Role Of Gait Speed Research Articles

The Role of Gait Speed in Dementia: A Secondary Analysis from the SABE Colombia Study

Introduction: Gait speed (GS) is a predictor of negative outcomes in older adults and in those in risk to develop cognitive impairment; as such, it has been associated with dementia. Studies in Latin-American older adults showing this association are scarce. This study aimed to evaluate the relationship between GS and dementia in a representative sample of Colombian older adults. Methods: This study is a secondary analysis from the Survey on Health, Well-Being, and Aging, SABE (from initials in Spanish: Salud, Bienestar & Envejecimiento) Colombia’s survey conducted in 2015 with a sample of 23,694 elderly adults aged 60 years or older. Results: A total of 19,470 participants from the SABE Colombia survey were available for analysis. The multivariate analysis shows that dementia was associated with slow GS (PR 2.39; CI 1.91–3.01) independently to the other variables (p < 0.001). Similarly, GS as a continuous variable shows a statistically significant association with dementia in the adjusted analysis (OR 0.06; CI 0.04–0.09; p < 0.001). Conclusion: Dementia was associated with slow GS. This finding provides evidence to include GS as a complementary parameter in the assessment of Colombian elderly adults.

Role of Gait Speed, Strength, and Balance in Predicting Adverse Outcomes of Acutely Ill Older Outpatients.

To evaluate the ability of the Short Physical Performance Battery (SPPB) for predicting 1-year adverse outcomes of acutely ill older outpatients. Prospective study with 512 acutely ill older outpatients (79.4±8.3 years, 63% female) in an acute care day hospital. The SPPB was administered at admission. Participants were classified as low (0-4 points), intermediate (5-8 points), or high (9-12 points) performance. Primary outcomes were new dependence in basic activities of daily living (ADL), hospitalization, and death at 1 year. Cox models tested whether the SPPB predicted outcomes after adjustment for sociodemographic factors, comorbidities and well-known geriatric conditions. We also estimated whether the chair-stand and balance tests improve the SPPB's ability to identify patients at high risk of adverse outcomes. Patients with intermediate or low SPPB performance were at higher risk of 1-year new ADL dependence (32% vs 13%: adjusted hazard ratio [aHR]=2.00; 95%CI=1.18-3.37; 58% vs 13%: aHR=3.40; 95%CI=2.00-5.85, respectively), hospitalization (43% vs 29%: aHR=1.56; 95%CI=1.04-2.33; 44% vs 29%: aHR=1.80; 95%CI=1.15-2.82), and death (18% vs 6%: aHR=2.54; 95%CI=1.17-5.53; 21% vs 6%: aHR=2.70; 95%CI=1.17-6.21). Use of all three components (versus gait speed alone) improved predictions of new ADL dependence (Harrell's C=0.73 vs 0.70;P=0.01), hospitalization (Harrell's C=0.60 vs 0.57;P=0.04), and death (Harrell's C=0.67 vs 0.62;P=0.04). The SPPB is as a powerful tool for identifying acutely ill older outpatients at high-risk of adverse outcomes. The combination of the three components of the SPPB resulted in better predictive performance than gait speed alone.

Measuring gait speed to better identify prodromal dementia

Slow gait speed has been shown to predict incident dementia and cognitive decline in older individuals. We aimed to summarize the evidence concerning the association of slow gait speed with cognitive decline and dementia, and discuss the possible shared pathways leading to cognitive and motor impairments, under the unifying hypothesis that body and mind are intimately connected. This is a scoping review supported by a systematic search of the literature, performed on PubMed and Web of Science. Longitudinal studies providing information on the role of gait speed in the prediction of cognitive decline and dementia in cognitively intact people and in those with initial cognitive impairment were eligible. Of 39 studies selected, including overall 57,456 participants, 33 reported a significant association between gait speed and cognitive outcomes, including dementia. Neurodegenerative pathology and cerebrovascular burden may damage cerebral areas involved in both cognitive functions and motor control. At the same time, systemic conditions, characterized by higher cardiorespiratory, and metabolic and inflammatory burden, can affect a number of organs and systems involved in motor functions, including the brain, having ultimately an impact on cognition. The interplay of body and mind seems relevant during the development of cognitive decline and dementia. The measurement of gait speed may improve the detection of prodromal dementia and cognitive impairment in individuals with and without initial cognitive deficits. The potential applicability of such a measure in both clinical and research settings points at the importance of expanding our knowledge about the common underlying mechanisms of cognitive and motor decline.

Effect of multimorbidity on gait speed in well‐functioning older people: A population‐based study in Peru

To determine the association between multimorbidity and gait speed in a population-based sample of older people without functional dependency. Data were obtained from a previously made cross-sectional population-based study of individuals aged >60 years carried out in San Martin de Porres, the second most populous district in Lima, Peru. We included well-functioning, independent older people. Exclusion criteria emphasized removing conditions that would impair gait. The exposure of interest was non-communicable chronic disease multimorbidity, and the outcome was gait speed determined by the time required for the participant to walk a distance of 8 m out of a total distance of 10 m. Generalized linear models were used to estimate adjusted gait speed by multimorbidity status. Data from 265 older adults with a median age of 68 years (IQR 63-75 years) and 54% women were analyzed. The median gait speed was 1.06 m/s (SD 0.27) and the mean number of chronic conditions per adult was 1.1 (SD ±1). The difference in mean gait speed between older adults without a chronic condition and those with ≥3 chronic conditions was 0.24 m/s. In crude models, coefficients decreased by a significant exponential factor for every increase in the number of chronic conditions. Further adjustment attenuated these estimates. Slower speed gaits are observed across the spectrum of multimorbidity in older adults without functional dependency. The role of gait speed as a simple indicator to evaluate and monitor general health status in older populations is expanded to include older adults without dependency. Geriatr Gerontol Int 2018; 18: 293-300.

Effects of Aging on Arm Swing during Gait: The Role of Gait Speed and Dual Tasking.

Healthy walking is characterized by pronounced arm swing and axial rotation. Aging effects on gait speed, stride length and stride time variability have been previously reported, however, less is known about aging effects on arm swing and axial rotation and their relationship to age-associated gait changes during usual walking and during more challenging conditions like dual tasking. Sixty healthy adults between the ages of 30–77 were included in this study designed to address this gap. Lightweight body fixed sensors were placed on each wrist and lower back. Participants walked under 3 walking conditions each of 1 minute: 1) comfortable speed, 2) walking while serially subtracting 3’s (Dual Task), 3) walking at fast speed. Aging effects on arm swing amplitude, range, symmetry, jerk and axial rotation amplitude and jerk were compared between decades of age (30–40; 41–50; 51–60; 61–77 years). As expected, older adults walked slower (p = 0.03) and with increased stride variability (p = 0.02). Arm swing amplitude decreased with age under all conditions (p = 0.04). In the oldest group, arm swing decreased during dual task and increased during the fast walking condition (p<0.0001). Similarly, arm swing asymmetry increased during the dual task in the older groups (p<0.004), but not in the younger groups (p = 0.67). Significant differences between groups and within conditions were observed in arm swing jerk (p<0.02), axial rotation amplitude (p<0.02) and axial jerk (p<0.001). Gait speed, arm swing amplitude of the dominant arm, arm swing asymmetry and axial rotation jerk were all independent predictors of age in a multivariate model. These findings suggest that the effects of gait speed and dual tasking on arm swing and axial rotation during walking are altered among healthy older adults. Follow-up work is needed to examine if these effects contribute to reduced stability in aging.

TCT-729 The Role of Gait Speed as a Measure of Frailty in the Evaluation of Elderly Patients With Severe Aortic Stenosis for Treatment

TCT-729 The Role of Gait Speed as a Measure of Frailty in the Evaluation of Elderly Patients With Severe Aortic Stenosis for Treatment

Role of Gait Speed in the Assessment of Older Patients

OVER THE LAST 3 DECADES, A LARGE AND increasing amount of evidence has documented the importance of physical function in elderly individuals, both as a crucial component of clinical assessment as well as a specific outcome for interventions. However, the evaluation of physical function is still not considered as relevant as that of other clinical or biochemical parameters. Insufficient time, inadequate space, and the need for special equipment are some of the obstacles to the routine assessment of physical function in the geriatric clinical settings. To overcome these limitations, gait speed has repeatedly and increasingly been proposed as an unique measure of physical performance and as a potential screening tool, but adoption has remained inconsistent. In this issue of JAMA, the study by Studenski et al fills an important research gap and paves the way to a broader adoption of gait speed assessment. Their findings from a pooled analysis of 9 major cohort studies confirm gait speed as a predictor of mortality in older persons and also provide the statistical foundations to estimate expected survival at different ages based only on gait speed. Several barriers limiting the clinical use of physical performance measures might thus be considered overcome. First, the study establishes the validity of a test readily adoptable to clinical use that, differently from other functional assessment tools, is inexpensive, objective, and easy to interpret. Second, the study standardizes the methods to assess gait speed to the 4-meter-long track starting from a still, standing position. This is not a trivial accomplishment because gait speed has often been measured testing individuals over tracks of different lengths (eg, 8 ft or 4 or 6 m), sometimes after exclusion of the initial acceleration time, leading to difficulties in interpretation, comparability, or both. Third, the study by Studenski et al assesses survival of older persons associated with various gait speed results. The increase in life expectancy at a population level has further highlighted the heterogeneity of individuals, making it increasingly difficult to distinguish merely old (chronologically aged) from geriatric (biologically aged) patients. This very ability to screen frail geriatric patients vs old individuals is an urgent matter in geriatrics but increasingly urgent in other specialties. For example, oncologists seek objective methods to identify patients eligible for standard and more aggressive interventions because they are chronologically, but not biologically, old. Also, cardiac surgeons have proposed gait speed as a means to identify which older patients undergoing surgery may be at increased risk for adverse outcomes. Assessment of gait speed may serve as a single-item screening tool to determine which patients need a geriatric multidisciplinary approach to care. At the same time, gait speed should be regarded as an important component of the comprehensive geriatric assessment, provided it facilitates clinical decisions on the basis of a “hard” outcome such as life expectancy. The study by Studenski et al may also be of interest for investigators involved in clinical research on aging. Researchers and clinicians seek results that are clinically, not just statistically, significant. Because of the established association of gait speed with survival, it could be used as a surrogate for survival outcomes in clinical trials of older persons. Gait speed should not be regarded solely as a measure of lower extremity function. Gait speed has been associated with clinical (eg, comorbidities) as well as subclinical conditions (eg, atherosclerosis or inflammatory status) and is able to predict several health-related events even apparently unrelated to physical function (eg, cognitive impairment, hospitalization, institutionalization). Gait speed may serve as a marker of physiological reserve and potentially could quantify overall health status. Indeed, a close relationship between mobility performance and the aging process has been documented in humans and animals. This convergence may indicate the existence of shared pathophysiological mechanisms; thus, at some point, gait speed may be considered a new “vital sign,” specifically sensitive for older persons. Results by Studenski et al showed that gait speed had only a statistically fair accuracy for predicting survival for gait speed (pooled area under the receiver operator char-

Cognitive Function, Habitual Gait Speed, and Late-Life Disability in the National Health and Nutrition Examination Survey (NHANES) 1999–2002

Background: Both cognitive function and gait speed are important correlates of disability. However, little is known about the combined effect of cognitive function and gait speed on multiple domains of disability as well as about the role of gait speed in the association between cognitive function and late-life disability. Objective: To investigate (1) how cognition and habitual gait speed are related to late-life disability; (2) the role of habitual gait speed in the cognitiondisability association; and (3) the combined effect of cognitive function and habitual gait speed on late-life disability. Method: Participants (>60 years, n = 2,481) were from the National Health and Nutrition Examination Survey 1999–2002. Disability in activities of daily living (ADL), instrumental ADL (IADL), leisure and social activities (LSA), and lower extremity mobility (LEM) was obtained by self-report. Cognitive function was measured by a 2-min timed Digit Symbol Substitution Test (DSST), an executive function measure from the Wechsler Adult Intelligence Test. Habitual gait speed was obtained from a 20-foot timed walk. Multiple logistic regression was used to assess the association between cognitive function and disability. Results: Cognitive function was associated with decreased likelihood for disability in each domain. The odds ratios (ORs) for disability in ADL, IADL, LSA, and LEM for each standard deviation (SD) increase in the DSST score were 0.47 (95% confidence interval [CI] = 0.34–0.64), 0.53 (95% CI = 0.42–0.67), 0.61 (95% CI = 0.47–0.79), and 0.73 (95% CI = 0.61–0.86), respectively, in the multi-variable models. After additional adjustment for habitual gait speed in the cognition-disability relationship, DSST score was no longer a significant correlate for LSA and LEM disability. The strength of the association between DSST score and disability in ADL/IADL was also diminished. The attenuated association between cognition and disability implies that limitation in gait speed likely mediates the association between cognitive function and disability. We found additive effects of cognition and habitual gait speed on late-life disability. The OR of disability in respective domains were lowest among participants with high-DSST score (high executive function) and with high gait speed. In contrast, the OR tended to be highest among participants with low-DSST score (low executive function) and low gait speed. Conclusion: Cognitive function was associated with multiple domains of disability. There was a joint effect of cognitive function and gait speed on late-life disability. This study also suggested that habitual gait speed partially mediated the inverse association between cognitive function and late-life disability, providing a mechanistic explanation in the context of disablement process.