Gait Disorders and Falls
Abstract
Since approximately 30% of persons over the age of 65 fall each year, prevention of falls is a very important topic. Gait disorders and diminished ability to walk safely are associated with an increased risk of falling. In older adults, falls commonly lead to injuries, institutionalization, and early death. The resultant decline in activities of daily living further contributes to loss of mobility and independence. Gait analysis using the dual-task paradigm (e.g., walking and carrying a cup of tea) offers a sensible tool for detecting older persons prone to falling. Changes in gait patterns due to simultaneously performing a secondary attention-demanding task are interpreted as interference by competing demands for attentional resources in gait control. Exercise interventions such as Jaques-Dalcroze eurhythmics address these attentional properties and aim to decrease such interference. To fully stress physical capacities in older adults, not only does automaticity of walking have to be trained, but also simultaneous performance of additional tasks. Exercise interventions for fall prevention should focus on developing basic skeletal muscle strength as a prerequisite to training gait automaticity in dual or multiple task situations. Recommendations for further research center on new approaches to combine exercises with additional tasks to improve gait and functionality in older adults.
References
2007). Changes in gait while backward counting in demented older adults with frontal lobe dysfunction. Gait and Posture, 26, 572–576.
(2004). Un atelier de danse pour les personnes âgées à l’hôpital – Bouger avec plaisir [
(A dance studio for older adults at the hospital – Moving with joy ]. Geriatrie Practique, 3, 32–34.2004). Physical activity programs and behavior counseling in older adult populations. Medicine and Science in Sports and Exercise, 36, 1997–2003.
. (2009). Progression models in resistance training for healthy adults. Medicine and Science in Sports and Exercise, 41, 687–708.
. (2001). Guideline for the prevention of falls in older persons. Journal of the American Geriatrics Society, 49, 664–672.
. (2005). Gait disorders: Search for multiple causes. Cleveland Clinic Journal of Medicine, 72, 586–600.
(1997). Strength in the lower limbs, visual contrast sensitivity, and simple reaction time predict cognition in older women. Psychology and Aging, 12, 137–144.
(2009). Vitamin D and cognitive performance in adults: A systematic review. European Journal of Neurology, 16, 1083–1089.
(2009). Vitamin D and muscle function: New prospects? Biofactors, 35(1), 3–4.
(2009). Vitamin D deficiency-related quadriceps weakness: Results of the Epidémiologie de L’Osteoporose Cohort. Journal of the American Geriatrics Society, 57, 368–369.
(2007). Multi-modal exercise programs for older adults. Age and Ageing, 36, 375–381.
(2008). Gait analysis using a shoe-integrated wireless sensor system. IEEE Transactions on Information Technology in Biomedicine, 12, 413–423.
(2008). Sarcopenia and frailty: A clinician’s controversial point of view. Experimental Gerontology, 43, 674–678.
(2006). Gait and dual task: Definition, interest, and perspectives in the elderly. Psychologie & Neuropsychiatrie du Vieillissement, 4, 215–225.
(2005). Dual-task related gait changes in the elderly: Does the type of cognitive task matter? Journal of Motor Behavior, 37, 270–275.
(2005). Dual-task-related gait changes in transitionally frail older adults: The type of the walking-associated cognitive task matters. Gerontology, 51(1), 48–52.
(2005). Stride-to-stride variability while backward counting among healthy young adults. Journal of Neuroengineering and Rehabilitation, 2, 26.
(2003). Age-related decline of gait control under a dual-task condition. Journal of the American Geriatrics Society, 51, 1187–1188.
(2000). Epidemiology of accidents sustained by senior citizens. Swiss Council for Accident Prevention (BFU), 42, 142–149.
(1989). Instrumentation used in clinical gait studies: A review. Journal of Medical Engineering and Technology, 13, 290–295.
(2002). Effects of exercise training on frailty in community-dwelling older adults: Results of a randomized, controlled trial. Journal of the American Geriatrics Society, 50, 1921–928.
(2009). Fall prevention with supplemental and active forms of vitamin D: A meta-analysis of randomized controlled trials. British Medical Journal (Clinical Research Ed.), 339. doi: 10.1136/bmj.b3692.
(1989). Risk factors for falls in a community-based prospective study of people 70 years and older. Journal of Gerontology, 44, 112–117.
(2002). The biochemistry of aging muscle. Experimental Gerontology, 37, 477–489.
(1998). Is lower extremity strength gain associated with improvement in physical performance and disability in frail, community-dwelling elders? Archives of Physical Medicine and Rehabilitation, 79(1), 24–30.
(1996). Stepping over obstacles: Dividing attention impairs performance of old more than young adults. The Journals of Gerontology. Series A. Biological Sciences and Medical Sciences, 51(3), 116–122.
(2008). Sarcopenia? Dynapenia. Journal of Gerontology, 63, 829–834.
(2003). Maximal voluntary and functional performance levels needed for independence in adults aged 65 to 97 years. Physical Therapy, 83, 37–48.
(1996). Continuous-scale physical functional performance in healthy older adults: A validation study. Archives of Physical Medicine and Rehabilitation, 77, 1243–1250.
(2005). Continuous-scale physical functional performance test: Validity, reliability, and sensitivity of data for the short version. Physical Therapy, 85, 323–335.
(2006). A home-based multidimensional exercise program reduced physical impairment and fear of falling. Acta Clinica Belgica, 61, 340–350.
(2005). Optimal load for increasing muscle power during explosive resistance training in older adults. The Journals of Gerontology. Series A. Biological Sciences and Medical Sciences, 60, 638–647.
(2008). Effect of power-training intensity on the contribution of force and velocity to peak power in older adults. Journal of Aging and Physical Activity, 16, 393–407.
(2009). Baseline indicators for measuring progress in preventing falls injury in older people. Australian and New Zealand Journal of Public Health, 33, 413–417.
(2006). Relationships between dual-task related changes in stride velocity and stride time variability in healthy older adults. Human Movement Science, 25, 372–382.
(1992). Mortality, disability and falls in older persons: The role of underlying disease and disability. American Journal of Public Health, 82, 395–400.
(2000). Gait disorders and fall risk: Detection and prevention. Comprehensive Therapy, 26, 238–245.
(1994). Exercise training and nutritional supplementation for physical frailty in very elderly people. The New England Journal of Medicine, 330, 1796–1775.
(2000). Falls in the elderly. American Family Physician, 61, 2173–2174.
(1987). The prevention of falls in later life. A report of the Kellog International Working Group on the prevention of falls by the elderly. Danish Medical Bulletin, 34, 1–24.
(2009, April 15). Interventions for preventing falls in older people living in the community. Cochrane Database of Systematic Reviews, 2009 (2). Retrieved December 23, 2009, from The Cochrane Library Database. doi: 10.1002/14651858.CD007146.pub2.
(2003). Gehen verstehen. Ganganalyse in der Physiotherapie [
(Understanding gait. Gait analysis in physiotherapy ]. Stuttgart, Germany: Thieme.2000). Lower extremity function and subsequent disability: Consistency across studies, predictive models, and value of gait speed alone compared with the short physical performance battery. The Journals of Gerontology. Series A. Biological Sciences and Medical Sciences, 55, M221–231.
(1995). Lower-extremity function in persons over the age of 70 years as a predictor of subsequent disability. The New England Journal of Medicine, 332, 556–561.
(2008). Mortality following hip fracture: Trends and geographical variations over the last 40 years. Injury, 39, 1157–1163.
(2008). Tai Chi and falls prevention in older people. Medicine and Sport Science, 52, 124–134.
(2005). Gait variability: Methods, modeling and meaning. Journal of Neuroengineering and Rehabilitation, 2, 19.
(1997). Increased gait unsteadiness in community-dwelling elderly fallers. Archives of Physical Medicine and Rehabilitation, 78, 278–283.
(2001). Gait variability and fall risk in community-living older adults: A 1-year prospective study. Archives of Physical Medicine and Rehabilitation, 82, 1050–1056.
(2007). Functional benefit of power training for older adults. Journal of Aging and Physical Activity, 15, 349–359.
(2002). Longitudinal changes in body composition in older men and women: Role of body weight change and physical activity. The American Journal of Clinical Nutrition, 76, 473–481.
(1998). Neuropathological and neuropsychological changes in “normal” aging: Evidence for preclinical Alzheimer disease in cognitive normal individuals. Journal of Neuropathology and Experimental Neurology, 57, 1168–1174.
(2004). Effects of resistance training on older adults. Sports Medicine, 34, 329–348.
(2008). Age-associated effects of a concurrent cognitive task on gait speed and stability during narrow-base walking. The Journals of Gerontology. Series A. Biological Sciences and Medical Sciences, 63, 1329–1334.
(2009). Aging, exercise, and muscle protein metabolism. Journal of Applied Physiology, 106, 2040–2048.
(2003). Selektion, Optimierung und Kompensation in Doppelaufgaben [
(Allocation of cognitive resources during the simultaneous performance of cognitive and sensorimotor tasks ]. Der Nervenarzt, 74, 211–218.2004). Die Rolle der Ganganalyse in therapeutischen Trainingsprogrammen von Betagten [
(Role of gait analysis and tailored exercise prescription in older adults ]. Zeitschrift für Gerontologie und Geriatrie, 37, 15–19.1998). Körperliche Aktivität und Alterungsprozess [
(Physical activity and the aging process ]. Schweizerische Medizinische Wochenschrift, 128, 1181–1186.2005). Long-term practice of Jaques-Dalcroze eurhythmics prevents age-related increase of gait variability under a dual task. Journal of the American Geriatrics Society, 53, 728–729.
(2003). T’ai Chi chez les personnes âgées: Aspects practiques [
(Tai Chi for older adults: Practical aspects ]. Revue Médicale de la Suisse Romande, 123, 671–675.2004). Temporal and spatial features of gait in older adults transitioning to frailty. Gait and Posture, 20(1), 30–35.
(2008). Gait variability while dual-tasking: Fall predictor in older inpatients? Aging Clinical and Experimental Research, 20, 123–130.
(1993). Attentional demands for static and dynamic equilibrium. Experimental Brain Research, 97(1), 139–144.
(2005). Development of a common outcome data set for fall injury prevention trials: The prevention of falls network Europe consensus. Journal of the American Geriatrics Society, 53, 1618–1622.
. (2003). A randomized, controlled trial of quadriceps resistance exercise and vitamin D in frail older people: The Frailty Interventions Trail in Elderly Subjects (FITNESS). Journal of the American Geriatrics Society, 51, 291–299.
(2004). Systematic review of progressive resistance training in older adults. The Journals of Gerontology. Series A. Biological Sciences and Medical Sciences, 59(1), 48–61.
(2009). Strategic capacity sharing between two tasks: Evidence from tasks with the same and with different task sets. Psychological Research, 73, 707–726.
(2009, July 8). Progressive resistance strength training for improving physical function in older adults. Cochrane Database of Systematic Reviews, 2009 (3). Retrieved October 14, 2009, from The Cochrane Library Database. doi: 10.1002/14651858.CD002759.pub2
(2009). Comparison of gait characteristics between older rolling walker users and older potential walker users. Archives of Gerontology and Geriatrics, 48, 276–280.
(1996). The effect of exercise on gait patterns in older women: A randomized controlled trial. The Journal of Gerontology. Series A. Biological Sciences and Medical Sciences, 51(2), 64–70.
(2007). Falls in older people. Risk factors and strategies for prevention. Cambridge, UK: Cambridge University Press.
(2009). A systematic review of the effectiveness of Tai Chi on fall reduction among the elderly. Archives of Gerontology and Geriatrics, 48, 325–331.
(1997). “Stops walking when talking” as a predictor of falls in elderly people. Lancet, 349, 617.
(1997). Gait changes in older adults: Predictors of falls or indicators of fear? Journal of the American Geriatrics Society, 45, 313–320.
(2004). Reliability of the GAITRite® walkway system for the quantification of temporo-spatial parameters of gait in young and older people. Gait and Posture, 20(1), 20–25.
(2003). Age-related differences in walking stability. Age and Ageing, 32, 137–142.
(2009). Arzneimittel und Stürze im Alter [
(Medicine and falls in the elderly ]. Der Internist, 50, 493–500.1999). The functional ambulation performance of elderly fallers and nonfallers walking at their preferred velocity. NeuroRehabilitation, 13, 141–146.
(2005). Gang, Gleichgewicht und Stürze – Ursachen und Konsequenzen [
(Gait, balance and falls – Cause and consequences ]. Deutsche Medizinische Wochenschrift, 130, 958–960.1993). Basic gait parameters: Reference data for normal subjects, 10–79 years of age. Journal of Rehabilitation Research and Development, 30, 210–223.
(2006). Power training improves balance in healthy older adults. The Journal of Gerontology. Series A. Biological Sciences and Medical Sciences, 61(1), 78–85.
(1997). Falls in the elderly related to postural imbalance. British Medical Journal, 1, 261–264.
(1994). Dual-task interference in simple tasks: Data and theory. Psychological Bulletin, 116, 220–244.
(2005). The neural correlates of motor skill automaticity. The Journal of Neuroscience, 25, 5356–5364.
(2006). Power training for older adults. Applied Physiology, Nutrition, and Metabolism, 31(2), 87–94.
(2008). Age-related differences in dual task walking: A cross sectional study. Journal of Neuroengineering and Rehabilitation, 5, 29.
(2005). Prevention of falls in older patients. American Family Physician, 72(1), 81–88.
(2008). Lower extremity power training in elderly subjects with mobility limitations: A randomized controlled trial. Aging Clinical and Experimental Research, 20, 337–343.
(2003). Methods to assess and improve the physical parameters associated with fall risk in older adults. Preventive Medicine, 36, 255–264.
(2006). Falls in older people: Epidemiology, risk factors and strategies for prevention. Age and Ageing, 35, 37–41.
(2002). The epidemiology of falls and syncope. Clinics in Geriatric Medicine, 18, 141–158.
(1991). Times, places, and mechanisms of falls among the elderly. Zeitschrift für Gerontologie, 24, 154–161.
(2000). Quality of life related to fear of falling and hip fracture in older women: A time trade off study. British Medical Journal (Clinical Research Ed.), 320(7231), 341–346.
(1992). Falls among older persons: A public health perspective. Annual Review of Public Health, 13, 489–508.
(2007). Gait in aging and associated dementias; its relationship with cognition. Neuroscience and Biobehavioral Reviews, 31, 485–497.
(2007). Multifactorial and functional mobility assessment tools for fall risk among older adults in community, home-support, long-term and acute care settings. Age and Ageing, 36, 130–139.
(2007). The role of higher-level cognitive function in gait: Executive dysfunction contributes to fall risk in Alzheimer’s disease. Dementia and Geriatric Cognitive Disorder, 24, 125–137.
(2003). Influence of executive function on locomotor function: Divided attention increases gait variability in Alzheimer’s disease. Journal of the American Geriatrics Society, 51, 1633–1637.
(2004). Physical activity interventions to prevent falls among older people: Update of the evidence. Journal of Science and Medicine in Sport/Sports Medicine Australia, 7(1), 43–51.
(2008). Effective exercise for the prevention of falls: A systematic review and metaanalysis. Journal of the American Geriatrics Society, 56, 2234–2243.
(2000). Predicting the probability for falls in community-dwelling older adults using the Timed Up & Go test. Physical Therapy, 80, 896–903.
(1997). The effect of multidimensional exercises on balance, mobility, and fall risk in community-dwelling older adults. Physical Therapy, 77, 46–57.
(2006). Dual-tasking effects on gait variability: The role of aging, falls, and executive function. Movement Disorders, 21, 950–957.
(2003). Physical performance measures in the clinical setting. Journal of the American Geriatrics Society, 51, 314–322.
(2004). What are the main risk factors for falls among older people and what are the most effective interventions to prevent these falls? Copenhagen, WHO Regional Office for Europe, Health Evidence Network Report. Retrieved December 23, 2009, from www.euro.who.int/document/E82552.pdf
(2002). Effectiveness of physical activity interventions for older adults: A review. American Journal of Preventive Medicine, 22, 120–133.
(2006). Epidemiology of gait disorders in community-residing older adults. Journal of the American Geriatrics Society, 54, 255–261.
(2007). The effects of systematic resistance training in the elderly. International Journal of Sports Medicine, 28(1), 59–65.
(2005). La rythmique Jaques-Dalcroze – Une activité physique novatrice pour les personnes âgées [
(Rhythmics of Jaques-Dalcroze – A new physical activity for older adults ]. Geriatrie Practique, 3, 52–55.2003). Selected as the best paper in the 1990s: Reducing frailty and falls in older persons: An investigation of Tai Chi and computerized balance training. Journal of the American Geriatrics Society, 51, 1794–1803.
Atlanta FICSIT Group. (2008). Reinvestment and falls in community-dwelling older adults. Neurorehabilitation and Neural Repair, 22, 410–414.
(1990). Changes in posture control across the life span – A system approach. Physical Therapy, 70, 799–807.
(2002). Attention and the control of posture and gait: A review of an emerging area of research. Gait and Posture, 16, 1–14.
(2008). The role of executive function and attention in gait. Movement Disorders, 23, 329–342.
(2007). Prevalence and correlates of fear of falling, and associated avoidance of activity in the general population of community-living older people. Age and Ageing, 36, 304–309.
(