Gait disturbances as specific predictive markers of the first fall onset in elderly people: a two-year prospective observational study

Abstract

Falls are common in the elderly, and potentially result in injury and disability. Thus, preventing falls as soon as possible in older adults is a public health priority, yet there is no specific marker that is predictive of the first fall onset. We hypothesized that gait features should be the most relevant variables for predicting the first fall. Clinical baseline characteristics (e.g., gender, cognitive function) were assessed in 259 home-dwelling people aged 66 to 75 that had never fallen. Likewise, global kinetic behavior of gait was recorded from 22 variables in 1036 walking tests with an accelerometric gait analysis system. Afterward, monthly telephone monitoring reported the date of the first fall over 24 months. A principal components analysis was used to assess the relationship between gait variables and fall status in four groups: non-fallers, fallers from 0 to 6 months, fallers from 6 to 12 months and fallers from 12 to 24 months. The association of significant principal components (PC) with an increased risk of first fall was then evaluated using the area under the Receiver Operator Characteristic Curve (ROC). No effect of clinical confounding variables was shown as a function of groups. An eigenvalue decomposition of the correlation matrix identified a large statistical PC1 (termed “Global kinetics of gait pattern”), which accounted for 36.7% of total variance. Principal component loadings also revealed a PC2 (12.6% of total variance), related to the “Global gait regularity.” Subsequent ANOVAs showed that only PC1 discriminated the fall status during the first 6 months, while PC2 discriminated the first fall onset between 6 and 12 months. After one year, any PC was associated with falls. These results were bolstered by the ROC analyses, showing good predictive models of the first fall during the first six months or from 6 to 12 months. Overall, these findings suggest that the performance of a standardized walking test at least once a year is essential for fall prevention.

Gait patterns in COPD: the Rotterdam Study

“…Although causes of falls are often multifactorial, the majority of falls occurs during walking and gait analysis may be the best tool to predict the first fall onset [11,12]. Poor gait is indeed one of the main risk factors of falls and an important indicator of general health [13][14][15].…”

Pharmacologically induced impairment of neurovascular coupling responses alters gait coordination in mice

“…Although there is growing evidence that neurovascular uncoupling contributes to cognitive decline, the role of neurovascular health in gait abnormalities remains elusive. Second, gait dysfunction in older adults is a major cause of functional impairment, contributes to falls, and predicts increased risk of institutionalization and mortality (Mignardot et al 2014;Nakamura et al 1996;Sorond et al 2010;Verghese et al 2009). Third, gait abnormalities were shown to be associated with survival in older adults (Studenski et al 2011).…”

Muscle Spindles and Locomotor Control-An Unrecognized Falls Determinant?

“…Akira et al [71] found that ice immersion, which is a method of reducing muscle spindle function, had a significant impact on the walking velocity of young adult males, suggesting a possible link between muscle spindle function and a decrement in walking ability, a well-accepted falls determinant. Additional related research suggests it is morphological changes of muscle spindles that many environmental hazards exist that increase the proclivity to falling [69,70,72,74] .…”