Visual dependence in postural control is increased in older adults

Abstract Successful postural control depends on the integration of visual, vestibular, and proprioceptive inputs. With age, postural control degrades, leading to impaired balance and greater fall risk. Understanding how this integration changes over the lifespan is invaluable for designing more effective interventions that enable healthy postural control in older age. Earlier studies measured visual dependence using perceptual tasks or spontaneous sway comparisons across visual conditions. This study evaluates how visual dependence differs between younger and older adults within the postural control mechanism using a Central Sensorimotor Integration (CSMI) test. Eighty healthy adults (n=40, 60-87 years, n=40, 21-52 years) were exposed to small pseudorandom visual scene movements implemented in virtual reality while standing on a compliant surface. Sway responses were measured using virtual reality trackers and interpreted using an established frequency domain balance control model. Model parameters included visual weight, proportional and derivative feedback gains, time delay, and torque feedback gain. Test–retest reliability was assessed in a subgroup (n = 40) and showed excellent intra-class correlation coefficients for visual weight, proportional and derivative feedback gains (ICC = 0.89– 0.96), and lower ICCs for time delay (ICC=0.59) and torque parameters (ICC=0.39). The main difference between age groups was visual dependence, with older adults relying 40% on vision, compared to 33% for the younger group (p = 0.042). No significant group differences were found in other model parameters. Our results provide direct evidence of an increase in visual contribution to posture control with age.