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Longitudinal Associations Between Falls and Risk of Gait Decline: Results From the Central Control of Mobility and Aging Study

Published:September 12, 2022DOI:https://doi.org/10.1016/j.apmr.2022.08.975

      Highlights

      • Gait impairments in older age are a marker of declining functional health.
      • Gait is multifaceted and pace, rhythm, variability represent main gait domains.
      • In multiple fallers pace declined, rhythm and variability increased at faster rates.
      • In single fallers only variability increased at a faster rate.
      • Falls were not associated with risk of clinical gait abnormalities.

      Abstract

      Objective

      To examine whether falls are associated with longitudinal changes in different gait domains and onset of clinical gait abnormalities.

      Design

      Longitudinal study.

      Setting

      General community.

      Participants

      Ambulatory older adults free of dementia (N=428; mean age, 77.8±6.4 years).

      Interventions

      Not applicable.

      Main Outcome Measures

      Gait was assessed with a computerized walkway. Pace, rhythm, and variability (outcome measures) were derived from individual gait measures, using principal component analysis. Clinical gait abnormalities (neurologic, nonneurologic, mixed) were visually assessed by clinicians. Linear mixed-effects models were used to examine the associations between falls (the exposure variable coded as none, single, and multiple) and changes in gait domains. Multinomial logistic regression was used to examine associations between falls and the onset of clinical gait abnormalities. Models were adjusted for sex, education, age, body mass index, number of comorbidities, gait speed at the first follow-up, and time between the last fall and the first follow-up gait assessment.

      Results

      Pace declined while rhythm and variability increased at a faster rate (P<.05) among 32 participants with multiple falls in the first year of follow-up compared with 299 participants with no falls. Risk for clinical gait abnormalities between those with no falls, a single fall, or multiple falls was not different.

      Conclusions

      Multiple falls predict future gait decline in multiple domains in aging. Interventions to prevent gait decline after multiple falls should be investigated.

      Keywords

      List of abbreviations:

      BMI (body index), CI (confidence interval)
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