P3-547: GAIT PARAMETERS AND CHARACTERISTICS ASSOCIATED WITH INCREASED RISK OF FALLS IN PEOPLE WITH DEMENTIA: A SYSTEMATIC REVIEW

ABSTRACTBackground:People with dementia fall twice as often and have more serious fall-related injuries than healthy older adults. While gait impairment as a generic term is understood as a fall risk factor in this population, a clear elaboration of the specific components of gait that are associated with falls risk is needed for knowledge translation to clinical practice and the development of fall prevention strategies for people with dementia.Objective:To review gait parameters and characteristics associated with falls in people with dementia.Methods:Electronic databases CINAHL, EMBASE, MedLine, PsycINFO, and PubMed were searched (from inception to April 2017) to identify prospective cohort studies evaluating the association between gait and falls in people with dementia.Results:Increased double support time variability, use of mobility aids, walking outdoors, higher scores on the Unified Parkinson’s Disease Rating Scale, and lower average walking bouts were associated with elevated risk of any fall. Increased double support time and step length variability were associated with recurrent falls. The reviewed articles do not support using the Performance Oriented Mobility Assessment and the Timed Up-and-Go tests to predict any fall in this population. There is limited research on the use of dual-task gait assessments for predicting falls in people with dementia.Conclusion:This systematic review shows the specific spatiotemporal gait parameters and features that are associated with falls in people with dementia. Future research is recommended to focus on developing specialized treatment methods for these specific gait impairments in this patient population.

Download Full-text

Assessing gait parameters with accelerometer-based methods to identify older adults at risk of falls: a systematic review

European Geriatric Medicine ◽

10.1007/s41999-018-0061-3 ◽

2018 ◽

Vol 9 (4) ◽

pp. 435-448 ◽

Cited By ~ 3

Author(s):

S. Gillain ◽

M. Boutaayamou ◽

C. Beaudart ◽

M. Demonceau ◽

O. Bruyère ◽

...

Keyword(s):

Systematic Review ◽

Older Adults ◽

At Risk ◽

Gait Parameters ◽

Risk Of Falls

Download Full-text

A Cross-Sectional Study on Balance Deficits and Gait Deviations in COPD Patients

Canadian Respiratory Journal ◽

10.1155/2021/6675088 ◽

2021 ◽

Vol 2021 ◽

pp. 1-5

Author(s):

Priyanka Jirange ◽

K. Vaishali ◽

Mukesh Kumar Sinha ◽

Kalyana Chakravarthy Bairapareddy ◽

Gopala Krishna Alaparthi

Keyword(s):

Dynamic Balance ◽

Cross Sectional Study ◽

Cross Sectional ◽

Copd Patients ◽

Gait Parameters ◽

Increased Risk ◽

Significant Difference ◽

Risk Of Falls ◽

Balance Deficits ◽

Fear Of Falls

Background. The gait abnormalities were linked to the balance deficits in the previous studies. However, the deviations in the gait parameters in COPD are currently not known. The study aims to compare gait parameters, static and dynamic balance, and risk of falls in COPD with those in non-COPD individuals. Method. Fourty-two patients with COPD aged 45 years and gender-matched control subjects were included in the study. Gait parameters were assessed by Win-Track gait analyzer, the static balance was assessed by posturography, and the dynamic balance was assessed by the time up and go test. The fear of falls was assessed by Falls Efficacy Scale. Results. COPD individuals had decreased static and dynamic balance as assessed by posturography ( p < 0.05 ) and TUG ( p < 0.01 ), respectively. A significant difference in swing duration ( p = 0.004 ) and also increased risk of falls ( p < 0.01 ) was observed in COPD patients as compared to non-COPD individuals. Conclusion. COPD individuals have increased swing duration, reduced static and dynamic balance, and increased fear of falls as compared to non-COPD individuals.

Download Full-text

Hearing Loss Is Associated with Increased Variability in Double Support Period in the Elderly

Sensors ◽

10.3390/s21010278 ◽

2021 ◽

Vol 21 (1) ◽

pp. 278

Author(s):

Betsy Szeto ◽

Damiano Zanotto ◽

Erin M. Lopez ◽

John A. Stafford ◽

John S. Nemer ◽

...

Keyword(s):

Hearing Loss ◽

Auditory Feedback ◽

Low Frequency ◽

The Elderly ◽

Double Support ◽

Gait Parameters ◽

Hearing Thresholds ◽

Increased Risk ◽

Risk Of Falls ◽

The Right

Hearing loss is a disabling condition that increases with age and has been linked to difficulties in walking and increased risk of falls. The purpose of this study is to investigate changes in gait parameters associated with hearing loss in a group of older adults aged 60 or greater. Custom-engineered footwear was used to collect spatiotemporal gait data in an outpatient clinical setting. Multivariable linear regression was used to determine the relationship between spatiotemporal gait parameters and high and low frequency hearing thresholds of the poorer hearing ear, the left ear, and the right ear, respectively, adjusting for age, sex, race/ethnicity, and the Dizziness Handicap Inventory–Screening version score. Worsening high and low frequency hearing thresholds were associated with increased variability in double support period. Effects persisted after adjusting for the effects of age and perceived vestibular disability and were greater for increases in hearing thresholds for the right ear compared to the left ear. These findings illustrate the importance of auditory feedback for balance and coordination and may suggest a right ear advantage for the influence of auditory feedback on gait.

Download Full-text

Does Obesity Increase the Risk and Severity of Falls in People Aged 60 Years and Older? A Systematic Review and Meta-analysis of Observational Studies

The Journals of Gerontology Series A ◽

10.1093/gerona/glz272 ◽

2019 ◽

Vol 75 (5) ◽

pp. 952-960 ◽

Cited By ~ 5

Author(s):

Silvia G R Neri ◽

Juliana S Oliveira ◽

Amabile B Dario ◽

Ricardo M Lima ◽

Anne Tiedemann

Keyword(s):

Systematic Review ◽

Older Adults ◽

Relative Risk ◽

Observational Studies ◽

Data Extraction ◽

Meta Analysis ◽

Random Effect ◽

Relative Risks ◽

Increased Risk ◽

Risk Of Falls

Abstract Background Recent investigations suggest that obesity may be associated with an increased risk of falls; however, this theory has yet to be definitively confirmed. This systematic review and meta-analysis examined the strength of the association between obesity and falls, multiple falls, fall-related injuries, and fall-related fractures among older adults. Methods MEDLINE, Embase, CINAHL, PsycINFO, SPORTDiscus, LILACS, and Web of Science databases were searched to identify observational studies that assessed the association between obesity and fall-related outcomes in participants aged 60 years and older. Two independent reviewers performed data extraction and quality assessment. Relative risks and 95% confidence intervals (CI) were pooled using random effect meta-analyses. Results Thirty-one studies including a total of 1,758,694 participants were selected from 7,815 references. Pooled estimates showed that obese older adults have an increased risk of falls compared with nonobese counterparts (24 studies; relative risk: 1.16; 95% CI: 1.07–1.26; I2: 90%). Obesity was also associated with an increased risk of multiple falls (four studies; relative risk: 1.18; 95% CI: 1.08–1.29; I2: 0%). There was no evidence, however, of an association between obesity and fall-related injuries (seven studies; relative risk: 1.04; 95% CI: 0.92–1.18; I2: 65%). Fall-related fractures were reported in only one study, which demonstrated a lower risk of hip fracture with obesity (odds ratio: 0.65; 95% CI: 0.63–0.68). Conclusions Obesity increases the risk of falls and multiple falls in people aged 60 years and older; however, there is insufficient evidence of an association with fall-related injuries or fractures. Prevention and treatment of obesity may play a role in preventing falls in older age.

Download Full-text

Walking with rollator: a systematic review of gait parameters in older persons

European Review of Aging and Physical Activity ◽

10.1186/s11556-019-0222-5 ◽

2019 ◽

Vol 16 (1) ◽

Cited By ~ 6

Author(s):

Marion Mundt ◽

Joao Pedro Batista ◽

Bernd Markert ◽

Cornelius Bollheimer ◽

Thea Laurentius

Keyword(s):

Systematic Review ◽

Older Adults ◽

Older Persons ◽

Assistive Technologies ◽

Younger Adults ◽

Temporal Parameters ◽

Gait Parameters ◽

Risk Of Falls ◽

Gait Mechanics ◽

Spatio Temporal

Abstract Background The aging population increasingly needs assistive technologies, such as rollators, to function and live less dependently. Rollators are designed to decrease the risk of falls by improving the gait mechanics of their users. However, data on the biomechanics of rollator assisted gait of older adults are limited, or mostly derived from experiments with younger adults. Methods and results This review summarises the data from 18 independent studies on the kinematic and kinetic gait parameters of assisted gait of older persons. All of these studies evaluated spatio-temporal parameters, but not joint angles or moments. Conclusion Due to the limited research on rollator supported gait in older adults, the number of parameters that could be analysed in this systematic review was restricted. Further research in the analysis of spatio-temporal parameters and a higher standardisation in clinical research will be necessary.

Download Full-text

Quantitative Mobility Assessment for Fall Risk Prediction in Dementia: A Systematic Review

Dementia and Geriatric Cognitive Disorders ◽

10.1159/000490850 ◽

2018 ◽

Vol 45 (5-6) ◽

pp. 353-367 ◽

Cited By ~ 13

Author(s):

Elham Dolatabadi ◽

Karen Van Ooteghem ◽

Babak Taati ◽

Andrea Iaboni

Keyword(s):

Systematic Review ◽

Fall Risk ◽

Postural Stability ◽

Timed Up And Go ◽

Mobility Assessment ◽

Increased Risk ◽

Risk Of Falls ◽

High Risk Populations ◽

Cognitively Intact ◽

The Relationship

Background: Impairments of gait and balance often progress through the course of dementia, and are associated with increased risk of falls. Summary: This systematic review provides a critical analysis of the evidence linking quantitative measures of gait and balance to fall risk in older adults with dementia. Various instrumented measures of gait and postural stability including gait speed and non-instrumented performance measures including Timed Up and Go were shown to be capable of distinguishing fallers from non-fallers. Key Messages: Existing reviews indicate that impairments of gait and balance are associated with increased risk of falls in cognitively intact older people. There are inconsistencies, however, regarding the characteristics most predictive of a fall. In order to advance fall prevention efforts, there is an important need to understand the relationship between gait, balance, and fall risk, particularly in high-risk populations such as individuals with dementia.

Download Full-text

Critical spatiotemporal gait parameters for individuals with dementia: A systematic review and meta-analysis

Hong Kong Physiotherapy Journal ◽

10.1142/s101370252130001x ◽

2020 ◽

pp. 1-14

Author(s):

Rita Chiaramonte ◽

Matteo Cioni

Keyword(s):

Systematic Review ◽

Gait Analysis ◽

Dual Task ◽

Stride Length ◽

Meta Analysis ◽

Time Variability ◽

Stride Time ◽

Single Task ◽

Gait Parameters ◽

Risk Of Falls

Instrumented gait analysis allows for the identification of walking parameters to predict cognitive decline and the worsening of dementia. The aim of this study was to perform a meta-analysis to better clarify which gait parameters are affected or modified with the progression of the dementia in a larger sample, as well as which gait assessment conditions (single-task or dual-task conditions) would be more sensitive to reflect the influence of dementia. Literature searches were conducted with the keywords “quantitative gait” OR “gait analysis” AND “dementia” AND “single-task” AND “dual-task,” and for “quantitative gait” OR “gait analysis” AND “dementia” AND “fall risk” on PubMed, EMBASE, the Cochrane Library, Scopus, and Web of Science. The results were used to perform a systematic review focussing on instrumental quantitative assessment of the walking of patients with dementia, during both single and dual tasks. The search was performed independently by two authors (C. R. and C. M.) from January 2018 to April 2020 using the PICOS criteria. Nine publications met the inclusion criteria and were included in the systematic review. Our meta-analysis showed that during a single task, most of the spatiotemporal parameters of gait discriminated best between patients with dementia and healthy controls, including speed, cadence, stride length, stride time, stride time variability, and stance time. In dual tasks, only speed, stride length, and stride time variability discriminated between the two groups. In addition, compared with spatial parameters (e.g. stride length), some temporal gait parameters were more correlated to the risk of falls during the comfortable walking in a single task, such as cadence, stride time, stride time variability, and stance time. During a dual task, only the variability of stride time was associated with the risk of falls.

Download Full-text

Orthostatic Hypotension and Antiparkinsonian Drugs: A Systematic Review and Meta-analysis

Journal of Geriatric Psychiatry and Neurology ◽

10.1177/08919887211060017 ◽

2021 ◽

pp. 089198872110600

Author(s):

Danielle, Nimmons ◽

Cini Bhanu ◽

Mine Orlu ◽

Anette Schrag ◽

Kate Walters

Keyword(s):

Systematic Review ◽

Orthostatic Hypotension ◽

Dopamine Agonists ◽

Fixed Effects ◽

Meta Analysis ◽

Vital Signs ◽

Mao B ◽

Increased Risk ◽

Risk Of Falls ◽

Antiparkinsonian Drugs

Background Orthostatic hypotension (OH) is multifactorial in Parkinson’s disease (PD). Antiparkinsonian medication can contribute to OH, leading to increased risk of falls, weakness and fatigue. Methods We conducted a systematic review and meta-analysis of randomised controlled trials (RCTs) of antiparkinsonian drugs associated with OH as an adverse effect, compared to placebo. We searched EMBASE, MEDLINE and Web of Science databases until November 2020. Analysis used fixed-effects models and the GRADE tool to rate quality of evidence. Meta-analysis was performed if 3 or more studies of a drug group were available. Results Twenty-one RCTs including 3783 patients were included comparing 6 PD drug groups to placebo (MAO-B inhibitors, dopamine agonists, levodopa, COMT inhibitors, levodopa and adenosine receptor antagonists). OH was recorded as an adverse event or measurement of vital signs, without further specification on how this was defined or operationalised. Meta-analysis was performed for MAO-B inhibitors and dopamine agonists, as there were 3 or more studies for these drug groups. In this analysis, compared with placebo, neither MAO-B inhibitors or dopamine agonists were associated with increased risk of OH, (OR 2.28 [95% CI:0.81–6.46]), (OR 1.39 [95% CI:0.97–1.98]). Conclusions Most studies did not specifically report OH, or reporting of OH was limited, including how and when it was measured. Furthermore, studies specifically reporting OH included participants that were younger than typical PD populations without multimorbidity. Future trials should address this, for example,, by including individuals over the age of 75, to improve estimations of how antiparkinsonian medications affect risk of OH.

Download Full-text

Fear of falling assessments in older people with dementia

Reviews in Clinical Gerontology ◽

10.1017/s0959259815000106 ◽

2015 ◽

Vol 25 (2) ◽

pp. 98-106 ◽

Cited By ~ 1

Author(s):

Chantel Cox ◽

Michael Vassallo

Keyword(s):

Older People ◽

Social Services ◽

Fear Of Falling ◽

Assessment Tools ◽

People With Dementia ◽

Increased Risk ◽

Risk Of Falls ◽

Specific Assessment ◽

Key Issues

SummaryFear of falling (FoF) is a common condition in older age. However, there is a paucity of research on its prevalence, impact and treatment in older people with dementia. People with dementia have an increased risk of falls which present a significant threat to their independence, as well as having a significant economic impact on health and social services. This review outlines the key issues in relation to FoF, current guidelines and assessment tools and their use for people with dementia. Further research needs to be completed in both addressing the specific assessment barriers that people with dementia may face regarding the use of current FoF tools, with further exploration surrounding the individual's experience of FoF and how this may be impacting upon their quality of life and functionality. Until a well-validated method has been developed, clinicians need to utilize available tools as guidelines, seek the assistance of proxies at all stages of the care journey, and use clinical judgement to assess FoF in patients with dementia.

Download Full-text