Are the spatio-temporal parameters of gait capable of distinguishing a faller from a non-faller elderly?

Fall is a common and a major cause of injuries. It is important to find elderlies who are prone to falls. The majority of serious falls occur during walking among the older adults. Analyzing the spatio-temporal parameters of walking is an easy way of assessment in the clinical setting, but is it capable of distinguishing a faller from a non-faller elderly? Through a systematic review of the literature, the objective of this systematic review was to identify and summarize the differences in the spatio-temporal parameters of walking in elderly fallers and non-fallers and to find out if these parameters are capable of distinguishing a faller from a non-faller. All original research articles which compared any special or temporal walking parameters in faller and non-faller elderlies were systematically searched within the Scopus and Embase databases. Effect size analysis was also done to standardize findings and compare the gait parameters of fallers and non-fallers across the selected studies. The electronic search led to 5381 articles. After title and abstract screening 30 articles were chosen; further assessment of the full texts led to 17 eligible articles for inclusion in the review. It seems that temporal measurements are more sensitive to the detection of risk of fall in elderly people. The results of the 17 selected studies showed that fallers have a tendency toward a slower walking speed and cadence, longer stride time, and double support duration. Also, fallers showed shorter stride and step length, wider step width and more variability in spatio-temporal parameters of gait. According to the effect size analysis, step length, gait speed, stride length and stance time variability were respectively more capable of differentiating faller from non-faller elderlies. However, because of the difference of methodology and number of studies which investigated each parameter, these results are prone to imprecision. Spatio-temporal analysis of level walking is not sufficient and cannot act as a reliable predictor of falls in elderly individuals.

[1]  M. Gossman,et al.  Balance performance and step width in noninstitutionalized, elderly, female fallers and nonfallers. , 1989, Physical therapy.

[2]  R. Wood,et al.  Falls Risk Factors and a Compendium of Falls Risk Screening Instruments , 2010, Journal of geriatric physical therapy.

[3]  T. Masud,et al.  Epidemiology of falls. , 2001, Age and ageing.

[4]  Vanessa Gomes Da Silva,et al.  Influence of Frailty and Falls on Functional Capacity and Gait in Community-Dwelling Elderly Individuals , 2012 .

[5]  Benno M. Nigg,et al.  Gait characteristics as a function of age and gender , 1994 .

[6]  G. Gehlsen,et al.  Falls in the elderly: Part I, Gait. , 1990, Archives of physical medicine and rehabilitation.

[7]  Arthur J. Nelson,et al.  The functional ambulation performance of elderly fallers and non-fallers walking at their preferred velocity , 1999 .

[8]  C. Becker,et al.  Cost of falls in old age: a systematic review , 2010, Osteoporosis International.

[9]  R. Newton,et al.  Relationship between balance and gait stability in healthy older adults. , 2004, Journal of aging and physical activity.

[10]  J. Collins,et al.  Kinetic alterations independent of walking speed in elderly fallers. , 2000, Archives of physical medicine and rehabilitation.

[11]  Y. Lajoie,et al.  Step Length Variability at Gait Initiation in Elderly Fallers and Non-Fallers, and Young Adults , 2002, Gerontology.

[12]  D. Winter,et al.  Biomechanical walking pattern changes in the fit and healthy elderly. , 1990, Physical therapy.

[13]  L. Wolfson,et al.  Gait assessment in the elderly: a gait abnormality rating scale and its relation to falls. , 1990, Journal of gerontology.

[14]  P O Riley,et al.  Reduced hip extension during walking: healthy elderly and fallers versus young adults. , 2001, Archives of physical medicine and rehabilitation.

[15]  Murray Mp,et al.  Kinematic and EMG patterns during slow, free, and fast walking , 1984, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[16]  R. Cromwell,et al.  Adaptive changes in gait of older and younger adults as responses to challenges to dynamic balance. , 2008, Journal of aging and physical activity.

[17]  E. McAuley,et al.  Gait adjustments in older adults: activity and efficacy influences. , 1998, Psychology and aging.

[18]  M. Lusardi.  Using Walking Speed in Clinical Practice: Interpreting Age-, Gender-, and Function-Specific Norms , 2012 .

[19]  B. Auvinet,et al.  Accelerometric gait analysis for use in hospital outpatients. , 1999, Revue du rhumatisme.

[20]  Joji Onishi,et al.  Physical and functional factors in activities of daily living that predict falls in community‐dwelling older women , 2011, Geriatrics & gerontology international.

[21]  P. Kannus,et al.  Prevention of falls and consequent injuries in elderly people , 2005, The Lancet.

[22]  A Thevenon,et al.  Identification of healthy elderly fallers and non-fallers by gait analysis under dual-task conditions , 2006, Clinical rehabilitation.

[23]  S. Studenski,et al.  Too much or too little step width variability is associated with a fall history in older persons who walk at or near normal gait speed , 2005, Journal of NeuroEngineering and Rehabilitation.

[24]  S. Cummings,et al.  Risk factors for injurious falls: a prospective study. , 1991, Journal of gerontology.

[25]  Siv Sadigh,et al.  Falls and Fall-Related Injuries Among the Elderly: A Survey of Residential-Care Facilities in a Swedish Municipality , 2004, Journal of Community Health.

[26]  B. Auvinet,et al.  Gait Abnormalities in Elderly Fallers , 2003 .

[27]  P Laippala,et al.  Physiological factors and medications as predictors of injurious falls by elderly people: a prospective population-based study. , 1996, Age and ageing.

[28]  L. Chou,et al.  Detection of gait instability using the center of mass and center of pressure inclination angles. , 2006, Archives of physical medicine and rehabilitation.

[29]  W. Hayes,et al.  Functional mobility discriminates nonfallers from one-time and frequent fallers. , 2000, The journals of gerontology. Series A, Biological sciences and medical sciences.

[30]  Anne Tiedemann,et al.  Which Neuromuscular or Cognitive Test Is the Optimal Screening Tool to Predict Falls in Frail Community-Dwelling Older People? , 2009, Gerontology.

[31]  Glenn N. Williams,et al.  Aging skeletal muscle: physiologic changes and the effects of training. , 2002, Physical therapy.

[32]  Pekka Laippala,et al.  Risk Factors for Major Injurious Falls among the Home-Dwelling Elderly by Functional Abilities , 1998, Gerontology.

[33]  A. Campbell,et al.  Randomised controlled trial of a general practice programme of home based exercise to prevent falls in elderly women , 1997, BMJ.

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

[35]  Jeffrey M. Hausdorff,et al.  Increased gait unsteadiness in community-dwelling elderly fallers. , 1997, Archives of physical medicine and rehabilitation.

[36]  A. Gitter,et al.  Gait Variables Differentiating Fallers from Nonfallers , 2007, Journal of geriatric physical therapy.

[37]  Greg Maislin,et al.  Risk Factors for Hip Fracture in Black Women , 1994 .

[38]  A Critical Point for the Onset of Falls in the Elderly , 2000, Gerontology.

[39]  Jacob Cohen.  Statistical Power Analysis for the Behavioral Sciences , 1969, The SAGE Encyclopedia of Research Design.

[40]  L. Nyberg,et al.  Predisposing and precipitating factors for falls among older people in residential care. , 2002, Public health.

[41]  Takao Suzuki,et al.  Relationship between Age-Associated Changes of Gait and Falls and Life-Space in Elderly People , 2010 .

[42]  Shuichi Obuchi,et al.  Comparison of Smoothness during Gait between Community Dwelling Elderly Fallers and Non-Fallers Using Power Spectrum Entropy of Acceleration Time-Series , 2008 .

[43]  C. Becker,et al.  Systematic review of definitions and methods of measuring falls in randomised controlled fall prevention trials. , 2006, Age and ageing.

[44]  M. Woollacott,et al.  Balance control during walking in the older adult: research and its implications. , 1997, Physical therapy.

[45]  S. Lord,et al.  Physiological Factors Associated with Falls in Older Community‐Dwelling Women , 1994, Journal of the American Geriatrics Society.

[46]  Laura A Talbot,et al.  Falls in young, middle-aged and older community dwelling adults: perceived cause, environmental factors and injury , 2005, BMC public health.

[47]  Irênio Gomes,et al.  Analysis of extrinsic and intrinsic factors that predispose elderly individuals to fall. , 2012, Revista da Associacao Medica Brasileira.

[48]  Navrag B. Singh,et al.  Kinematic measures for assessing gait stability in elderly individuals: a systematic review , 2011, Journal of The Royal Society Interface.

[49]  F. Ando,et al.  Frequencies and circumstances of falls in the National Institute for Longevity Sciences, Longitudinal Study of Aging (NILS-LSA). , 2000, Journal of epidemiology.

[50]  P. Cavanagh,et al.  Stair Negotiation in Older People: A Review , 2000, Journal of the American Geriatrics Society.

[51]  H. Menz,et al.  Falls in Older People: Risk Factors and Strategies for Prevention , 2000 .

[52]  G. Okamoto,et al.  Hospitalizations for hip fractures among elderly persons in Hawaii, 1986-1990. , 1992, Archives of physical medicine and rehabilitation.

[53]  L. Larsson,et al.  Aging-Related Changes in Skeletal Muscle , 2000, Drugs & aging.

[54]  D. Grossman,et al.  Injury prevention. Second of two parts. , 1997, The New England journal of medicine.

[55]  Identification of kinetic differences between fallers and nonfallers in the elderly. , 1998, American journal of physical medicine & rehabilitation.

[56]  C Ronald MacKenzie,et al.  Hip fractures among the elderly: causes, consequences and control , 2003, Ageing Research Reviews.

[57]  D G Lloyd,et al.  Sensori-motor function, gait patterns and falls in community-dwelling women. , 1996, Age and ageing.