Evidence for a Selectively Regulated Prioritization Shift Depending on Walking Situations in Older Adults

Background: Older adults are at increased risk of balance problems and falls, particularly during walking and turning in daily life. Changes in task prioritization during dual-task walking may contribute to these deficits. This study investigated whether prioritization strategies in older adults differ between walking situations.

Methods: A total of 1,054 participants aged 50–83 years from the TREND study were classified as good or poor performers on the Trail Making Test (TMT), reflecting differences in cognitive flexibility. Dual-task performance and relative dual-task costs (DTC) were assessed during walking combined with serial subtraction or box checking. Tasks were performed on straight and curved walking paths.

Results: Poor TMT performers showed worse performance in all single and dual tasks. However, DTC patterns differed by walking condition. On straight paths, poor performers showed similar DTC of walking compared to good performers but lower DTC of subtracting. In contrast, on curved paths, poor performers showed similar DTC of subtracting but significantly higher DTC of walking.

Conclusion: These findings indicate a situation-dependent change in task prioritization in older adults. More demanding walking conditions, such as curved paths, shift prioritization toward cognitive tasks at the expense of gait. Situation-dependent prioritization may contribute to gait and balance impairments and increased fall risk in older adults and should be considered in future research.