Normal limits of home measured spatial gait parameters of the elderly population and their association with health variables

Gait studies in the elderly population have been always conducted in gait labs or spacious clinical facilities, which influence gait parameters, and also implies that the participants have to be able to move to these facilities. Indoors gait characteristics of the elderly population have been very little studied. In this study, we aim to define the normal limits of the spatial gait parameters of the elderly, when walking at home, and to analyze relationship existing between the spatial gait parameters to other health variables. For such purpose, we conducted a transversal study on a probabilistic sample of 431 Spanish community-dwelling older, in which the spatial gait parameters were recorded by using an ink footprints method. We found that the mean stride length indoors was 88.47 cm (SD:26.05 cm; mean CI95%:85.52-91.41 cm), and the mean step width was 10.34 cm (SD:4.37 cm; mean CI95%:9.84-10.83 cm). Stride length was shorter in women and the oldest group, and was significantly influenced by the strength, balance, and physical activity. Stride width was larger in the oldest group and mainly affected by balance. A composite parameter including width and normalized stride length was independent from sex, and strongly differentiated between age groups. This parameter was affected by strength

The Spatial parameters of gait and their association with falls, functional decline and death in older adults: a prospective study

Association between spatial gait parameters and adverse health outcomes in the elderly has not been sufficiently studied. The goal of this study is to evaluate whether the stride length or the step width predict falls, functional loss and mortality. We conducted a prospective cohort study on a probabilistic sample of 431 noninstitutionalized, older-than-64-years subjects living in Spain, who were followed-up for five years. In the baseline visit, spatial gait parameters were recorded along with several control variables, with special emphasis on known medical conditions, strength, balance and functional and cognitive capacities. In the follow-up calls, vital status, functional status and number of falls from last control were recorded. We found that a normalized-to-height stride length shorter than 0.52 predicted recurrent falls in the next 6 months with 93% sensitivity and 53% specificity (AUC: 0.72), and in the next 12 months with 81% sensitivity and 57% specificity (AUC: 0.67). A normalized stride length <0.5 predicted functional loss at 12 months with a sensitivity of 79.4% and specificity of 65.6% (AUC: 0.75). This predictive capacity remained independent after correcting for the rest of risk factors studied. Step-with was not clearly related to functional loss or falls. Both shorter normalized stride length (OR1.56; AUC: 0.62; p < 0.05) and larger step width (OR1.42; AUC: 0.62; p < 0.05) were associated with risk of death at 60 months; however, none of them remained as independent predictor of death, after correcting for other risk factors. In summary, spatial gait parameters may be risk markers for adverse outcomes in the elderly. Step length is independently associated with functional loss and falls at one year, after correction for numerous known risk factors

Estudio de los parámetros espaciales de la marcha en la población anciana española y su asociación con resultados adversos de salud.

Introducción Los estudios de la marcha de los ancianos se han conducido siempre en amplias dependencias clínicas o laboratorios de marcha, lo cual puede influir en los resultados, y dejar fuera del estudio a los ancianos incapaces de desplazarse a estos centros. Por otro lado, la asociación entre los parámetros espaciales de la marcha con la aparición de resultados adversos de salud, no ha sido suficientemente estudiada. En este estudio pretendemos definir los límites normales de los parámetros espaciales de la marcha, registrados estos en el domicilio, y estudiar la posible relación de estos parámetros con diversos efectos adversos de salud: caídas, deterioro funcional y muerte. Métodos Estudio prospectivo de cohortes sobre una muestra probabilista de 431 ancianos residentes en la comunidad, que fueron seguidos por un periodo de 60 meses (entrevista basal y contactos telefónicos a los 4,6,9,12 y 60 meses). En la visita basal se registraron los parámetros espaciales de la marcha mediante el método de impresión de pisadas y se recogieron diversas variables de control: edad, sexo, fuerza muscular, equilibrio, capacidad funcional (índice de Katz), capacidad cognitiva, depresión, comorbilidad y polifarmacia. Durante el seguimiento se registraron las caídas, los cambios en la capacidad funcional y la fecha y causa de muerte en su caso. Resultados La longitud de la zancada media fue de 88.47 cm (DE:26.05cm, CI95% de la media: 85.52-91.41cm). La longitud de la zancada normalizada por altura fue de 0.55 (DE:0.15; CI95% de la media: 0.54-0.57). La anchura del paso fue en promedio 10.34cm (DE:4.37cm; CI95% de la media: 9.84-10.83cm). Los participantes con múltiples caídas durante el primer años tenían una longitud de zancada menor 74.0 cm vs 91.4 cm (p<0.05). La anchura del paso no predijo la aparición de caídas recurrentes. Una longitud de la zancada normalizada <0,52 predijo caídas recurrentes con una sensibilidad del 93%, especificidad 53% y ABC-COR 0.67 (IC95%: 0.56-0.79). La asociación de la longitud de la zancada con las caídas fue independiente del resto de factores de riesgo de caída estudiados. Los ancianos en los que apareció discapacidad durante el primer año, tenían una longitud de zancada normalizada menor 0.52 vs 0.60 (diferencia de medias:-0.08; CI95%:0.04 to-0.13; p=0.001). Una longitud de zancada normalizada menor de 0,5 predijo deterioro funcional a los 12 meses con una sensibilidad del 79,4%, una especificidad del 65,6% y ABC-COR de 0,75. Esta capacidad predictiva se mantuvo incluso después de corregir por otros factores de riesgo de dependencia. La menor longitud de zancada (OR1.56; ABC-COR:0.62; p<0.05) la mayor anchura del paso (OR1.42; ABC-COR: 0.62; p<0.05) se asociaron a incremento de riesgo de muerte a los 5 años, si bien esta asociación no fue independiente de otros factores de riesgo de mortalidad. Conclusiones La longitud del paso en la población anciana es menor de lo previamente reportado, cuando el estudio se conduce en el domicilio. La longitud del paso es un predictor independiente y potente de caídas repetidas y deterioro funcional, incluso después de corregir por otros factores de riesgo

The Spatial parameters of gait and their association with falls, functional decline and death in older adults: a prospective study

Association between spatial gait parameters and adverse health outcomes in the elderly has not been sufficiently studied. The goal of this study is to evaluate whether the stride length or the step width predict falls, functional loss and mortality. We conducted a prospective cohort study on a probabilistic sample of 431 noninstitutionalized, older-than-64-years subjects living in Spain, who were followed-up for five years. In the baseline visit, spatial gait parameters were recorded along with several control variables, with special emphasis on known medical conditions, strength, balance and functional and cognitive capacities. In the follow-up calls, vital status, functional status and number of falls from last control were recorded. We found that a normalized-to-height stride length shorter than 0.52 predicted recurrent falls in the next 6 months with 93% sensitivity and 53% specificity (AUC: 0.72), and in the next 12 months with 81% sensitivity and 57% specificity (AUC: 0.67). A normalized stride length <0.5 predicted functional loss at 12 months with a sensitivity of 79.4% and specificity of 65.6% (AUC: 0.75). This predictive capacity remained independent after correcting for the rest of risk factors studied. Step-with was not clearly related to functional loss or falls. Both shorter normalized stride length (OR1.56; AUC: 0.62; p < 0.05) and larger step width (OR1.42; AUC: 0.62; p < 0.05) were associated with risk of death at 60 months; however, none of them remained as independent predictor of death, after correcting for other risk factors. In summary, spatial gait parameters may be risk markers for adverse outcomes in the elderly. Step length is independently associated with functional loss and falls at one year, after correction for numerous known risk factors