Risk of falls in older people during fast-walking - The TASCOG study

Aims: To investigate the relationship between fast-walking and falls in older people. Methods: Individuals aged 60-86 years were randomly selected from the electoral roll (n = 176). Gait speed, step length, cadence and a walk ratio were recorded during preferred-and fast-walking using an instrumented walkway. Falls were recorded prospectively over 12 months. Log multinomial regression was used to estimate the relative risk of single and multiple falls associated with gait variables during fast-walking and change between preferred-and fast-walking. Covariates included age, sex, mood, physical activity, sensorimotor and cognitive measures. Results: The risk of multiple falls was increased for those with a smaller walk ratio (shorter steps, faster cadence) during fast-walking (RR 0.92, CI 0.87, 0.97) and greater reduction in the walk ratio (smaller increase in step length, larger increase in cadence) when changing to fast-walking (RR 0.73, CI 0.63, 0.85). These gait patterns were associated with poorer physiological and cognitive function (p < 0.05). A higher risk of multiple falls was also seen for those in the fastest quarter of gait speed (p = 0.01) at fast-walking. A trend for better reaction time, balance, memory and physical activity for higher categories of gait speed was stronger for fallers than non-fallers (p < 0.05). Conclusion: Tests of fast-walking may be useful in identifying older individuals at risk of multiple falls. There may be two distinct groups at risk - the frail person with short shuffling steps, and the healthy person exposed to greater risk. (C) 2012 Elsevier B.V. All rights reserved.