The predictive value of gait speed and maximum step length for falling in community-dwelling older persons

The prediction model of fall risk for the elderly based on gait analysis

INTRODUCTION

Early screening and identification are crucial for fall prevention, and developing a new method to predict fall risk in the elderly can address the current lack of objectivity in assessment tools.

METHODS

A total of 132 elderly individuals over 80 years old residing in some nursing homes in Shanghai were selected using a convenient sampling method. Fall history information was collected, and gait data during a 10-meter walk were recorded. Logistic regression was employed to establish the prediction model, and a nomogram was used to assess the importance of the indicators. The Bootstrap method was utilized for internal validation of the model, while the verification set was used for external validation. The predictive performance of the model was evaluated using the area under the ROC curve, calibration curve, and decision curve analysis (DCA) to assess clinical benefits.

RESULTS

The incidence of falls in the sample population was 36.4%. The Tinetti Gait and Balance Test (TGBT) score (OR = 0.832, 95% CI: 0.734,0.944), stride length (OR = 0.007, 95% CI: 0.000,0.104), difference in standing time (OR = 0.001, 95% CI: 0.000,0.742), and mean stride time (OR = 0.992, 95% CI:0.984,1.000) were identified as significant factors. The area under the ROC curve was 0.878 (95% CI: 0.805, 0.952), with a sensitivity of 0.935 and specificity of 0.726. The Brier score was 0.135, and the Hosmer-Lemeshow test (χ2 = 10.650, P = 0.222) indicated a good fit and calibration of the model.

CONCLUSION

The TGBT score, stride length, difference in standing time, and stride time are all protective factors associated with fall risk among the elderly. The developed risk prediction model demonstrates good discrimination and calibration, providing valuable insights for early screening and intervention in fall risk among older adults.

Relationship between respiratory muscle strength and dynamic balance in older persons requiring care or support: Focusing on the maximal single step length test and maximal double step length test as dynamic balance indices

BACKGROUND

Falls are a major health problem. The relationship between dynamic balance related to falls and respiratory muscle strength related to sarcopenia and frailty is poorly understood.

RESEARCH QUESTION

How do dynamic balance measures, such as maximal single step length test (MSL) and maximal double step length test (MDST), and respiratory muscle strength measures, such as maximal inspiratory (PImax) and maximal expiratory (PEmax), related to the requirement for long-term care or support in older people who live in the community?

METHODS

This was a cross-sectional study of 39 older people (17 men, 22 women) aged ≥ 65 years community-dwelling who were certified as requiring long-term care or support under the Japanese system. The participants' PImax, PEmax, MSL, and MDST results were recorded. The measurement data were evaluated using Pearson's correlation coefficients and multiple regression analysis.

RESULTS

MDST showed a positive correlation with PImax (r = 0.430, p = 0.006) but no correlation with PEmax. MSL showed no correlation with PImax or PEmax. A positive correlation was found between MDST and MSL (r = 0.851, p < 0.001), and multiple regression analysis with MDST as the dependent variable and PImax and MST as independent variables showed significant differences for MSL (p < 0.001) and PImax (p = 0.027).

SIGNIFICANCE

In older people requiring long-term care or support, MDST had a greater association with inspiratory muscle strength compared with MSL. These results suggest the importance of inspiratory muscle strength training and MDST assessment in the prevention of falls in older people requiring long-term care or support.

Change in gait speed and fall risk among community-dwelling older adults with and without mild cognitive impairment: a retrospective cohort analysis

BACKGROUND

Although slow gait speed is an established risk factor for falls, few studies have evaluated change in gait speed as a predictor of falls or considered variability in effects by cognitive status. Change in gait speed may be a more useful metric because of its potential to identify decline in function. In addition, older adults with mild cognitive impairment are at an elevated risk of falls. The purpose of this research was to quantify the association between 12-month change in gait speed and falls in the subsequent 6 months among older adults with and without mild cognitive impairment.

METHODS

Falls were self-reported every six months, and gait speed was ascertained annually among 2,776 participants in the Ginkgo Evaluation of Memory Study (2000-2008). Adjusted Cox proportional hazards models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for fall risk relative to a 12-month change in gait speed.

RESULTS

Slowing gait speed over 12 months was associated with increased risk of one or more falls (HR:1.13; 95% CI: 1.02 to 1.25) and multiple falls (HR:1.44; 95% CI: 1.18 to 1.75). Quickening gait speed was not associated with risk of one or more falls (HR 0.97; 95% CI: 0.87 to 1.08) or multiple falls (HR 1.04; 95% CI: 0.84 to 1.28), relative to those with a less than 0.10 m/s change in gait speed. Associations did not vary by cognitive status (pinteraction = 0.95 all falls, 0.25 multiple falls).

CONCLUSIONS

Decline in gait speed over 12 months is associated with an increased likelihood of falls among community-dwelling older adults, regardless of cognitive status. Routine checks of gait speed at outpatient visits may be warranted as a means to focus fall risk reduction efforts.

Using conditional inference forests to examine predictive ability for future falls and syncope in older adults: Results from The Irish Longitudinal Study on Ageing

BACKGROUND

The extent to which gait and mobility measures predict falls relative to other risk factors is unclear. This study examined predictive accuracy of over 70 baseline risk factors, including gait and mobility, for future falls and syncope using conditional inference forest models.

METHODS

Data from three waves of The Irish Longitudinal Study on Ageing (TILDA), a population-based study of community-dwelling adults aged ≥50 years were used (n=4,706). Outcome variables were recurrent falls, injurious falls, unexplained falls and syncope occurring over four year follow-up. Predictive accuracy was calculated using 5 fold cross-validation; as there was class imbalance, the algorithm was trained using undersampling of the larger class. Classification rate, area under the receiver operating characteristic curve (AUROC) and area under the precision recall curve (PRAUC) assessed predictive accuracy.

RESULTS

Highest overall accuracy was 69.7% for recurrent falls in 50-64 year olds. AUROC and PRAUC were ≤0.69 and ≤0.39 respectively for all outcomes indicating low predictive accuracy. History of falls, unsteadiness while walking, fear of falling, mobility, medications , mental health and cardiovascular health and function were the most important predictors for most outcomes.

CONCLUSIONS

Conditional inference forest models using over 70 risk factors resulted in low predictive accuracy for future recurrent, injurious and unexplained falls and syncope in community-dwelling adults. Gait and mobility impairments were important predictors of most outcomes but did not discriminate well between fallers and non-fallers. Results highlight the importance of multifactorial risk assessment and intervention and validate key modifiable risk factors for future falls and syncope.

Accuracy of Tools to Differentiate Single From Recurrent Fallers Pre-Frail Older Women

Objectives

The objectives of this study were to analyze and compare musculoskeletal and functional performance and present cutoff points to differentiate pre-frail community-dwelling older women regarding their fall history: non fallers (0 falls), fallers (single fall), and recurrent fallers (≥2 falls).

Method

This is a cross-sectional, retrospective study on 90 pre-frail community-dwelling older women (71.2 ± 4.49 years) according to Fried criteria. We assessed peak torque (PT) (isokinetic dynamometer), muscle architecture/mass (ultrasound/dual-energy X-ray absorptometry), and the following functional performance: usual gait speed (UGS), fast gait speed (FGS), walking speed reserve (WSR), cadence and step length, and timed up and go.

Results

The recurrent fallers presented lower UGS (1.12 ± 0.18 vs. 1.29 ± 0.28 m/s; p = 0.05) and isometric PT of knee extensors than the fallers (89.88 ± 20.99 vs. 115.55 ± 23.09 Nm; p = 0.01), and lower FGS than the fallers (1.35 ± 0.26 vs. 1.5 ± 0.29 m/s; p = 0.03) and non-fallers (1.35 ± 0.26 vs. 1.52 ± 0.26 m/s; p = 0.01). The outcomes that differentiated the fallers from the non-fallers were both WSR calculated as a difference (WSRdiff) (≤0.26 m/s) and WSR calculated as a ratio (WSRratio) (≤1.25 m/s), while to differentiate the recurrent fallers from the non-fallers were FGS (≤1.44 m/s) and step length (≤73 cm). The following cutoff points might be used to differentiate recurrent fallers and fallers: UGS (≤1.12 m/s), FGS (≤1.34m/s), step length (≤73 cm), PT knee extension (≤114.2 Nm), PT knee flexion (≤46.3 Nm), and PT ankle dorsiflexion (≤22.1 Nm).

Conclusion

Recurrent fallers community-dwelling pre-frail older women presented a worse musculoskeletal and functional performance when compared to the non-fallers and fallers. Gait speed, step length, PT of both knee extension and flexion, and ankle dorsiflexion can be used to identify both single and recurrent fallers pre-frail older women, contributing to guide interventions and prevent falls and fractures.

Association with sagittal alignment and osteoporosis-related fractures in outpatient women with osteoporosis

The baseline sagittal vertical axis (SVA) and pelvic tilt (PT) are independent risk factors of osteoporosis-related fractures in women with osteoporosis. We clarified the SVA and PT to predict the incidence of osteoporosis-related fractures.

PURPOSE

Sagittal alignment with osteoporosis women deteriorates with advancing age and sagittal alignment may indicate osteoporosis-related fractures in the future. However, whether the sagittal alignment predicts future osteoporosis-related fracture in patients with osteoporosis has not been clarified. We aimed to investigate the association between sagittal alignment and future osteoporosis-related fractures.

METHODS

This was a retrospective cohort study. Of the 313 participants (mean follow-up period, 2.9 years), 236 were included in the analysis. At baseline, we measured bone mineral density (BMD) of the lumbar spine and the femoral neck, sagittal vertical axis (SVA), thoracic kyphosis, pelvic incidence minus lumbar lordosis, sacral slope, pelvic tilt (PT), geriatric locomotive function scale (GLFS), two-step value, and stand-up test. The information on medications and the duration of treatment were reviewed from the medical records. Additionally, participants reported their history of falls at baseline. Multiple logistic regression analysis was used to determine the association of future osteoporosis-related fracture, and adjusted Odds ratios (OR) and 95% confidence interval (CI) were calculated with all predictors as covariates. All continuous variables were calculated using standardized OR (sOR).

RESULTS

Osteoporosis-related fractures occurred in 33 of 313 participants (10.5%). Multiple logistic regression analysis showed that a history of falls (OR =4.092, 95% CI: 1.029-16.265, p =0.045), SVA (sOR =4.228, 95% CI: 2.118-8.439, p <0.001), and PT (sOR =2.497, 95% CI: 1.087-5.733, p =0.031) were independent risk factors for future osteoporosis-related fractures.

CONCLUSIONS

This study revealed the SVA and PT to predict osteoporosis-related fractures.

TRIAL REGISTRATION NUMBER AND DATE OF REGISTRATION

UMIN000036516 (April 1, 2019).

The effect of the interaction between fall-related self-efficacy and gait function on the occurrence of falls in community-dwelling older people

Background

Fall-related self-efficacy and gait function are known to be associated. However, whether the interaction between fall-related self-efficacy and gait function affects future falls has not been investigated.

Aim

The aim of this study was to investigate the effect of the interaction between fall-related self-efficacy and spatiotemporal gait parameters on the occurrence of falls in community-dwelling older people.

Methods

A total of 265 elderly persons (age ≥ 65 years) living independently in the community were recruited. For gait function, spatiotemporal gait parameters at usual and maximum effort paces were measured using a 2.4-m walkway system with embedded pressure sensors. Furthermore, changes in gait parameters between usual and maximum paces were calculated (Δgait parameters). Fall-related self-efficacy was assessed using the short version of the Falls Efficacy Scale International (Short FES-I). The occurrence of falls was prospectively investigated 6 months later. The effect of the interaction between short FES-I and gait parameters on falls was analyzed using logistic regression analysis adjusted for confounding factors.

Results

Several gait parameters were significantly different by self-efficacy level. As for the effect of the interaction of fall-related self-efficacy and gait parameters on falls, smaller Δgait parameters in those with high efficacy were associated with higher odds ratios of falls, whereas Δgait parameters in those with low efficacy were not associated with falls.

Discussion and conclusions

The interaction between fall-related self-efficacy and gait function appeared to affect future falls. Assessments combining fall-related self-efficacy and gait function may improve the accuracy of prediction of future falls.

Practical and validated tool to assess falls risk in the primary care setting: a systematic review

OBJECTIVE

Although several falls risk assessment tools are available, it is unclear which have been validated and which would be most suitable for primary care practices. This systematic review aims to identify the most suitable falls risk assessment tool for the primary care setting (ie, requires limited time, no expensive equipment and no additional space) and that has good predictive performance in the assessment of falls risk among older people living independently.

DESIGN

A systematic review based on prospective studies.

METHODS

An extensive search was conducted in the following databases: PubMed, Embase, CINAHL, Cochrane and PsycINFO. Tools were excluded if they required expensive and/or advanced software that is not usually available in primary care units and if they had not been validated in at least three different studies. Of 2492 articles published between January 2000 and July 2020, 27 were included.

RESULTS

Six falls risk assessment tools were identified: Timed Up and Go (TUG) test, Gait Speed test, Berg Balance Scale, Performance Oriented Mobility Assessment, Functional Reach test and falls history. Most articles reported area under the curve (AUC) values ranging from 0.5 to 0.7 for these tools. Sensitivity and specificity varied substantially across studies (eg, TUG, sensitivity:10%-83.3%, specificity:28.4%-96.6%).

CONCLUSIONS

Given that none of the falls risk assessment tools had sufficient predictive performance (AUC <0.7), other ways of assessing high falls risk among independently living older people in primary care should be investigated. For now, the most suitable way to assess falls risk in the primary care setting appears to involve asking patients about their falls history. Compared with the other five tools, the falls history requires the least amount of time, no expensive equipment, no training and no spatial adjustments. The clinical judgement of healthcare professionals continues to be most important, as it enables the identification of high falls risk even for patients with no falls history.

TRIAL REGISTRAION NUMBER

The Netherlands Trial Register, NL7917; Pre-results.

Dynamic alignment changes during level walking in patients with dropped head syndrome: analyses using a three-dimensional motion analysis system

In patients with dropped head syndrome (DHS), cervical malalignment is one of the risk factors for impaired horizontal gaze and restrictions to ambulation. The characteristics of gait in patients with DHS have not been clarified biomechanically from the viewpoint of dynamic alignment and lower limb kinematics. This study aimed to clarify kinematic and kinetic differences during level walking in patients with DHS compared to the healthy elderly. Twelve patients with DHS and healthy elderly individuals performed level walking at a self-selected speed. Spatiotemporal, kinematic, and kinetic data were recorded using a three-dimensional motion analysis system. Statistical analysis was performed to compare these data between the two groups, respectively. Compared with the healthy elderly, stride length and peak hip-joint extension angle in patients with DHS were significantly shorter and smaller. The thorax was also significantly tilted backwards. Peak ankle-joint plantar-flexion moment was significantly smaller despite larger dorsiflexion angle compared with the healthy elderly. The walking of DHS patients demonstrated kinematic and kinetic characteristics of the lower limb joints and alignment of the thorax and pelvis corresponding to their short stride and walking speed.

Stand-up test predicts occurrence of non-traumatic vertebral fracture in outpatient women with osteoporosis

INTRODUCTION

The purpose of this retrospective study was to clarify the incidence of non-traumatic vertebral fracture among outpatient women with osteoporosis and to determine whether the stand-up test predicted the occurrence of non-traumatic vertebral fracture.

MATERIALS AND METHODS

A total of 242 postmenopausal women over 60 years of age who received outpatient osteoporosis treatment at our hospital between November 2013 and July 2020 were longitudinally evaluated in this study. We obtained medical information and radiographic parameters, including sagittal vertical axis, thoracic kyphosis, pelvic incidence, lumbar lordosis, pelvic tilt, and sacral slope at baseline. Additionally, we measured physical parameters, including height, weight, body mass index, lumbar bone mineral density, visual analog scale score for pain, and the stand-up test.

RESULTS

Vertebral fractures occurred in 20 of 242 participants (8.3%), and accounted for 48.8% the 41 total fractures in the study group. Among vertebral fractures, eight (40.0%) were traumatic, resulting from falls, and 12 (60.0%) were non-traumatic. Cox multivariate logistic regression analysis adjusted for age, body mass index, lumbar bone mineral density, and the time to non-traumatic vertebral fracture showed that the sagittal vertical axis (HR = 1.013, 95% CI 1.001-1.026), stand-up test score (HR = 3.977, 95% CI 1.156-13.683), and presence of difficulty with standing from a 20-cm-high seat using both legs (HR = 3.329, 95% CI 1.625-6.82) were independent risk factors for the occurrence of non-traumatic vertebral fracture.

CONCLUSION

The stand-up test may be useful as a simple screening tool for non-traumatic vertebral fracture in patients with osteoporosis.

Stepping impairment and falls in older adults: A systematic review and meta-analysis of volitional and reactive step tests

OBJECTIVE

To systematically examine stepping performance as a risk factor for falls. More specifically, we examined (i) if step tests can distinguish fallers from non-fallers and (ii) the type of step test (e.g. volitional vs reactive stepping) that is required to distinguish fallers from non-fallers.

DATA SOURCE

PubMed, EMBASE, CINAHL, Cochrane Database of Systematic Reviews and reference lists of included articles.

STUDY SELECTION

Cross-sectional and cohort studies that assessed the association between at least one step test and falls in older people (age ≥ 60 and/or mean age of 65).

RESULTS

A meta-analysis of 61 studies (n = 9536) showed stepping performance was significantly worse in fallers compared to non-fallers (Cohen'sd 0.56, 95 % CI 0.48 to 0.64, p < 0.001, I2 66 %). This was the case for both volitional and reactive step tests. Twenty-three studies (n = 3615) were included in a diagnostic meta-analysis that showed that step tests have moderate sensitivity (0.70, 95 % CI 0.62 to 0.77), specificity (0.68, 95 % CI 0.58 to 0.77) and area under the receiver operating characteristics curve (AUC) (0.75, 95 % CI 0.59 to 0.86) in discriminating fallers from non-fallers.

CONCLUSIONS

This large systematic review demonstrated that both volitional and reactive stepping impairments are significant fall risk factors among older adults. Step tests can identify fallers from non-fallers with moderate accuracy.

Predicting Short-Term Risk of Falls in a High-Risk Group With Dementia

OBJECTIVES

To develop a prognostic model to predict the probability of a short-term fall (within the next 7 to 30 days) in older adults with dementia.

DESIGN

Prospective observational study.

SETTING AND PARTICIPANTS

Fifty-one individuals with dementia at high risk of falls from a specialized dementia inpatient unit.

METHODS

Clinical and demographic measures were collected and a vision-based markerless motion capture was used to record the natural gait of participants over a 2-week baseline. Falls were tracked throughout the length of stay. Cox proportional hazard regression analysis was used to build a prognostic model to determine fall-free survival probabilities at 7 days and at 30 days. The model's discriminative ability was also internally validated.

RESULTS

Fall history and gait stability (estimated margin of stability) were statistically significant predictors of time to fall and included in the final prognostic model. The model's predicted survival probabilities were close to observed values at both 7 and 30 days. The area under the receiver operating curve was 0.80 at 7 days, and 0.67 at 30 days and the model had a discrimination performance (the Harrel concordance index) of 0.71.

CONCLUSIONS AND IMPLICATIONS

Our short-term falls risk model had fair to good predictive and discrimination ability. Gait stability and recent fall history predicted an imminent fall in our population. This provides some preliminary evidence that the degree of gait instability may be measureable in natural everyday gait to allow dynamic falls risk monitoring. External validation of the model using a separate data set is needed to evaluate model's predictive performance.

Stride length of elderly patients with lumbar spinal stenosis: Multi-center study using the Two-Step test

BACKGROUND

Short stride length is one of clinical symptoms associated with lumbar spinal stenosis (LSS). Short stride is a risk factor for falls; therefore, identification of factors associated with short stride is critical for fall prevention in LSS patients. Although the Two-Step test can conveniently assess maximal stride length, it has not become widely used; therefore, its data are limited. We identified the potential factors associated with short stride of elderly LSS patients using Two-Step test.

METHODS

Clinical data of patients aged >65 years who planned to undergo surgery for LSS were prospectively collected at multiple institutions. Patients were assessed with the Two-Step test and Timed Up-and-Go Test prior to surgery; 357 consecutive patients were enrolled. We determined the cut-off value of the Two-Step test score for short stride, referring to the Timed Up-and-Go Test score of 13.5 s, used to indicate high risk of falls in elderly individuals. Logistic regression model was constructed to identify factors associated with short stride.

RESULTS

The Two-Step test score showed moderate-to-strong inverse correlation with that of Timed Up-and-Go Test (r = -0.65, p < 0.001). Using the tentative Two-Step test cut-off value (0.93) for short stride, multivariable analysis showed that age ≥80 years (OR = 2.3, 95% CI:1.1-4.8), a score of <60 for lumbar function in Japanese Orthopedic Association Back Pain Evaluation Questionnaire (OR = 2.7, 95% CI:1.5-4.7), motor deficit (OR = 2.7, 95% CI:1.2-6.1), and sagittal vertical axis ≥50 mm (OR = 2.1, 95% CI:1.2-3.5) were factors significantly associated with short stride in elderly patients with LSS.

CONCLUSIONS

Using the Two-Step test, we found that 80 years old and over, lumbar dysfunction, motor deficit of the lower extremities, and forward-bent posture were associated with short stride in LSS patients. Therefore, elderly LSS patients with these conditions may have a higher risk for falls.

Simulating the effects of a clinical guidelines screening algorithm for fall risk in community dwelling older adults

Background

The current guidelines for fall prevention in community-dwelling older adults issued by the American Geriatrics Society and British Geriatrics Society (AGS/BGS) indicate an algorithm for identifying who is at increased risk of falling. The predictive accuracy of this algorithm has never been assessed, nor have the consequences that its introduction in clinical practice would bring about.

Aims

To evaluate this risk screening algorithm, estimating its predictive accuracy and its potential impact.

Methods

The analyses are based on 438 community-dwelling older adults, participating in the InCHIANTI study. We analysed different tests for gait and balance assessment. We compared the AGS/BGS algorithm with alternative strategies for fall prevention not based on fall risk evaluation.

Results

The AGS/BGS screening algorithm (using TUG, cut-off 13.5 s) has a sensitivity for single falls of 35.8% (95% confidence interval 23.2%–52.7%) and a specificity of 84.0% (79.3%–88.4%). It marks 18.0% (13.7%–22.4%) of the older population as at high risk. A policy of targeting people with preventive intervention regardless of their individual risk could be as effective as the policy based on risk screening but at the price of intervening on 17.3% (4.1%–34.0%) more people of the older population.

Discussion

This study is the first that validates and estimates the impact of the screening algorithm of these guidelines. Main limitations are related to some modelling assumptions.

Conclusions

The AGS/BGS screening algorithm has low sensitivity. Nevertheless, its adoption would bring benefits with respect to policies of preventive interventions that act regardless of individual risk assessment.

Electronic supplementary material

The online version of this article (10.1007/s40520-018-1051-5) contains supplementary material, which is available to authorized users.

The spatial parameters of gait and their association with falls, functional decline and death in older adults: a prospective study

Association between spatial gait parameters and adverse health outcomes in the elderly has not been sufficiently studied. The goal of this study is to evaluate whether the stride length or the step width predict falls, functional loss and mortality. We conducted a prospective cohort study on a probabilistic sample of 431 noninstitutionalized, older-than-64-years subjects living in Spain, who were followed-up for five years. In the baseline visit, spatial gait parameters were recorded along with several control variables, with special emphasis on known medical conditions, strength, balance and functional and cognitive capacities. In the follow-up calls, vital status, functional status and number of falls from last control were recorded. We found that a normalized-to-height stride length shorter than 0.52 predicted recurrent falls in the next 6 months with 93% sensitivity and 53% specificity (AUC: 0.72), and in the next 12 months with 81% sensitivity and 57% specificity (AUC: 0.67). A normalized stride length <0.5 predicted functional loss at 12 months with a sensitivity of 79.4% and specificity of 65.6% (AUC: 0.75). This predictive capacity remained independent after correcting for the rest of risk factors studied. Step-with was not clearly related to functional loss or falls. Both shorter normalized stride length (OR1.56; AUC: 0.62; p < 0.05) and larger step width (OR1.42; AUC: 0.62; p < 0.05) were associated with risk of death at 60 months; however, none of them remained as independent predictor of death, after correcting for other risk factors. In summary, spatial gait parameters may be risk markers for adverse outcomes in the elderly. Step length is independently associated with functional loss and falls at one year, after correction for numerous known risk factors.

Estimation of reduced walking speed using simple measurements of physical and psychophysiological function in community-dwelling elderly people: a cross-sectional and longitudinal study

BACKGROUND

Early detection of reduced mobility function is important in elderly people. Usual walking speed is useful to assess mobility function, but is often not feasible in a community setting.

AIMS

This study aimed to explore a simple surrogate indicator of usual walking speed in elderly people.

METHODS

The participants were 516 community-dwelling elderly people. As a baseline survey, the usual walking speed and candidates of surrogate indicators including physical function and psychophysiological function were measured. After 2 years, the occurrence of mobility limitation was assessed.

RESULTS

In cross-sectional analysis, a linear regression model with maximum step length, age, and sex presented the most favourable adjusted R² of 0.426 for estimating usual walking speed. Maximum step length (MSL) also showed good predictive accuracy for usual walking speed < 0.8 m/s {area under the curve [AUC] 0.908 [95% confidence interval (CI) 0.811, 1.000]} and < 1.0 m/s [AUC 0.883 (95% CI) 0.832, 0.933)] in receiver-operating characteristic (ROC) analysis. In longitudinal analysis, the predictive accuracy of MSL for mobility limitation [AUC 0.813 (95% CI 0.752, 0.874)] was similar to that of usual walking speed [AUC 0.808 (95% CI 0.747, 0.869)] in ROC analysis.

CONCLUSIONS AND DISCUSSION

The results of this study suggest that MSL may serve as a simple surrogate indicator of UWS in elderly people.

Characteristics of ataxic gait in familial dysautonomia patients

Introduction and objectives

Progressive ataxic gait is a common symptom in individuals with Familial Dysautonomia (FD). At least 50% of adults with FD require assistance with walking. Our aims were to describe the medical condition of individuals with FD (ii) compare their gait characteristics to healthy individuals, and (iii) assess correlations between gait measures, presence of unstable gait pattern and frequency of falls.

Methods

Twelve subjects with FD (7 males, age 25.3±10.6 years) and 16 healthy participants (6 males, age 35.9±11.9 years) were recruited. Gait kinematics, gait symmetry, dynamic muscle activity, and foot deep vibration sensation were recorded.

Results

Ataxic gait degrees were: severe (6 out of 12), moderate (4 out of 12) and low (2 out of 12). The number of falls correlated with base width asymmetry. Crouch gait was noted in 3 out of 12 of the subjects.

Conclusions

In-depth quantitative gait analysis of individuals with FD revealed ataxic gait. The ataxic pattern might be a result of combined neurological deficiencies and osseous deformities. Increasing the base of support of patients with FD might increase the symmetry of the base width during gait and decrease the number of falls. Additionally, perturbation treatment and dynamic balance exercises may be recommended in order to improve compensatory strategies. Future investigation of this population should include quantification of osseous rotations of the lower limb in order to fully understand its effect on their gait pattern and falls.

Does functional capacity, fall risk awareness and physical activity level predict falls in older adults in different age groups?

The aims of this study were to examine whether: i) functional capacity and physical activity level differ between fallers and non-fallers older adults, by controlling for fall risk awareness; ii) functional capacity, fall risk awareness and physical activity differ between fallers and non-fallers older adults, by controlling for age; iii) variables and which may predict falls in different age groups. 1826 older adults performed a series of functional tests and reported their fall episodes, fall risk awareness and physical activity level. The overall incidence of falls was high (40.2%), and falls risk awareness scores reduced with age. The older adults with greater falls risk awareness and non-fallers presented better scores in all functional tests and physical activity level (P < .05). Functional tests and falls risk awareness differed among age groups and differed between fallers and non-fallers, irrespective of age group (P < .05). Falls risk awareness predicted falls in all age groups (odds ranging: 1.05-1.09). Handgrip strength and balance scores predicted falls until 79 years (OR = 1.04, 95%CI = 1.01-1.06). The physical activity level predicted falls up to 70 years (OR = 1.09, 95%CI = 1.06-1.12). Functional mobility was able to predict falls up to 80 years (OR = 1.06, 95%CI = 1.01-1.08). Therefore, according to age, functional capacity, physical activity level and falls risk awareness can be a predictor of falls in older adults.

Timed Up and Go Test can predict recurrent falls: a longitudinal study of the community-dwelling elderly in China

Purpose

Falling is a major health problem in community-dwelling elderly individuals. The aim of the present study was to conduct a prospective investigation to evaluate the accuracy of the Timed Up and Go Test (TUGT), 4-meter walking test, and grip strength test to screen for the risk of falls and to determine a cutoff point to be used clinically.

Patients and methods

This was a prospective study that included 541 participants. The fall data were obtained via face-to-face interview, and the date, site, and circumstances of any falls were recorded. TUGTs were recorded as part of a comprehensive geriatric assessment. We collected the same data at baseline and after follow-up via comprehensive geriatric assessment.

Results

The incidence of falls of our study subjects was 20.8%. The recurrent-fall group had a fall rate of 6.8% during the follow-up year. The standard area under the curve (AUC) of our screening tool was >0.70, and hence our tool can be used for clinical purposes. After adjusting for age and gender, the AUC of TUGT became 0.642, so it cannot be used as a predictive tool for measuring any types of falls. However, when recurrent falls were adjusted for age and gender, the TUGT’s AUC improved to 0.733 and a score of 15.96 seconds is used as a cut-point to screen recurrent falls in community-dwelling elderly Chinese individuals.

Conclusion

Future falls were best predicted by TUGT in recurrent fallers at baseline. A score of 15.96 seconds is used as a cut-point to screen recurrent falls in community-dwelling elderly Chinese individuals.

Head flexion and different walking speeds do not affect gait stability in older females

Head flexion is destabilizing in older individuals during quiet stance, yet the effect head flexion has on gait is not known. The study examined whether head flexion and gait parameters were altered when walking freely and fixed to a visual target, at different walking speeds. 15 young (23±4years) and 16 older (76±6years) healthy females walked at three different walking speeds (slow, comfortable, and fast) under two visual conditions (natural and fixed [focusing on a visual target set at eye level]). Head flexion was assessed using 2D video analysis, whilst gait parameters (step length, double support time, step time, and gait stability ratio) were recorded during a 9m flat walkway. A mixed design ANOVA was performed for each variable, with age as the between-subject factor and, visual condition and walking speed as within-subject factors. When walking freely, older displayed a greater need for head flexion between walking speeds (P<0.05) when compared to young. Walking under fixed condition reduced head flexion at all walking speeds in the older (P<0.05), but had no effect on the young (P>0.05). Walking at different speeds showed no difference in head flexion when walking under either visual condition and had no effect on gait stability for both groups. Despite older displaying differences in head flexion between visual conditions, there was no effect on gait parameters. Walking speed presented trivial difference in head flexion in older females, whilst overall gait stability was unaffected by different walking speeds.

[Subjective Gait Stability in the Elderly]

BACKGROUND

It can be assumed that the feeling of gait stability or gait instability in the elderly may be independent of a possible fear of falling or a history of falling when walking. Up to now, there has been a lack of spatiotemporal gait parameters for older people who subjectively feel secure when walking.

OBJECTIVE

The aim of the study is to analyse the distribution of various gait parameters for older people who subjectively feel secure when walking.

MATERIALS AND METHODS

In a cross-sectional study, the gait parameters stride time, step time, stride length, step length, double support, single support, and walking speed were measured using a Vicon three-dimensional motion capture system (Plug-In Gait Lower-Body Marker Set) in 31 healthy people aged 65 years and older (mean age 72 ± 3.54 years) who subjectively feel secure when walking.

RESULTS

There was a homogeneous distribution in the gait parameters examined, with no abnormalities. The mean values have a low variance with narrow confidence intervals.

CONCLUSION

This study provides evidence that people who subjectively feel secure when walking demonstrate similarly objective gait parameters..

Feasibility of repeated self-measurements of maximum step length and gait speed by community-dwelling older persons

OBJECTIVES

Self-management of mobility and fall risk can be important in fall prevention; however, it remains unstudied. Therefore, the current study assessed whether community-dwelling older persons were able to repeatedly self-assess maximum step length (MSL) and gait speed (GS) in their own home for a 6-month period, how these tests changed during this period and if these changes were related to falling.

DESIGN

This is a prospective study.

SETTING

This study was conducted at home.

PARTICIPANTS

A total of 56 community-dwelling older adults (24 women (43%), mean age 76.2 (SD 3.9) years) entered the study; of which, 45 completed the study.

METHODS

Participants performed MSL and GS once a week in their own home during a 6-month period.

PRIMARY AND SECONDARY OUTCOMES

Repeated MSL and GS measurements were the primary outcomes. Falls, self-management and mobility were the secondary outcomes.

RESULTS

Self-assessment of MSL and GS by older persons is feasible. Compliance of repeatedly self-measuring MSL and GS was good; the median number of weekly measurements was 23.0 (88%) and 21.0 (81%) for MSL and GS, respectively. Drop-outs showed less self-management abilities compared to the participants who completed the study (p=0.049). Linear mixed models showed a small significant improvement in MSL and GS over time (p<0.001), without an influence on falling.

CONCLUSIONS

Most community-dwelling older persons are able and willing to repeatedly assess their MSL and GS. Self-managing mobility and fall risk did not increase fall occurrence. The fact that older persons can be actively involved in their own healthcare is clinically relevant. Further studies are needed to examine the (cost-)effectiveness of self-management in fall prevention interventions.

Mobility and Muscle Strength Together are More Strongly Correlated with Falls in Suburb-Dwelling Older Chinese

Falls are common in older adults and result in adverse outcomes. Impaired mobility and poor muscle strength have been consistently identified as the main contributors to falls. We choose three easy-to-perform tests (i.e. Timed Up and Go test (TUGT), walking speed (WS) and grip strength (GS)) in order to assess mobility and muscle strength to further define their relationship with falls. This study is cross-sectional, consisting of 1092 residents over 60-year-old; 589 were female. 204 (18.68%) participants reported falling at least once in the past year. It was found that, of the three tests evaluated independently, a TUGT < 9.1750 s had the strongest association with fewer falls. When evaluating these tests as pairs, the combination of a TUGT < 9.1750 s and a WS < 0.9963 m/s was the best protective indicator of falls after adjusting for age, sex and other variables. When evaluating all three tests in conjunction with each other, the combination of a TUGT < 9.1750 s, a WS < 0.9963 m/s, and a GS > 0.3816 was most correlated with less possibility of falls. The combination of a better TUGT performance, a stronger GS, and a slower WS is the most strongly correlated with less possibility of falls.

Effects of age and step length on joint kinetics during stepping task

Following a balance perturbation, a stepping response is commonly used to regain support, and the distance of the recovery step can vary. To date, no other studies have examined joint kinetics in young and old adults during increasing step distances, when participants are required to bring their rear foot forward. Therefore, the purpose of this study was to examine age-related differences in joint kinetics with increasing step distance. Twenty young and 20 old adults completed the study. Participants completed a step starting from double support, at an initial distance equal to the individual's average step length. The distance was increased by 10% body height until an unsuccessful attempt. A one-way, repeated measures ANOVA was used to determine the effects of age on joint kinetics during the maximum step distance. A two-way, repeated measures, mixed model ANOVA was used to determine the effects of age, step distance, and their interaction on joint kinetics during the first three step distances for all participants. Young adults completed a significantly longer step than old adults. During the maximum step, in general, kinetic measures were greater in the young than in the old. As step distance increased, all but one kinetic measure increased for both young and old adults. This study has shown the ability to discriminate between young and old adults, and could potentially be used in the future to distinguish between fallers and non-fallers.