Hostname: page-component-76fb5796d-x4r87 Total loading time: 0 Render date: 2024-04-25T07:15:27.133Z Has data issue: false hasContentIssue false
  • English
  • Français

Gait parameters and characteristics associated with increased risk of falls in people with dementia: a systematic review

Published online by Cambridge University Press:  06 December 2018

Shirin Modarresi ,
Alison Divine ,
Jessica A. Grahn ,
Tom J. Overend  and
Susan W. Hunter
Shirin Modarresi*
Affiliation:
Health & Rehabilitation Sciences, University of Western Ontario, London, ON, Canada
Alison Divine
Affiliation:
Health & Rehabilitation Sciences, University of Western Ontario, London, ON, Canada
Jessica A. Grahn
Affiliation:
Brain and Mind Institute, Department of Psychology, University of Western Ontario, London, ON, Canada
Tom J. Overend
Affiliation:
Health & Rehabilitation Sciences, University of Western Ontario, London, ON, Canada School of Physical Therapy, Elborn College, University of Western Ontario, London, ON, Canada
Susan W. Hunter
Affiliation:
Health & Rehabilitation Sciences, University of Western Ontario, London, ON, Canada School of Physical Therapy, Elborn College, University of Western Ontario, London, ON, Canada
*
Correspondence should be addressed to: Shirin Modarresi, Health and Rehabilitation Sciences, University of Western Ontario, London, ON, Canada. Phone: +1(226) 884-9910. Email: smodarre@uwo.ca.
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:

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.

Keywords

systematic reviewdementiagaitmobilityaccidental fallsrisk assessment
Type
Review Article
Information
International Psychogeriatrics , Volume 31 , Issue 9: Issue Theme: Self-Esteem, Resilience, and Emotional Intelligence , September 2019 , pp. 1287 - 1303
Copyright
© International Psychogeriatric Association 2018 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Allali, G., Assal, F., Kressig, R. W., Dubost, V., Herrmann, F. R. and Beauchet, O. (2008). Impact of impaired executive function on gait stability. Dementia and Geriatric Cognitive Disorders, 26, 364–369. doi: 10.1159/000162358.CrossRefGoogle ScholarPubMed
Allan, L. M., Ballard, G. R., Rowan, E. N. and Kenny, R. A. (2009). Incidence and prediction of falls in dementia: a prospective study in older people. PloS ONE, 4, e5521. doi: 10.1371/journal.pone.0005521.CrossRefGoogle ScholarPubMed
Baddeley, A. D., Baddeley, H. A., Bucks, R. S. and Wilcock, G. K. (2001). Attentional control in Alzheimer’s disease. Brain, 124, 1492–1508. doi: 10.1093/brain/124.8.1492.CrossRefGoogle ScholarPubMed
Bateni, H., Heung, E., Zettel, J., McIIroy, E. E. and Maki, B. E. (2004). Can use of walkers or canes impede lateral compensatory stepping movements?. Gait & Posture, 20, 74–83. doi: 10.1016/S0966-6362(03)00098-5.CrossRefGoogle ScholarPubMed
Bateni, H. and Maki, B. E. (2005). Assistive devices for balance and mobility: benefits, demands, and adverse consequences. Archives of Physical Medicine and Rehabilitation, 86, 134–145. doi: 10.1016/j.apmr.2004.04.023.CrossRefGoogle ScholarPubMed
Beauchet, O., Fantino, B., Allali, G., Muir, S. W., Montero-Odasso, M. and Annweiler, C. (2011). Timed up and go test and risk of falls in older adults: a systematic review. The Journal of Nutrition, Health & Aging, 15, 933–938. doi: 10.1007/s12603-011-0062-0.CrossRefGoogle ScholarPubMed
Ble, A. et al. (2005). Executive function correlates with walking speed in older persons: the InCHIANTI study. Journal of the American Geriatrics Society, 53, 410–415. doi: 10.1111/j.1532-5415.2005.53157.x.CrossRefGoogle ScholarPubMed
Buchner, D. M. and Larson, E. B. (1987). Falls and fractures in patients with Alzheimer-type dementia. The Journal of the American Medical Association, 257, 1492–1495. doi: 10.1001/jama.1987.03390110068028.CrossRefGoogle ScholarPubMed
Camicioli, R. and Licis, L. (2004). Motor impairment predicts falls in specialized Alzheimer care units. Alzheimer Disease and Associated Disorders, 18, 214–218.Google ScholarPubMed
Deandrea, S., Lucenteforte, E., Bravi, F., Foschi, R., La Vecchia, C. and Negri, E. (2010). Risk factors for falls in community-dwelling older people: a systematic review and meta-analysis. Epidemiology, 21, 658–668. doi: 10.1097/EDE.0b013e3181e89905.CrossRefGoogle ScholarPubMed
Doi, T. et al. (2015). Cognitive function and falling among older adults with mild cognitive impairment and slow gait. Geriatrics & Gerontology International, 15, 1073–1078. doi: 10.1111/ggi.12407.CrossRefGoogle ScholarPubMed
Eriksson, S., Gustafson, Y. and Lundin-Olsson, L. (2008). Risk factors for falls in people with and without a diagnose of dementia living in residential care facilities: a prospective study. Archives of Gerontology and Geriatrics, 46, 293–306. doi: 10.1016/j.archger.2007.05.002.CrossRefGoogle ScholarPubMed
Fernando, E., Fraser, M., Hendriksen, J., Kim, C. H. and Muir-Hunter, S. W. (2017). Risk factors associated with falls in older adults with dementia: a systematic review. Physiotherapy Canada, 69, 161–170. doi: 10.3138/ptc.2016-14.CrossRefGoogle ScholarPubMed
Fox, B., Henwood, T., Keogh, J. and Neville, C. (2016). Psychometric viability of measures of functional performance commonly used for people with dementia: a systematic review of measurement properties. JBI Database of Systematic Reviews and Implementation Reports, 14, 115–171. doi: 10.11124/JBISRIR-2016-003064.CrossRefGoogle ScholarPubMed
Gietzelt, M., Feldwieser, F., Govercin, M., Steinhagen-Thiessen, E. and Marschollek, M. (2014). A prospective field study for sensor-based identification of fall risk in older people with dementia. Informatics for Health & Social Care, 39, 249–261. doi: 10.3109/17538157.2014.931851.CrossRefGoogle ScholarPubMed
Harlein, J., Dassen, T., Halfens, R. J. and Heinze, C. (2009). Fall risk factors in older people with dementia or cognitive impairment: a systematic review. Journal of Advanced Nursing, 65, 922–933. doi: 10.1111/j.1365-2648.2008.04950.x.CrossRefGoogle ScholarPubMed
Hausdorff, J. M., Yogev, G., Springer, S., Simmon, E. S. and Giladi, N. (2005). Walking is more like catching than tapping: gait in the elderly as a complex cognitive task. Experimental Brain Research, 164, 541–548. doi: 10.1007/s00221-005-2280-3.CrossRefGoogle ScholarPubMed
Hill-Westmoreland, E. E., Soeken, K. and Spellbring, A. M. (2002). A meta-analysis of fall prevention programs for the elderly: how effective are they?. Nursing Research, 51, 1–8. doi: 10.1097/00006199-200201000-00002.CrossRefGoogle Scholar
Horikawa, E., Matsui, T., Arai, H., Seki, T., Iwasaki, K. and Sasaki, H. (2005). Risk of falls in Alzheimer’s disease: a prospective study. Internal Medicine, 44, 717–721. doi: 10.2169/internalmedicine.44.717.CrossRefGoogle ScholarPubMed
Inoue, K., Sawada, M., Kawai, S., Nakahara, R. and Sano, H. (2000). Mortality from pneumonia and hip fractures in patients with advanced dementia. The Journal of the American Medical Association, 284, 2447. doi: 10.1001/jama.284.19.2447-jlt1115-2-1.CrossRefGoogle ScholarPubMed
Jahn, K., Zwergal, A. and Schniepp, R. (2010). Gait disturbances in old age: classification, diagnosis, and treatment from a neurological perspective. Deutsches Arzteblatt International. 107, 306–316. doi: 10.3238/arztebl.2010.0306.Google ScholarPubMed
Kallin, K., Gustafson, Y., Sandman, P. O. and Karlsson, S. (2005). Factors associated with falls among older, cognitively impaired people in geriatric care settings: a population-based study. The American Journal of Geriatric Psychiatry, 13, 501–509. doi: 10.1097/00019442-200506000-00009.CrossRefGoogle ScholarPubMed
Kearney, F. C., Harwood, R. H., Gladman, J. R., Lincoln, N. and Masud, T. (2013). The relationship between executive function and falls and gait abnormalities in older adults: a systematic review. Dementia and Geriatric Cognitive Disorders, 36, 20–35. doi: 10.1159/000350031.CrossRefGoogle ScholarPubMed
Kropelin, T. F., Neyens, J. C., Halfens, R. J., Kempen, G. I. and Hamers, J. P. (2013). Fall determinants in older long-term care residents with dementia: a systematic review. International Psychogeriatrics, 25, 549–563. doi: 10.1017/S1041610212001937.CrossRefGoogle ScholarPubMed
Leavy, B., Byberg, L., Michaelsson, K., Melhus, H. and Aberg, A. C. (2015). The fall descriptions and health characteristics of older adults with hip fracture: a mixed methods study. BMC Geriatrics, 15, 40. doi: 10.1186/s12877-015-0036-x.CrossRefGoogle ScholarPubMed
Levinoff, E. J., Saumier, D. and Chertkow, H. (2005). Focused attention deficits in patients with Alzheimer’s disease and mild cognitive impairment. Brain and Cognition, 57, 127–130. doi: 10.1016/j.bandc.2004.08.058.CrossRefGoogle ScholarPubMed
Lowry, K. A., Brach, J. S., Nebes, R. D., Studenski, S. A. and VanSwearingen, J. M. (2012). Contributions of cognitive function to straight- and curved-path walking in older adults. Archives of Physical Medicine and Rehabilitation, 93, 802–807. doi: 10.1016/j.apmr.2011.12.007.CrossRefGoogle ScholarPubMed
Magaziner, J., Simonsick, E. M., Kashner, T. M., Hebel, J. R. and Kenzora, J. E. (1990). Predictors of functional recovery one year following hospital discharge for hip fracture: a prospective study. Journal of Gerontology, 45, M101–M107. doi: 10.1093/geronj/45.3.M101.CrossRefGoogle ScholarPubMed
McIsaac, T. L., Lamberg, E. M. and Muratori, L. M. (2015). Building a framework for a dual task taxonomy. BioMed Research International, 2015, 591475. doi: 10.1155/2015/591475.CrossRefGoogle ScholarPubMed
Merory, J. R., Wittwer, J. E., Rowe, C. C. and Webster, E. E. (2007). Quantitative gait analysis in patients with dementia with Lewy bodies and Alzheimer’s disease. Gait & Posture, 26, 414–419. doi: 10.1016/j.gaitpost.2006.10.006.CrossRefGoogle ScholarPubMed
Moher, D., Liberati, A., Tetzlaff, J., Altman, D. G. and Prisma Group. (2010). Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. International Journal of Surgery, 8, 336–341. doi: 10.1016/j.ijsu.2010.02.007.CrossRefGoogle ScholarPubMed
Montero-Odasso, M., Muir, S. W. and Speechley, M. (2012). Dual-task complexity affects gait in people with mild cognitive impairment: the interplay between gait variability, dual tasking, and risk of falls. Archives of Physical Medicine and Rehabilitation, 93, 293–299. doi: 10.1016/j.apmr.2011.08.026.CrossRefGoogle ScholarPubMed
Moyle, W., McAllister, M., Venturato, L. and Adams, T. (2007). Quality of life and dementia: the voice of the person with dementia. Dementia, 6, 175–191. doi: 10.1177/1471301207080362.CrossRefGoogle Scholar
Muir, S. W., Beauchet, O., Montero-Odasso, M., Annweiler, C., Fantino, B. and Speechley, M. (2013). Association of executive function impairment, history of falls and physical performance in older adults: a cross-sectional population-based study in eastern France. The Journal of Nutrition, Health & Aging, 17, 661–665. doi: 10.1007/s12603-013-0045-4.CrossRefGoogle ScholarPubMed
Muir-Hunter, S. W. and Montero-Odasso, M. (2017). The attentional demands of ambulating with an assistive device in older adults with Alzheimer’s disease. Gait & Posture, 54, 202–208. doi: 10.1016/j.gaitpost.2017.03.011.CrossRefGoogle ScholarPubMed
Muir-Hunter, S. W. and Wittwer, J. E. (2016). Dual-task testing to predict falls in community-dwelling older adults: a systematic review. Physiotherapy, 102, 29–40. doi: 10.1016/j.physio.2015.04.011.CrossRefGoogle ScholarPubMed
Nadkarni, N. K., Mawji, E., McIlroy, W. E. and Black, S. E. (2009). Spatial and temporal gait parameters in Alzheimer’s disease and aging. Gait & Posture, 30, 452–454. doi: 10.1016/j.gaitpost.2009.07.003.CrossRefGoogle ScholarPubMed
Nakamura, T., Meguro, K. and Sasaki, H. (1996). Relationship between falls and stride length variability in senile dementia of the Alzheimer type. Gerontology, 42, 108–113. doi: 10.1159/000213780.CrossRefGoogle ScholarPubMed
Pate, D. S. and Margolin, D. I. (1994). Cognitive slowing in Parkinson’s and Alzheimer’s patients: distinguishing bradyphrenia from dementia. Neurology, 44, 669. doi: 10.1212/WNL.44.4.669.CrossRefGoogle ScholarPubMed
Pellfolk, T., Gustafsson, T., Gustafson, Y. and Karlsson, S. (2009). Risk factors for falls among residents with dementia living in group dwellings. International Psychogeriatrics, 21, 187–194. doi: 10.1017/S1041610208007837.CrossRefGoogle ScholarPubMed
Pfortmueller, C. A., Lindner, G. and Exadaktylos, A. K. (2014). Reducing fall risk in the elderly: risk factors and fall prevention, a systematic review. Minerva Medica, 105, 275–281.Google Scholar
Phelan, E. A., Mahoney, J. E., Voit, J. C. and Stevens, J. A. (2015). Assessment and management of fall risk in primary care settings. The Medical Clinics of North America, 99, 281–293. doi: 10.1016/j.mcna.2014.11.004.CrossRefGoogle ScholarPubMed
Phillips, B., Ball, C., Sackett, D., Badenoch, D., Straus, S., Haynes, B. and Dawes, M. (2001). Evidence-Based Medicine Levels of Evidence. Oxford: Oxford Centre for Evidence-Based Medicine, University of Oxford.Google Scholar
Plummer, P. et al. (2013). Cognitive-motor interference during functional mobility after stroke: state of the science and implications for future research. Archives of Physical Medicine and Rehabilitation, 94, 2565–2574.e6. doi: 10.1016/j.apmr.2013.08.002.CrossRefGoogle ScholarPubMed
Portney, L. G. and Watkins, M. P. (1993). Foundations of Clinical Research: Application to Practice. Stamford: Appleton & Lange.Google Scholar
Prince, M., Comas-Herrera, A., Knapp, M., Guerchet, M. and Karagiannidou, M. (2016). World Alzheimer report (2016): improving healthcare for people living with dementia: coverage, quality and costs now and in the future. Available at: https://www.alz.co.uk/research/WorldAlzheimerReport2016.pdf.Google Scholar
Ries, J. D., Echternach, J. L., Nof, L. and Gagnon Blodgett, M. (2009). Test-retest reliability and minimal detectable change scores for the timed “up & go” test, the six-minute walk test, and gait speed in people with Alzheimer disease. Physical Therapy, 89, 569–579. doi: 10.2522/ptj.20080258.CrossRefGoogle Scholar
Rosano, C., Aizenstein, H., Brach, J., Longenberger, A., Studenski, S. and Newman, A. B. (2008). Special article: gait measures indicate underlying focal gray matter atrophy in the brain of older adults. The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 63, 1380–1388. doi: 10.1093/gerona/63.12.1380.CrossRefGoogle ScholarPubMed
Schwenk, M., Hauer, K., Zieschang, T., Englert, S., Mohler, J. and Najafi, B. (2014). Sensor-derived physical activity parameters can predict future falls in people with dementia. Gerontology, 60, 483–492. doi: 10.1159/000363136.CrossRefGoogle ScholarPubMed
Scott, V., Votova, K., Scanlan, A. and Close, J. (2007). Multifactorial and functional mobility assessment tools for fall risk among older adults in community, home-support, long-term and acute care settings. Age and Ageing, 36, 130–139. doi: 10.1093/ageing/afl165.CrossRefGoogle ScholarPubMed
Shaw, F. E. et al. (2003). Multifactorial intervention after a fall in older people with cognitive impairment and dementia presenting to the accident and emergency department: randomised controlled trial. BMJ, 326, 73. doi: 10.1136/bmj.326.7380.73.CrossRefGoogle ScholarPubMed
Sterke, C. S., Huisman, S. L., van Beeck, E. F., Looman, C. W. and van der Cammen, T. J. (2010). Is the Tinetti performance oriented mobility assessment (POMA) a feasible and valid predictor of short-term fall risk in nursing home residents with dementia?. International Psychogeriatrics, 22, 254–263. doi: 10.1017/S1041610209991347.CrossRefGoogle ScholarPubMed
Sterke, C. S., van Beeck, E. F., Looman, C. W. and van der Cammen, T. J. (2012). An electronic walkway can predict short-term fall risk in nursing home residents with dementia. Gait & Posture, 36, 95–101. doi: 10.1016/j.gaitpost.2012.01.012.CrossRefGoogle ScholarPubMed
Suttanon, P., Hill, K. D., Said, C. M. and Dodd, K. J. (2013). A longitudinal study of change in falls risk and balance and mobility in healthy older people and people with Alzheimer disease. American Journal of Physical Medicine & Rehabilitation, 92, 676–685. doi: 10.1097/PHM.0b013e318278dcb3.CrossRefGoogle ScholarPubMed
Tappen, R. M., Roach, K. E., Buchner, D., Barry, C. and Edlstein, J. (1997). Reliability of physical performance measures in nursing home residents with Alzheimer’s disease. The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 52, M52–M55. doi: 10.1093/gerona/52A.1.M52.CrossRefGoogle ScholarPubMed
Taylor, M. E., Delbaere, K., Lord, S. R., Mikolaizak, A. S. and Close, J. C. (2013). Physical impairments in cognitively impaired older people: implications for risk of falls. International Psychogeriatrics, 25, 148–156. doi: 10.1017/S1041610212001184.CrossRefGoogle ScholarPubMed
Taylor, M. E., Delbaere, K., Lord, S. R., Mikolaizak, A. S., Brodaty, H. and Close, J. C. (2014). Neuropsychological, physical, and functional mobility measures associated with falls in cognitively impaired older adults. The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 69, 987–995. doi: 10.1093/gerona/glt166.CrossRefGoogle ScholarPubMed
Taylor, M. E., Ketels, M. M., Delbaere, K., Lord, S. R., Mikolaizak, A. S. and Close, J. C. (2012). Gait impairment and falls in cognitively impaired older adults: an explanatory model of sensorimotor and neuropsychological mediators. Age and Ageing, 41, 665–669. doi: 10.1093/ageing/afs057.CrossRefGoogle ScholarPubMed
Tinetti, M. E., Speechley, M. and Ginter, S. F. (1988). Risk factors for falls among elderly persons living in the community. The New England Journal of Medicine, 319, 1701–1707. doi: 10.1056/NEJM198812293192604.CrossRefGoogle ScholarPubMed
Tooth, L., Ware, R., Bain, C., Purdie, D. M. and Dobson, A. (2005). Quality of reporting of observational longitudinal research. American Journal of Epidemiology, 161, 280–288. doi: 10.1093/aje/kwi042.CrossRefGoogle ScholarPubMed
van Iersel, M. B., Benraad, C. E. M. and Rikkert, M. G. M. O. (2007). Validity and reliability of quantitative gait analysis in geriatric patients with and without dementia. Journal of the American Geriatrics Society, 55, 632–634. doi: 10.1111/j.1532-5415.2007.01130.x.CrossRefGoogle ScholarPubMed
van Iersel, M. B., Hoefsloot, W., Munneke, M., Bloem, B. R. and Rikkert, M. M. (2004). Systematic review of quantitative clinical gait analysis in patients with dementia. Zeitschrift fur Gerontologie und Geriatrie, 37, 27–32. doi: 10.1007/s00391-004-0176-7.CrossRefGoogle ScholarPubMed
Vidan, M., Serra, J. A., Moreno, C., Riquelme, G. and Ortiz, J. (2005). Efficacy of a comprehensive geriatric intervention in older patients hospitalized for hip fracture: a randomized, controlled trial. Journal of the American Geriatrics Society, 53, 1476–1482. doi: 10.1111/j.1532-5415.2005.53466.x.CrossRefGoogle ScholarPubMed
Watson, N. L. et al. (2010). Executive function, memory, and gait speed decline in well-functioning older adults. The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 65, 1093–1100. doi: 10.1093/gerona/glq111.CrossRefGoogle ScholarPubMed
Wimo, A. and Prince, M. (2010). World Alzheimer report 2010: the global economic impact of dementia Alzheimer’s disease international. Available at: https://www.alz.co.uk/research/files/WorldAlzheimerReport2010ExecutiveSummary.pdf.Google Scholar
Supplementary material: File

Modarresi et al. supplementary material

Appendix A1

Download Modarresi et al. supplementary material(File)
File 19.7 KB