Abstract
Falls are common in the elderly, and potentially result in injury and disability. Thus, preventing falls as soon as possible in older adults is a public health priority, yet there is no specific marker that is predictive of the first fall onset. We hypothesized that gait features should be the most relevant variables for predicting the first fall. Clinical baseline characteristics (e.g., gender, cognitive function) were assessed in 259 home-dwelling people aged 66 to 75 that had never fallen. Likewise, global kinetic behavior of gait was recorded from 22 variables in 1036 walking tests with an accelerometric gait analysis system. Afterward, monthly telephone monitoring reported the date of the first fall over 24 months. A principal components analysis was used to assess the relationship between gait variables and fall status in four groups: non-fallers, fallers from 0 to 6 months, fallers from 6 to 12 months and fallers from 12 to 24 months. The association of significant principal components (PC) with an increased risk of first fall was then evaluated using the area under the Receiver Operator Characteristic Curve (ROC). No effect of clinical confounding variables was shown as a function of groups. An eigenvalue decomposition of the correlation matrix identified a large statistical PC1 (termed “Global kinetics of gait pattern”), which accounted for 36.7% of total variance. Principal component loadings also revealed a PC2 (12.6% of total variance), related to the “Global gait regularity.” Subsequent ANOVAs showed that only PC1 discriminated the fall status during the first 6 months, while PC2 discriminated the first fall onset between 6 and 12 months. After one year, any PC was associated with falls. These results were bolstered by the ROC analyses, showing good predictive models of the first fall during the first six months or from 6 to 12 months. Overall, these findings suggest that the performance of a standardized walking test at least once a year is essential for fall prevention.
Highlights
In view of the high prevalence of individuals in elderly populations with a risk of falling and the potentially dramatic consequences of fall-related injuries leading to self-imposed restriction in daily activities and, loss of independence (Arfken et al, 1994; Tinetti et al, 1994a; Tinetti and Williams, 1997; Scheffer et al, 2008), avoidance or delay of the first fall onset is a major public health concern
To tackle the major public health challenges of preventing falls in older adults as soon as possible, we argue that it is crucial to identify specific markers that are significantly associated with an increased risk of the first fall onset
The current findings provide for the first time the possibility of identifying relevant indicators of imminent fall occurrence, that is the “Global kinetics of gait pattern” (PC1) and the “Global gait regularity” (PC2)
Summary
In view of the high prevalence of individuals in elderly populations with a risk of falling and the potentially dramatic consequences of fall-related injuries (e.g., fractures and psychological trauma) leading to self-imposed restriction in daily activities and, loss of independence (Arfken et al, 1994; Tinetti et al, 1994a; Tinetti and Williams, 1997; Scheffer et al, 2008), avoidance or delay of the first fall onset is a major public health concern. To tackle the major public health challenges of preventing falls in older adults as soon as possible, we argue that it is crucial to identify specific markers that are significantly associated with an increased risk of the first fall onset. Identifying these markers would help the medical professional to prescribe an intervention early enough to effectively prevent a fall
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