Guidelines for clinical applications of spatio-temporal gait analysis in older adults

Quantifying spatio-temporal gait parameters in stationary and ambulatory geriatric settings may aid the early identification of potential fallers, as well as the documentation of illness-specific gait disorders and intervention-related changes in rehabilitative medicine. Bringing gait analysis out of the laboratory and into a clinical setting is the goal of the European GAITRite network group, initiated in 2003 in Geneva. To enhance reproducibility of gait measures and for better comparability of outcomes in clinical environments, a consensus on data collection was formulated and presented at the 2nd European GAITRite Meeting in Marseilles. The guidelines presented here are intended to facilitate network collaborations and to provide guidance to clinicians who wish to implement spatio-temporal gait analysis in clinical setting

Exercise Prescribing: Computer Application in Older Adults

Purpose: The purpose of this study was to determine if older adults are capable and willing to interact with a computerized exercise promotion interface and to determine to what extent they accept computer-generated exercise recommendations. Design and Methods: Time and requests for assistance were recorded while 34 college-educated volunteers, equal numbers of men and women, ranging in age from 60 to 87, interfaced with a health promotion tool. The computerized exercise promotion tool's ease of use and the acceptability of the exercise recommendations made were rated by the participants. Results:On average, completion of the items on the computer took 33 min and each participant made 3 requests for assistance, of which only 22% were mouse related. The system's ease of use and the exercise prescription acceptability ratings were high and independent of prior experience with computers. Implications: User friendliness of computerized health promotion tools will determine if, and how, health providers integrate these new technologies into daily practice. The participants in the study were able to complete the computerized items within a reasonable amount of time and with minimal assistance from the provider. These data support the potential of interactive technology in health promotion among the expanding older populatio

Stride-to-stride variability while backward counting among healthy young adults

BACKGROUND: Little information exists about the involvement of attention in the control of gait rhythmicity. Variability of both stride time and stride length is closely related to the control of the rhythmic stepping mechanism. We sought 1) to determine whether backward counting while walking could provoke significant gait changes in mean values and coefficients of variation of stride velocity, stride time and stride length among healthy young adults; and 2) to establish whether change in stride-to-stride variability could be related to dual-task related stride velocity change, attention, or both. METHODS: Mean values and coefficients of variation of stride velocity, stride time and stride length were recorded using the Physilog(®)-system, at a self-selected walking speed in 49 healthy young adults (mean age 24.1 ± 2.8 years, women 49%) while walking alone and walking with simultaneous backward counting. Performance on backward counting was evaluated by recording the number of figures counted while sitting alone and while walking. RESULTS: Compared with walking alone, a significant dual-task-related decrease was found for the mean values of stride velocity (p < 0.001), along with a small but significant increase for the mean values and coefficients of variation of stride time (p < 0.001 and p = 0.015, respectively). Stride length parameters did not change significantly between both walking conditions. Dual-task-related increase of coefficient of variation of stride time was explained by changing stride velocity and variability between subjects but not by backward counting. The number of figures counted while walking decreased significantly compared to backward counting alone. Further, the dual-task related decrease of the number of enumerated figures was significantly higher than the dual-task related decrease of stride velocity (p = 0.013). CONCLUSION: The observed performance-changes in gait and backward counting while dual tasking confirm that certain aspects of walking are attention-demanding in young adults. In the tested group of 49 young volunteers, dual tasking caused a small decrease in stride velocity and a slight increase in the stride-to-stride variability of stride time, while stride velocity variability was not affected by the attention-demanding task. The increase in stride time variability was apparently the result of a change in gait speed, but not a result of dual tasking. This suggests that young adults require minimal attention for the control of the rhythmic stepping mechanism while walking

Patients with geriatric syndromes and anti-amyloid therapies: lack of consideration? An exploratory analysis of the literature.

INTRODUCTION Patients who should benefit from anti-amyloid therapies (AAT) are found across all geriatric settings. Yet, it remains unclear how the use of AAT in patients with geriatric syndromes, such as frailty and polypharmacy, has so far been discussed in the literature. METHODS Articles on aducanumab, gantenerumab, lecanemab, donanemab, crenezumab, solanezumab were retrieved in MEDLINE from inception to July 2023. For each article, identified geriatric relevant terms were assigned to five discussion contexts (eligibility of AAT study population, safety, prescription, patient clinical profile, alternative outcomes measurement). Article type and the involvement of geriatric healthcare professionals as an author were further extracted. RESULTS Out of 538 articles, 23 (4.27%) were published in journals from the geriatric category, 44 (8.18%) included an author affiliated with a geriatric institution. One hundred and sixteen (21.56%) articles included at least one geriatric relevant term, which were mostly discussed in the context of safety and eligibility. Articles mentioning geriatric syndromes were more frequently authored by a geriatric healthcare professional (p = 0.044). DISCUSSION The use of AAT in patients with geriatric syndromes has so far received poor attention in the literature raising concerns on their use in this patient group. The involvement of geriatric healthcare professionals in future studies may increase the relevance of AAT research in patients with geriatric syndromes

Sarcopenia in hospitalized geriatric patients: insights into prevalence and associated parameters using new EWGSOP2 guidelines.

BACKGROUND Data on prevalence of sarcopenia and its associated parameters in hospitalized geriatric patients are heterogeneous due to various definitions of the disease. The aim of this study was to determine the prevalence of sarcopenia using latest recommendations of the European Working Group on Sarcopenia in Older People 2 (EWGSOP2), and to investigate associated parameters in patients admitted to acute geriatrics and geriatric rehabilitation. METHODS In this cross-sectional single-centre study including 305 hospitalized geriatric patients, handgrip strength (pneumatic hand dynamometer) and muscle quantity (body impedance analysis) were assessed. Probable sarcopenia was defined by low handgrip strength, and the diagnosis was confirmed when both handgrip strength and muscle quantity were below cut-off points. Furthermore, parameters of the geriatric baseline examination were analyzed for association with probable and confirmed sarcopenia using logistic regression models. RESULTS Median age of the study population was 84.0 years, and 65.6% were female. The prevalence of probable sarcopenia was 24.6% (CI 19.8-29.4%), and the prevalence of confirmed sarcopenia was 22.6% (CI 17.9-27.3%). Low calf circumference, low body mass index, cognitive impairment and an increased risk of malnutrition were found to be associated with confirmed sarcopenia. In contrast, only cognitive impairment was positively associated with probable sarcopenia. CONCLUSIONS Sarcopenia is highly prevalent in geriatric inpatients, and multiple parameters were found to be associated with the disease. To reduce negative clinical outcomes, our findings support the need for routinely performed admission examinations for prompt diagnosis of sarcopenia, and a timely start of treatment in hospitalized geriatric patients

Effects of muscle fatigue on gait characteristics under single and dual-task conditions in young and older adults

Muscle fatigue and dual-task walking (e.g., concurrent performance of a cognitive interference (CI) while walking) represent major fall risk factors in young and older adults. Thus, the objectives of this study were to examine the effects of muscle fatigue on gait characteristics under single and dual-task conditions in young and older adults and to determine the impact of muscle fatigue on dual-task costs while walking

Gait variability while dual-tasking: fall predictor in older inpatients?

Background and aims: Increased gait variability is associated with a high risk of falling in older community-dwellers, but no information exists about the relationship between increased gait variability and falls occurring in older hospitalized patients. We therefore sought to determine, in an acute geriatric setting, whether gait variability in single- (i.e., usual walking) or dual-task conditions can predict inpatient falls. Methods: Stride time variability was calculated in both single-task (i.e., usual walking) and dual-task conditions with a GAITRite®-System in 13 male and 44 female patients (mean age=85.0, SD=6.6 yrs) consecutively admitted to the acute care geriatric department of Geneva University Hospitals, Switzerland. All participants were able to walk without assistive devices at day 3 post-admission. Falls during hospital stay were identified through the hospital accident reporting system. Results: Ten fallers and 47 non-fallers were identified. The first fall events were significantly associated with the coefficient of variation of stride time in both walking conditions during hospital stay (OR 13.3, (95% CI 1.6-113.6), p=0.018 for usual walking; OR 8.6, (95% CI 1.9-39.6), p=0.006 for dual-task walking). Furthermore, the time elapsing between the first day of hospitalization and the first fall was significantly shorter when the cut-off value of stride time variability was calculated for dual-tasking compared with usual walking. The Cox regression model revealed that only the coefficient of variation of stride time during dual-task walking was significantly associated with the occurrence of the first fall event (p=0.006). Conclusion: Our results suggest that the degree of stride time variability in dual-task walking conditions distinguished fallers from non-fallers in a group of independently walking, older inpatient

The Interaction between Mobility Status and Exercise Specificity in Older Adults

Many adults older than 60 yr experience mobility limitations. Although physical exercise improves older adults' mobility, differences in baseline mobility produce large variations in individualresponses to interventions, and these responses could further vary by the type and dose of exercise. Here, we propose an exercise prescription model for older adults based on their current mobility status

Validity of the German Version of the Continuous-Scale Physical Functional Performance 10 Test

Background. The Continuous-Scale Physical Functional Performance 10 Test (CS-PFP 10) quantitatively assesses physical functional performance in older adults who have a broad range of physical functional ability. This study assessed the validity and reliability of the CS-PFP 10 German version. Methods. Forward-translations and backtranslations as well as cultural adaptions of the test were conducted. Participants were German-speaking Swiss community-dwelling adults aged 64 and older. Concurrent validity was assessed using Pearson correlation coefficients between CS-PFP 10 and gait velocity, Timed Up and Go Test, hand grip strength, SF-36 physical function domain, and Freiburger Physical Activity Questionnaire. Internal consistency was calculated by Cronbach’s alpha. Results. Backtranslation and cultural adaptions were accepted by the CS-PFP 10 developer. CS-PFP 10 total score and subscores (upper body strength, upper body flexibility, lower body strength, balance and coordination, and endurance) correlated significantly with all measures of physical function tested. Internal consistency was high (Cronbach’s alpha 0.95–0.98). Conclusion. The CS-PFP 10 German version is valid and reliable for measuring physical functional performance in German-speaking Swiss community-dwelling older adults. Quantifying physical function is essential for clinical practice and research and provides meaningful insight into physical functional performance of older adults. This trial is registered with ClinicalTrials.gov NCT01539200