Gait Changes in Older Adults

Reto W. Kressig
MOBEQ Unit Geriatrics Department Geneva University Hospitals, Switzerland

Outline
Definition of Gait Parameters Age-Related Gait Changes

Pathological Gait Changes

Gait Cycle
(Temporal Measures)

Gait Cycle
(right side)

Stance

Swing

Initial Double Support

Terminal Double Support

Spatial Gait Measures

Stride Width

Step Length

Stride Length

Gait Laboratory
Camera 1

Light Barrier 1
2 meters 6 meters
Force Plates 1 2

Light Barrier 2 2 meters

Camera 3

Starting Line Visual Target (Traffic Cone)

Camera 2

Biomechanical Gait Analysis

Electronic Walkway: GAITRite

Temporal and Spatial Measurements

One Completed Walk

Normal Walking
Age-Related Gait Changes

Normal Walking: Velocity

Normal velocity during free pace walking. (a) Males (n=135); (b) Females (n=158). Vertical scale = meters/minute Horizontal scale = age (20 to 85 yrs). Perry J: Gait Analysis: Normal and Pathological Function. Thorofare (NJ): Slack, Inc.; 1992

Normal Walking: Stride Length

Normal stride length during free pace walking. (a) Males (n=135); (b) Females (n=158). Vertical scale = meters; Horizontal scale = age (20 to 85 yrs).

Perry J: Gait Analysis: Normal and Pathological Function. Thorofare (NJ): Slack, Inc.; 1992

Normal Walking: Cadence

Normal cadence during free pace walking. (a) Males (n=135); (b) Females (n=158). Vertical scale = steps/minute; Horizontal scale = age (20 to 85 yrs).

Perry J: Gait Analysis: Normal and Pathological Function. Thorofare (NJ): Slack, Inc.; 1992

Comparison of Young Adults and Elderly Subjects

Spatial and Temporal Gait Parameters

Variable

Young Adult
(N = 11)

Elderly
(N = 18)

Signif.

Age (yrs.) Height (m) Cadence (steps/min.) Velocity (m/sec.) Stride Length (m) Stance Time (%)

24.9 1.9 1.75 0.08 110.5 8.3 1.29 0.13 1.56 0.10 62.3 1.48

68.9 4.0 1.71 0.10 111.8 8.7 1.44 0.19 1.38 0.12 65.7 1.52

p < 0.01 p < 0.01 p < 0.01

Winter DA. The biomechanics and motor control of human gait: Normal, elderly and pathological. 2nd ed. Waterloo: University of Waterloo Press; 1990

Comparison of Young Adults and Elderly Subjects

Significant Differences in Other Gait Parameters

Variable

Young Adult
(N = 11)

Elderly
(N = 18)

Signif.

Push-off work (J/kg) Head Hor. Acc (m/s) Hor HC Vel (m/sec)

0.293 0.057 0.475 0.365 0.872 0.148

0.190 0.043 0.621 0.215 1.15 0.29

p < 0.01 p < 0.05 p < 0.01

Winter DA. The biomechanics and motor control of human gait: Normal, elderly and pathological. 2nd ed. Waterloo: University of Waterloo Press; 1990

Gait Changes Related to :

Psychological Factors Increased Falling Risk Interventions

Slow Walkers are more likely to be fearful...

Table 4. Multiple Logistic Regression Modeling Results Variable OR Depression by CES-D Use of Walking Aid Slow Gait Speed Ethnicity: African American
*OR = Odds Ratio, CI = Confidence Interval

FES (95% CI)* (1.1, 3.4) (1.2, 3.7) (1.2, 3.7) (0.7, 2.2) p 0.028 0.008 0.009 0.492 OR 1.6 1.4 1.5 2.0

ABC (95% CI) (1.3, 2.3) (1.2, 1.9) (1.3, 2.2) (1.3, 2.5) p 0.012 0.001 0.006 0.025

1.9 2.1 2.1 1.2

Kressig RW, Wolf SL, Sattin RW et al. Associations of demographic, functional and behavioral characteristics with activity related fear of falling among older adults transitioning to frailty. J Am Geriatr Soc 2001; 49:1456-1462.

Fear of Falling and Gait Performance

Descriptive Statistics (mean SD) for the Gait Measures

Non-fallers Fearless Fearful n = 19 n = 13 Gait Measure Stride length (m) Stride width (m) Double support (% of stride) Stride velocity (ms) 1.01 0.23 0.14 0.04 14.1 4.40 0.79 0.20 0.87 0.17 0.14 0.03 19.0 5.00 0.68 0.19

Fallers Fearless Fearful n = 17 n = 26

0.89 0.19 0.15 0.03 18.2 6.00 0.76 0.19

0.83 0.16 0.16 0.04 19.8 5.50 0.66 0.19

Maki BE. Gait changes in older adults : Predictors of falls or indicators of fear ? J Am Geriatr Soc 1997 ; 45:313-320.

Associations of Gait Measures with Falling and Fear of Falling

Gait Measure OR for Falling
(95% confidence interval)

OR for Fear of Falling

(95% confidence interval)

Stride-to-Stride Average Stride length Double-support Stride velocity Stride-to-Stride SD Stride length Double-support Stride velocity
* (p < 0.05)

1.25 (0.64-2.47) 1.38 (0.76-2.50) 0.90 (0.50-1.63)

1.98 (1.04-3.75)* 1.98 (1.10-3.54)* 1.74 (1.01-3.02)*

1.95 (1.08-3.52)* 1.27 (0.77-2.11) 2.05 (1.11-3.77)* 1.38 (0.83-2.27) 2.30 (1.17-4.51)* 0.94 (0.58-1.51)

Maki BE. Gait changes in older adults: Predictors of falls of indicators of fear ? J Am Geriatr Soc 1997;45:313-20.

Correlation of Perceived Physical Health Status (Sickness Impact Profile Score, SIP) and Depression (CES-D Scale) With Gait Speed (N = 152, Age = 754.4)

Pearson R SIP Physical Depression (CES-D) -.42 -.22

p-value < .01 < .01

Notes : CES-D scored from 0 (best) to 60 (worst). SIP scored from 0 (best) to 100 (worst)

Buchner DM, Cress ME, Esselman PC et al. Factors Associated with changes in gait speed in older adults. J Gerontol 1996,51 :M297-302.

Gait Changes Related to :

Increased Falling Risk

Gait Variability: Stride-to-Stride Variability

Example: Stride Length

Coefficient of Variation, CoVar = (SD/M) 100

Stride-to-Stride Variability and Falls in Older Adults

Odds Ratio for

Falling

Gait Measure

Change

(95% Confidence Interval)

Stride-to-Stride-Standard Deviation
Stride Length Double-Support Stride Velocity +0.017m +0.72% +0.016m/s 1.95(1.08-3.52) 2.05(1.11-3.77) 2.30(1.17-4.51)

Maki BE. Gait changes in older adults: Predictors of falling or indicators of fear? J Am Geriatr Soc 1997;45:313-320

Stride/Swing Time Variability and Falls in Older Adults

(N = 52; mean age = 80.3 years)
Gait Measure Fallers
(n = 20)

Non-Fallers
(n = 32)

Stride time variability (msec) Swing time variability (msec)

106 30 39 4

49 4 27 2

< .04 < .03

Hausdorff J, Rios D, Edelberg H. Gait variability and fall risk in community-living older adults: A 1-year prospective Study. Arch Phys Med Rehabil 2001; 82: 1050-6.

Spatial and Temporal Gait Changes Related to Interventions ?

Individual Balance Training

Tinetti ME, Baker DI, Garrett PA et al. Yale FICSIT: Risk factor abatement strategy for fall prevention. J Am Geriatr Soc 1993;41:315-20

Tai Chi Inspired Exercise Program

Kressig RW, Wolf SL. Exploring guidelines for the application of Tai Chi to patients with stroke. Neurology Report 2001;25:50-54

Resistance Training

Take Home Messages (1)

In comparison to the young, the elderly

walk slower, have a shorter step length an increase in stance time and double support, and a far less vigorous push off.

Adaptations representing a safer gait pattern

Take Home Messages (2)

Reduced speed, reduced stride length, and increased double support time - are associated with fear of falling - but show no association with falling

Take Home Messages (3)

Stride-to-stride variability in the control of gait is an independent predictor of falling may be an important measure for
- identifying high risk individuals - evaluating preventive interventions