98 The Utility of Informant History in Delineating Narratives of Gait Disorder in Older Outpatients

Abstract

Abstract Background A scholarly focus on informant history is recent in geriatric medicine, mostly focused on cognition and syncope.1 Gait disorders are common in older people and accurate diagnosis facilitates treatment.2 As there is a disparity between self-rated and ‘objective’ estimates of health among older people, and gait disorders often co-exist with cognitive impairment, there may be a significant difference between patient and informant narratives of gait disorder. We investigated the existence and extent of this disparity. Methods As no suitable informant measure could be sourced from the biomedical literature, inquiry with senior academic physiotherapists or through appeals on social media relating to physiotherapy, a mobility scale was designed. We included all patients with a gait disorder at serial outpatient clinics. Exclusion criteria were absence of gait disorder and dementia of sufficient severity to be unable to participate in the consent process. Paired t tests and Fischer exact test were used to analyse the data. Results Of 45 participants (mean age 79.8; 50% men), 35 (77.7%) had MCI or dementia. Twenty two (47.8%) informants considered an acute event precipitated an acute deterioration in mobility. Twenty seven informants (60%) had a fear of the older person falling compared to 9 (20%) of patients (p=0.0002). Patient and informant impression of point on mobility scale differed (t=3.61, p=0.0003). Although Informants reported more falls (mean of 1.36 vs 0.91) in the previous year (t=1.63, p=0.055) this did not achieve statistical significance. Conclusions Our findings demonstrate a discrepancy between patient and informant narratives of level of mobility, and point to the benefit of obtaining an informant history of loss of gait stability, mobility and falls. In addition, perceptions of fear of falling may be of assistance in managing risk and independence.