Daily-Life Gait Quality as Predictor of Falls in Older People: A 1-Year Prospective Cohort Study

PLoS One. 2016 Jul 7;11(7):e0158623. doi: 10.1371/journal.pone.0158623. eCollection 2016.

Abstract

Falls can have devastating consequences for older people. We determined the relationship between the likelihood of fall incidents and daily-life behavior. We used wearable sensors to assess habitual physical activity and daily-life gait quality (in terms of e.g. stability, variability, smoothness and symmetry), and determined their predictive ability for time-to-first-and-second-falls. 319 older people wore a trunk accelerometer (Dynaport MoveMonitor, McRoberts) during one week. Participants further completed questionnaires and performed grip strength and trail making tests to identify risk factors for falls. Their prospective fall incidence was followed up for six to twelve months. We determined interrelations between commonly used gait characteristics to gain insight in their interpretation and determined their association with time-to-falls. For all data -including questionnaires and tests- we determined the corresponding principal components and studied their predictive ability for falls. We showed that gait characteristics of walking speed, stride length, stride frequency, intensity, variability, smoothness, symmetry and complexity were often moderately to highly correlated (r > 0.4). We further showed that these characteristics were predictive of falls. Principal components dominated by history of falls, alcohol consumption, gait quality and muscle strength proved predictive for time-to-fall. The cross-validated prediction models had adequate to high accuracy (time dependent AUC of 0.66-0.72 for time-to-first-fall and 0.69-0.76 for -second-fall). Daily-life gait quality obtained from a single accelerometer on the trunk is predictive for falls. These findings confirm that ambulant measurements of daily behavior contribute substantially to the identification of elderly at (high) risk of falling.

MeSH terms

  • Accelerometry
  • Accidental Falls / prevention & control*
  • Accidental Falls / statistics & numerical data*
  • Aged
  • Aged, 80 and over
  • Female
  • Gait / physiology*
  • Geriatric Assessment*
  • Humans
  • Incidence
  • Kaplan-Meier Estimate
  • Life Style
  • Male
  • Principal Component Analysis
  • Prospective Studies
  • Quality of Life
  • Reproducibility of Results
  • Risk Factors
  • Surveys and Questionnaires

Grants and funding

This work was supported by the Netherlands Organisation for Scientific Research (NWO TOP NIG grant 91209021 to MP (http://www.zonmw.nl/nl/projecten/project-detail/a-novel-instrument-to-support-fall-prevention-in-extramural-care/samenvatting/) and NWO grant 400-08-127 to AD (http://www.nwo.nl/onderzoek-en-resultaten/onderzoeksprojecten/i/80/4780.html)). KS was partially supported by a commercial grant of McRoberts (the Hague, the Netherlands; http://www.mcroberts.nl). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.