Gait parameters and characteristics associated with increased risk of falls in people with dementia: a systematic review

Abstract

Background: People with dementia fall twice as often and have more serious fall-related injuries than healthy older adults. While gait impairment as a generic term is understood as a fall risk factor in this population, a clear elaboration of the specific components of gait that are associated with falls risk is needed for knowledge translation to clinical practice and the development of fall prevention strategies for people with dementia.Objective: To review gait parameters and characteristics associated with falls in people with dementia.Methods: Electronic databases CINAHL, EMBASE, MedLine, PsycINFO, and PubMed were searched (from inception to April 2017) to identify prospective cohort studies evaluating the association between gait and falls in people with dementia.Results: Increased double support time variability, use of mobility aids, walking outdoors, higher scores on the Unified Parkinson's Disease Rating Scale, and lower average walking bouts were associated with elevated risk of any fall. Increased double support time and step length variability were associated with recurrent falls. The reviewed articles do not support using the Performance Oriented Mobility Assessment and the Timed Up-and-Go tests to predict any fall in this population. There is limited research on the use of dual-task gait assessments for predicting falls in people with dementia.Conclusion: This systematic review shows the specific spatiotemporal gait parameters and features that are associated with falls in people with dementia. Future research is recommended to focus on developing specialized treatment methods for these specific gait impairments in this patient population.

Enhanced Gait Variability Index in Older Asian Adults and Increased Physiological Fall Risk: Results from the Yishun Study

“…However in this study, we found that increased p step_time_mean was associated with physiological fall risk. Although the alternative parameters, p n ,could not be directly compared with published values of gait variability [due to methodological differences in derivation], our results suggested that the increase in variability of step length -which has been associated with falls, speci cally in populations with cognitive de cits [30] may indicate the strong association between cognitive demands and falls, especially among older adults.…”

Gait speed, cognition and falls in people living with mild-to-moderate Alzheimer disease: data from NILVAD

“…The increased risk represents the interaction of several risk factors such as autonomic symptoms, physical activity profile, orthostatic hypotension and polypharmacy [24]. Several studies have reported associations between spatiotemporal gait parameters and falls risk in older adults with dementia [27], however there are also conflicting results. Many studies have taken place in nursing home or long term care facilities and the association has been less-well explored in community dwelling older adults with a diagnosis of AD, particularly those with mild-to-moderate AD [27].…”

“…Several studies have reported associations between spatiotemporal gait parameters and falls risk in older adults with dementia [27], however there are also conflicting results. Many studies have taken place in nursing home or long term care facilities and the association has been less-well explored in community dwelling older adults with a diagnosis of AD, particularly those with mild-to-moderate AD [27]. Further, most studies on community dwelling older adults with AD have either occurred in cross-section or retrospectively with < 12 months follow up [27].…”

Specific Motor and Cognitive Performances Predict Falls during Ward-Based Geriatric Rehabilitation in Patients with Dementia

“…In this respect, hospitalized persons with dementia represent a particularly vulnerable population with an urgent need for adequate assessment to identify persons with the highest fall risk. To date, various approaches have been used to predict falls in various settings, including clinical assessments with a dual use for clinical routines, such as the geriatric assessment or use as variables for fall prediction [ 22 , 23 ]. These clinical assessments include multiple domains, such as functional, psychological, cognitive, or social status, using different assessment strategies, such as anamnesis (e.g., subjective report on previous falls, use of assistive devices), standardized assessments, using reporting by validated questionnaires or test-based measures (e.g., Falls Efficacy Scale-International (FES-I), Mini-Mental State Examination (MMSE)) and also including established capacity measures, (e.g., Short Physical Performance Battery (SPPB), Timed Up Go (TUG)) [ 24 ].…”

“…Two systematic reviews with a focus on fall risk assessments for PwD documented the inferiority of established clinical fall risk assessment, such as the Performance Oriented Mobility Assessment (POMA) and TUG, compared to objective instrumented measures for gait analysis [ 22 , 23 ].…”