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Gait variability and fall risk in community-living older adults: A 1-year prospective study☆1,☆2,☆3,☆4,☆5,☆6,☆7,☆8

https://doi.org/10.1053/apmr.2001.24893Get rights and content

Abstract

Hausdorff JM, Rios DA, Edelberg HK. Gait variability and fall risk in community-living older adults: a 1-year prospective study. Arch Phys Med Rehabil 2001;82:1050-6. Objective: To test the hypothesis that increased gait variability predicts falls among community-living older adults attending an outpatient clinic. Design: Prospective, cohort study. Setting: Three outpatient geriatric clinics. Participants: Fifty-two community-living, ambulatory men and women aged ≥ 70 years. Interventions: Not applicable. Main Outcome Measures: Subjects walked at a normal pace for up to 6 minutes wearing force-sensitive insoles that measured the gait rhythm on a stride-to-stride basis. Afterward, subjects reported fall status on a weekly basis for 1 year. The primary outcomes were the association between measures of the stride-to-stride fluctuations in gait rhythm and (1) subsequent falls during a 12-month follow-up period and (2) potential contributing factors. Results: Almost 40% of the subjects reported falling during the 12-month follow-up period. Stride time variability was 106 ± 30ms in subjects who subsequently fell (n = 20) and 49 ± 4ms in those who did not experience a fall (n = 32) during the 12-month follow-up period (p <.04). Logistic regression also showed that stride time variability predicted falls (p <.05). Stride time variability correlated significantly with multiple factors including strength, balance, gait speed, functional status, and even mental health, but these other measures did not discriminate future fallers from nonfallers. Conclusions: These findings show both the feasibility of obtaining stride-to-stride measures of gait timing in the ambulatory setting and the potential use of gait variability measures in augmenting the prospective evaluation of fall risk in community-living older adults. © 2001 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation

Section snippets

Subjects

This prospective cohort study was conducted at 3 hospital-affiliated geriatric clinics in the greater Boston area. Patients were recruited from the Beth Israel Deaconess Gerontology Group and the Youville Hospital and Rehabilitation Center outpatient clinics. All ambulatory, community-dwelling patients age 70 years and older who presented to 1 of the study sites were eligible for the study. Patients were excluded if they had severe cognitive impairment (unable to follow simple directions), were

Subject characteristics

Fifty-two subjects (36 women, 16 men) were tested and then followed-up for 12 months. There were no deaths and all subjects were in contact with the research staff on a weekly basis throughout the 1-year follow-up period. The mean age of the subjects was 80.3 ± 5.9 years. Mean height and weight were 161 ± 11cm and 66.9 ± 16.6kg, respectively. In general, the subjects were relatively healthy (CCI score, 0.9 ± 1.3), cognitively intact (MMSE score, 27.8 ± 4.1), and able to perform both basic and

Discussion

This quantitative study of gait variability has several key findings. First, among community-living older adults attending an outpatient geriatric clinic, increased gait variability is associated with an increased risk of future falls. In fact, the likelihood of falling was increased about fivefold with only a moderate increase in stride time variability (table 1). Second, in this population of older adults, measures of variability were not only associated with many factors that are intuitively

Conclusion

It has been suggested that increased gait variability is not an inevitable part of the aging process.21, 45 The present findings support the idea that changes in gait variability are likely to reflect underlying disease processes rather than age-related changes. Previous studies have shown that exercise may restore physiologic capacity and reduce gait variability46 and that exercise, Tai Chi, and other interventions may also be effective in minimizing fall risk.7, 8, 10, 11, 47 Although further

Acknowledgements

The authors thank the staff and patients of the geriatric outpatient clinics for their time and effort.

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    ☆1

    Supported in part by the National Institutes of Health (grant nos. AG11812, AG14100, AG08812, P41-RR13622), and by the American Federation for Aging Research.

    ☆2

    No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the author(s) or upon any organization with which the author(s) is/are associated.

    ☆3

    Reprint requests to Jeffrey M. Hausdorff, PhD, Gerontology Division, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Rm KS-B28, Boston, MA 02215, e-mail: [email protected].

    ☆4

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