Stability of gait and interlimb coordination in older adults

Most falls in older adults occur when walking, specifically following a trip. This study investigated the short- and longer term responses of young ( n = 24, 27.6 ± 4.5 yr) and older adults ( n = 18, 69.1 ± 4.2 yr) to a trip during gait at comfortable speed and the role of interlimb coordination in recovery from tripping. Subjects walked on a self-paced treadmill when forward movement of their dominant leg was unexpectedly arrested for 250 ms. Recovery of center of mass (COM) movements and of double-support duration following perturbation was determined. In addition, the disruption and recovery of interlimb coordination of the arms and legs was evaluated. Although young and older subjects used similar lower limb strategies in response to the trip, older adults had less stable COM movement patterns before perturbation, had longer transient destabilization (>25%) after perturbation, required more gait cycles to recover double-support duration (older, 3.48 ± 0.7 cycles; young, 2.88 ± 0.4 cycles), and had larger phase shifts that persisted after perturbation (older, −83° to −90°; young, −39° to −42°). Older adults also had larger disruptions to interlimb coordination of the arms and legs. The timing of the initial disruption in coordination was correlated with the disturbance in gait stability only in young adults. In older adults, greater initial COM instability was related to greater longer term arm incoordination. These results suggest a relationship between interlimb coordination and gait stability, which may be associated with fall risk in older adults. Reduced coordination and gait stability suggest a need for stability-related functional training even in high-functioning older adults.

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Adding Light Touch While Walking in Older Adults: Biomechanical and Neuromotor Effects

Journal of Aging and Physical Activity ◽

10.1123/japa.2019-0270 ◽

2020 ◽

Vol 28 (5) ◽

pp. 680-685

Author(s):

Alison R. Oates ◽

Aaron Awdhan ◽

Catherine Arnold ◽

Joyce Fung ◽

Joel L. Lanovaz

Keyword(s):

Older Adults ◽

Muscle Activity ◽

Balance Control ◽

Center Of Mass ◽

Gait Pattern ◽

Light Touch ◽

Margin Of Stability ◽

Complex Picture ◽

Falls In Older Adults ◽

Haptic Input

Adding haptic input may improve balance control and help prevent falls in older adults. This study examined the effects of added haptic input via light touch on a railing while walking. Participants (N = 53, 75.9 ± 7.9 years) walked normally or in tandem (heel to toe) with and without haptic input. During normal walking, adding haptic input resulted in a more cautious and variable gait pattern, reduced variability of center of mass acceleration and margin of stability, and increased muscle activity. During tandem walking, haptic input had minimal effect on step parameters, decreased lower limb muscle activity, and increased cocontraction at the ankle closest to the railing. Age was correlated with step width variability, stride length variability, stride velocity, variability of medial-lateral center of mass acceleration, and margin of stability for tandem walking. This complex picture of sensorimotor integration in older adults warrants further exploration into added haptic input during walking.

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Satisfaction with aging results in reduced risk for falling

International Psychogeriatrics ◽

10.1017/s1041610215001969 ◽

2015 ◽

Vol 28 (5) ◽

pp. 741-747 ◽

Cited By ~ 4

Author(s):

Liat Ayalon

Keyword(s):

Older Adults ◽

Walking Speed ◽

Functional Decline ◽

Psychosocial Interventions ◽

Protective Mechanism ◽

Gender Education ◽

Falls In Older Adults ◽

Nationally Representative ◽

Retirement Study

ABSTRACTBackground:Falls are highly frequent in older adults and are associated with increased morbidity and mortality. The present study was designed to assess the role of satisfaction with one's aging process as a predictor of the risk for falling over a four-year period and to identify potential mediators of this relationship.Methods:The Health and Retirement Study (HRS) is a US nationally representative sample of individuals over the age of 50 years and their spouse of any age. The present study was based on the 2008–2012 waves of the HRS. Analyses were restricted to 4,121 respondents over the age of 50 years, who had fall data in 2008 and 2012 and were eligible to complete the satisfaction with aging measure as part of the 2008 psychosocial questionnaire.Results:Overall, 38.1% of the sample reported having fallen at least once between 2006 and 2008 and 40.7% reported having fallen at least once between 2010 and 2012. Higher levels of satisfaction with aging in 2008 were found to be protective against falls assessed in 2012 (OR[95%CI] = 0.88[0.79–0.98]) even after adjustment for age, gender, education, ethnicity, medical status, functional status, cognitive functioning, walking speed, balance, vision, depressive symptoms, physical activities, and past falls. Bootstrap procedures have shown that the effect of satisfaction with aging on falls is partially accounted for through its effect on functional decline.Conclusions:The findings point to the important role of satisfaction with aging as a potential protective mechanism against falls. The results call for the development of psychosocial interventions to reduce falls in older adults.

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Effects of walking speed on gait stability and interlimb coordination in younger and older adults

Gait & Posture ◽

10.1016/j.gaitpost.2013.08.011 ◽

2014 ◽

Vol 39 (1) ◽

pp. 378-385 ◽

Cited By ~ 30

Author(s):

Tal Krasovsky ◽

Anouk Lamontagne ◽

Anatol G. Feldman ◽

Mindy F. Levin

Keyword(s):

Older Adults ◽

Walking Speed ◽

Interlimb Coordination ◽

Gait Stability

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What Role Does Activity Engagement Play in the Association between Cognitive Frailty and Falls among Older Adults? Evidence from Rural Shandong, China

Gerontology ◽

10.1159/000510639 ◽

2020 ◽

Vol 66 (6) ◽

pp. 593-602

Author(s):

Dan Zhao ◽

Jie Li ◽

Peipei Fu ◽

Wenting Hao ◽

Yemin Yuan ◽

...

Keyword(s):

Older Adults ◽

Cross Sectional Study ◽

Cross Sectional ◽

Cognitive Frailty ◽

Activity Engagement ◽

Mediating Role ◽

Falls In Older Adults ◽

The Relationship ◽

Rural Older Adults

Introduction: Previous studies have demonstrated the relationship between cognitive frailty and falls among older adults. Activity engagement (AE) is known to be related to falls in older adults but the subject has been limited to empirical study. This study aimed to explore the mediating role of AE between cognitive frailty and falls among older adults in rural Shandong, China. Methods: A total of 3,242 rural seniors (age ≥60 years; 63.6% women) were included in this cross-sectional study. Regression and bootstrap analyses were performed to explore the mediating role of AE between cognitive frailty and falls. Results: The prevalence of falls was 13.1% and the prevalence of cognitive frailty was 6.6% among the participants. AE mediated the association between cognitive frailty and falls (95% CI 0.077–0.223). However, the direct effect was no longer significant after being adjusted for AE (95% CI –0.037 to 0.684; p = 0.078). Conclusion: Cognitive frailty was found to be associated with falls among rural older adults, and AE mediated this association. More attention should be paid to promote AE among Chinese rural older adults with cognitive frailty.

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Hemodialysis Impact on Motor Function Beyond Aging and Diabetes – Objectively Assessing Gait and Balance by Wearable Technology

10.20944/preprints201809.0529.v1 ◽

2018 ◽

Author(s):

He Zhou ◽

Fadwa Al-Ali ◽

Hadi Rahemi ◽

Nishat Kulkarni ◽

Abdullah Hamad ◽

...

Keyword(s):

Older Adults ◽

Motor Function ◽

Effect Size ◽

Motor Performance ◽

Stride Length ◽

Gait Cycle ◽

Center Of Mass ◽

Static Balance ◽

Double Support ◽

Gait Parameters

Motor functions are deteriorated by aging. Some conditions may magnify this deterioration. To examine whether hemodialysis (HD) process would negatively impact gait and balance beyond diabetes condition among mid-age adults (48-64 years) and older adults (65+ years). One hundred and ninety-six subjects (age=66.2±9.1 years, body-mass-index=30.1±6.4 kg/m2, female=56%) in 5 groups were recruited: mid-age adults with diabetes undergoing HD (Mid-age HD+, n=38) and without HD (Mid-age HD-, n=40); older adults with diabetes undergoing HD (Older HD+, n=36) and without HD (Older HD-, n=37); and non-diabetic older adults (Older DM-, n=45). Gait parameters (stride velocity, stride length, gait cycle time, and double support) and balance parameters (ankle, hip, and center of mass sways) were quantified using validated wearable platforms. Groups with diabetes had overall poorer gait and balance compared to the non-diabetic group (p<0.050). Among people with diabetes, the HD+ had significantly worsened gait and balance when comparing to the HD- (Cohen’s effect size d=0.63-2.32, p<0.050). Between-group difference was more pronounced among older adults with the largest effect size observed for stride length (d=2.32, p<0.001). Results suggested that deterioration in gait speed among the HD+ was correlated with age (r=-0.440, p<0.001), while this correlation was diminished among the HD-. Interestingly, results also suggested that poor gait in the Older HD- related to poor balance, while no correlation was observed between poor balance and poor gait among the Older HD+. Using objective assessments, results confirmed that the presence of diabetes can deteriorate gait and balance, and this deterioration can be magnified by HD process. Among non-HD people with diabetes, poor static balance described poor gait. However, among people with diabetes undergoing HD, age was a dominate factor describing poor gait irrespective of static balance. Results also suggested feasibility of using wearable platforms to quantify motor performance during routine dialysis clinic visits. These objective assessments may assist in identifying early deterioration in motor function, which in turn may promote timely intervention.

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Risk Factors for Injurious Falls in Older Adults: The Role of Sex and Length of Follow-Up

Journal of the American Geriatrics Society ◽

10.1111/jgs.15657 ◽

2018 ◽

Vol 67 (2) ◽

pp. 246-253 ◽

Cited By ~ 10

Author(s):

Stina Ek ◽

Debora Rizzuto ◽

Laura Fratiglioni ◽

Amaia Calderón-Larrañaga ◽

Kristina Johnell ◽

...

Keyword(s):

Risk Factors ◽

Older Adults ◽

Injurious Falls ◽

Falls In Older Adults

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Hemodialysis Impact on Motor Function beyond Aging and Diabetes—Objectively Assessing Gait and Balance by Wearable Technology

Sensors ◽

10.3390/s18113939 ◽

2018 ◽

Vol 18 (11) ◽

pp. 3939 ◽

Cited By ~ 10

Author(s):

He Zhou ◽

Fadwa Al-Ali ◽

Hadi Rahemi ◽

Nishat Kulkarni ◽

Abdullah Hamad ◽

...

Keyword(s):

Older Adults ◽

Motor Function ◽

Effect Size ◽

Stride Length ◽

Gait Cycle ◽

Center Of Mass ◽

Clinic Visit ◽

Double Support ◽

Ankle Stability ◽

Gait Parameters

Motor functions are deteriorated by aging. Some conditions may magnify this deterioration. This study examined whether hemodialysis (HD) process would negatively impact gait and balance beyond diabetes condition among mid-age adults (48–64 years) and older adults (65+ years). One hundred and ninety-six subjects (age = 66.2 ± 9.1 years, body-mass-index = 30.1 ± 6.4 kg/m2, female = 56%) in 5 groups were recruited: mid-age adults with diabetes undergoing HD (Mid-age HD+, n = 38) and without HD (Mid-age HD−, n = 40); older adults with diabetes undergoing HD (Older HD+, n = 36) and without HD (Older HD−, n = 37); and non-diabetic older adults (Older DM−, n = 45). Gait parameters (stride velocity, stride length, gait cycle time, and double support) and balance parameters (ankle, hip, and center of mass sways) were quantified using validated wearable platforms. Groups with diabetes had overall poorer gait and balance compared to the non-diabetic group (p < 0.050). Among people with diabetes, HD+ had significantly worsened gait and balance when comparing to HD− (Cohen’s effect size d = 0.63–2.32, p < 0.050). Between-group difference was more pronounced among older adults with the largest effect size observed for stride length (d = 2.32, p < 0.001). Results suggested that deterioration in normalized gait speed among HD+ was negatively correlated with age (r = −0.404, p < 0.001), while this correlation was diminished among HD−. Interestingly, results also suggested that poor gait among Older HD− is related to poor ankle stability, while no correlation was observed between poor ankle stability and poor gait among Older HD+. Using objective assessments, results confirmed that the presence of diabetes can deteriorate gait and balance, and this deterioration can be magnified by HD process. Among HD− people with diabetes, poor ankle stability described poor gait. However, among people with diabetes undergoing HD, age was a dominate factor describing poor gait irrespective of static balance. Results also suggested feasibility of using wearable platforms to quantify motor performance during routine dialysis clinic visit. These objective assessments may assist in identifying early deterioration in motor function, which in turn may promote timely intervention.

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31 Evidence, Assumptions, and Emerging Treatments for Falls Prevention

Age and Ageing ◽

10.1093/ageing/afz164.31 ◽

2019 ◽

Vol 48 (Supplement_4) ◽

pp. iv9-iv12

Author(s):

Manuel Montero-Odasso

Keyword(s):

Older Adults ◽

Cognitive Processes ◽

Fall Risk ◽

Falls Prevention ◽

Cognitively Impaired ◽

Geriatric Syndrome ◽

Therapeutic Approaches ◽

Emerging Treatments ◽

Falls In Older Adults

Abstract Falls is a common geriatric syndrome that increases morbidity and mortality. Much of our understanding of falls mechanisms derives from studies that excluded or did not evaluate cognitively impaired older adults. This has limited the evidence for managing falls in this population and generated gaps in our understanding of how cognitive processes affect the pathophysiology of falls. This presentation will provide an overview of the role of cognition in falls with potential implications for managing and preventing falls in older adults. A thorough review of observational and interventional studies addressing the role of cognition on falls will be appraised. The importance of the gait-cognition relationship in aging and neurodegeneration is revised to highlight the role of brain motor control deficits in fall risk. The benefits of dual-task gait assessments as a marker of fall risk is reviewed. Therapeutic approaches for reducing falls by improving certain aspects of cognition will be also appraised.

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