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Neurological gait abnormalities and risk of falls in older adults

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Abstract

To estimate the validity of neurological gait evaluations in predicting falls in older adults. We studied 632 adults age 70 and over (mean age 80.6 years, 62% women) enrolled in the Einstein Aging Study whose walking patterns were evaluated by study clinicians using a clinical gait rating scale. Association of neurological gaits and six subtypes (hemiparetic, frontal, Parkinsonian, unsteady, neuropathic, and spastic) with incident falls was studied using generalized estimation equation procedures adjusted for potential confounders, and reported as risk ratio with 95% confidence intervals (CI). Over a mean follow-up of 21 months, 244 (39%) subjects fell. Mean fall rate was 0.47 falls per person year. At baseline, 120 subjects were diagnosed with neurological gaits. Subjects with neurological gaits were at increased risk of falls (risk ratio 1.49, 95% CI 1.11–2.00). Unsteady (risk ratio 1.52, 95% CI 1.04–2.22), and neuropathic gait (risk ratio 1.94, 95% CI 1.07–3.11) were the two gait subtypes that predicted risk of falls. The results remained significant after accounting for disability and cognitive status, and also with injurious falls as the outcome. Neurological gaits and subtypes are independent predictors of falls in older adults. Neurological gait assessments will help clinicians identify and institute preventive measures in older adults at high risk for falls.

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Acknowledgment

The Einstein Aging Study is funded by the National Institute on Aging (AG03949). Dr. Verghese is funded by the National Institute on Aging (RO1 AG025119).

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Authors and Affiliations

  1. Department of Neurology, Albert Einstein College of Medicine, Yeshiva University, 1165 Morris Park Avenue, Room 301, Bronx, NY, 10461, USA

    Joe Verghese & Richard B. Lipton

  2. Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Yeshiva University, Bronx, NY, USA

    Richard B. Lipton & Cuiling Wang

  3. Department of Physical Medicine and Rehabilitation, Mt. Sinai Medical Center, New York, USA

    Anne F. Ambrose

Authors
  1. Joe Verghese
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  2. Anne F. Ambrose
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  3. Richard B. Lipton
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  4. Cuiling Wang
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Correspondence to Joe Verghese.

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Verghese, J., Ambrose, A.F., Lipton, R.B. et al. Neurological gait abnormalities and risk of falls in older adults. J Neurol 257, 392–398 (2010). https://doi.org/10.1007/s00415-009-5332-y

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  • DOI: https://doi.org/10.1007/s00415-009-5332-y

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