Prevalence and Burden of Gait Disorders in Elderly Men and Women Aged 60–97 Years: A Population-Based Study

Background Although gait disorders are common in the elderly, the prevalence and overall burden of these disorders in the general community is not well defined. Methods In a cross-sectional investigation of the population-based Bruneck Study cohort, 488 community-residing elderly aged 60–97 years underwent a thorough neurological assessment including a standardized gait evaluation. Gait disorders were classified according to an accepted scheme and their associations to falls, neuropsychological measures, and quality of life were explored. Results Overall, 32.2% (95% confidence interval [CI] 28.2%–36.4%) of participants presented with impaired gait. Prevalence increased with age (p<0.001), but 38.3% (95%CI 30.1%–47.3%) of the subjects aged 80 years or older still had a normally preserved gait. A total of 24.0% (95%CI 20.4%–28.0%) manifested neurological gait disorders, 17.4% (14.3%–21.0%) non-neurological gait problems, and 9.2% (6.9%–12.1%) a combination of both. While there was no association of neurological gait disorders with gender, non-neurological gait disorders were more frequent in women (p = 0.012). Within the group of neurological gait disorders 69.2% (95%CI 60.3%–76.9%) had a single distinct entity and 30.8% (23.1%–39.7%) had multiple neurological causes for gait impairment. Gait disorders had a significant negative impact on quantitative gait measures, but only neurological gait disorders were associated with recurrent falls (odds ratio 3.3; 95%CI 1.4–7.5; p = 0.005 for single and 7.1; 2.7–18.7; p<0.001 for multiple neurological gait disorders). Finally, we detected a significant association of gait disorders, in particular neurological gait disorders, with depressed mood, cognitive dysfunction, and compromised quality of life. Conclusions Gait disorders are common in the general elderly population and are associated with reduced mobility. Neurological gait disorders in particular are associated with recurrent falls, lower cognitive function, depressed mood, and diminished quality of life.

[1]  P. Scheltens,et al.  MRI-Defined Subcortical Ischemic Vascular Disease: Baseline Clinical and Neuropsychological Findings , 2009, Cerebrovascular Diseases.

[2]  R. Lipton,et al.  Epidemiology of Gait Disorders in Community‐Residing Older Adults , 2006, Journal of the American Geriatrics Society.

[3]  Herman Buschke,et al.  Abnormality of gait as a predictor of non-Alzheimer's dementia. , 2002, The New England journal of medicine.

[4]  R. Holtzer,et al.  Transient Versus Persistent Fear of Falling in Community‐Dwelling Older Adults: Incidence and Risk Factors , 2011, Journal of the American Geriatrics Society.

[5]  W. Poewe,et al.  Prevalence of Primary Headaches and Cranial Neuralgias in Men and Women Aged 55–94 Years (Bruneck Study) , 2009, Cephalalgia : an international journal of headache.

[6]  R. Camicioli,et al.  Gait and posture impairment, parkinsonism and cognitive decline in older people , 2007, Journal of Neural Transmission.

[7]  G. Cooke,et al.  Toll-like receptor 4 polymorphisms and atherogenesis. , 2002, The New England journal of medicine.

[8]  James W Mold,et al.  The prevalence, predictors, and consequences of peripheral sensory neuropathy in older patients. , 2004, The Journal of the American Board of Family Practice.

[9]  W. Poewe,et al.  Prevalence of movement disorders in men and women aged 50–89 years (Bruneck Study cohort): a population-based study , 2005, The Lancet Neurology.

[10]  B. Bloem,et al.  Investigation of Gait in Elderly Subjects Over 88 Years of Age , 1992, Journal of geriatric psychiatry and neurology.

[11]  I. McKeith,et al.  SIC Task Force appraisal of clinical diagnostic criteria for parkinsonian disorders , 2003, Movement disorders : official journal of the Movement Disorder Society.

[12]  V. Srikanth,et al.  Gait, gait variability and the risk of multiple incident falls in older people: a population-based study. , 2011, Age and ageing.

[13]  Jeffrey M. Hausdorff,et al.  Executive control deficits as a prodrome to falls in healthy older adults: a prospective study linking thinking, walking, and falling. , 2010, The journals of gerontology. Series A, Biological sciences and medical sciences.

[14]  M. Tinetti.  Clinical practice. Preventing falls in elderly persons. , 2003, The New England journal of medicine.

[15]  P. Scheltens,et al.  Association of gait and balance disorders with age-related white matter changes , 2008, Neurology.

[16]  J G Nutt,et al.  Classification, diagnosis, and etiology of gait disorders. , 2001, Advances in neurology.

[17]  W. Leslie,et al.  Preventing falls in elderly persons. , 2003, The New England journal of medicine.

[18]  C. Marsden,et al.  Human walking and higher‐level gait disorders, particularly in the elderly , 1993, Neurology.

[19]  Allon Goldberg,et al.  Gait disorders: search for multiple causes. , 2005, Cleveland Clinic journal of medicine.

[20]  L. Sudarsky,et al.  Gait disorders: prevalence, morbidity, and etiology. , 2001, Advances in neurology.

[21]  A. Agresti,et al.  Approximate is Better than “Exact” for Interval Estimation of Binomial Proportions , 1998 .

[22]  H. Weiner,et al.  Intensive immunosuppression in progressive multiple sclerosis. A randomized, three-arm study of high-dose intravenous cyclophosphamide, plasma exchange, and ACTH. , 1983, The New England journal of medicine.

[23]  B. Bloem,et al.  Neurological gait disorders in elderly people: clinical approach and classification , 2007, The Lancet Neurology.

[24]  Theo Mulder,et al.  Gait in ageing and associated dementias; its relationship with cognition , 2007, Neuroscience & Biobehavioral Reviews.

[25]  G. Gronseth,et al.  Distal symmetric polyneuropathy: A definition for clinical research , 2005, Neurology.

[26]  M. Albert,et al.  Comparison of neurologic changes in 'successfully aging' persons vs the total aging population. , 1994, Archives of neurology.

[27]  Richard B. Lipton,et al.  Neurological gait abnormalities and risk of falls in older adults , 2010, Journal of Neurology.

[28]  M. Tinetti.  Performance‐Oriented Assessment of Mobility Problems in Elderly Patients , 1986, Journal of the American Geriatrics Society.

[29]  M. Tinetti,et al.  A multifactorial intervention to reduce the risk of falling among elderly people living in the community. , 1994, The New England journal of medicine.

[30]  Diane Podsiadlo,et al.  The Timed “Up & Go”: A Test of Basic Functional Mobility for Frail Elderly Persons , 1991, Journal of the American Geriatrics Society.