table 3. 120 subjects (47.2%) in total have been affected (serious, moderate, and mild) and 134 subjects (52.8%) have not been affected in terms of their cognitive status. Table 4 summarized results as a number and percent given to the 15 items of the Going Up and Down the Stairs Questionnaire for climbing up and down the stairs as ‘YES’ or ‘NO’. Table 5 shows that there were no significant differences in both climbing up and down the stairs affected groups in terms of the gender (p > 0.05). Stair negotiation in terms of cognitive status, subjects as the group of ‘Affected’, and as the group of ‘Unaffected’ it was found that there was no significant difference between these groups in terms of the answers given as ‘YES’ to the 15 items of the inquiry questionnaire for climbing up and down the stairs (p > 0.05). There was statistically significant differences in terms of subjects having lower extremity pathology have more difficulties than the ones having no lower extremity pathology during the climbing up and down the stairs (p
