Gait Changes

in Older Adults
Reto W. Kressig

“MOBEQ” Unit
Geriatrics Department
Geneva University Hospitals, Switzerland
Outline

• Definition of Gait Parameters

• Age-Related Gait Changes

• Pathological Gait Changes

 Gait Cycle
(Temporal Measures)

Gait Cycle
(right side)

Stance Swing

Initial Double Support Terminal Double Support

 Spatial Gait Measures

Stride Width

Step Length

Stride Length
 Gait Laboratory
Camera 1
Light Barrier Light Barrier
1 2

2 meters 6 meters 2 meters

Force Plates

1 2 Camera 3

Starting
Line
Visual Target
(Traffic Cone)

Camera 2
Biomechanical Gait Analysis
Electronic Walkway: GAITRite®
Temporal and Spatial Measurements
One Completed Walk
 Normal Walking

Age-Related Gait Changes

 Normal Walking: Velocity

Normal velocity during free pace walking. (a) Males (n=135); (b) Females (n=158). Vertical scale = meters/minute
Horizontal scale = age (20 to 85 yrs).

Perry J: Gait Analysis: Normal and Pathological Function. Thorofare (NJ): Slack, Inc.; 1992
 Normal Walking: Stride Length

Normal stride length during free pace walking. (a) Males (n=135); (b) Females (n=158). Vertical scale = meters;
Horizontal scale = age (20 to 85 yrs).

Perry J: Gait Analysis: Normal and Pathological Function. Thorofare (NJ): Slack, Inc.; 1992
 Normal Walking: Cadence

Normal cadence during free pace walking. (a) Males (n=135); (b) Females (n=158). Vertical scale = steps/minute;
Horizontal scale = age (20 to 85 yrs).

Perry J: Gait Analysis: Normal and Pathological Function. Thorofare (NJ): Slack, Inc.; 1992
Comparison of Young Adults and Elderly Subjects
Spatial and Temporal Gait Parameters

Variable Young Adult Elderly Signif.

(N = 11) (N = 18)

Age (yrs.) 24.9 ± 1.9 68.9 ± 4.0

Height (m) 1.75 ± 0.08 1.71 ± 0.10
Cadence (steps/min.) 110.5 ± 8.3 111.8 ± 8.7
Velocity (m/sec.) 1.29 ± 0.13 1.44 ± 0.19 p < 0.01
Stride Length (m) 1.56 ± 0.10 1.38 ± 0.12 p < 0.01
Stance Time (%) 62.3 ± 1.48 65.7 ± 1.52 p < 0.01

Winter DA. The biomechanics and motor control of human gait: Normal, elderly and pathological.
2nd ed. Waterloo: University of Waterloo Press; 1990
 Comparison of Young Adults and Elderly Subjects
Significant Differences in Other Gait Parameters

Variable Young Adult Elderly Signif.

(N = 11) (N = 18)

Push-off work (J/kg) 0.293 ± 0.057 0.190 ± 0.043 p < 0.01

Head Hor. Acc (m/s²) 0.475 ± 0.365 0.621 ± 0.215 p < 0.05
Hor HC Vel (m/sec) 0.872 ± 0.148 1.15 ± 0.29 p < 0.01

Winter DA. The biomechanics and motor control of human gait: Normal, elderly and pathological.
2nd ed. Waterloo: University of Waterloo Press; 1990
Gait Changes Related to :

• Psychological Factors
• Increased Falling Risk
• Interventions
 Slow Walkers are more likely to be fearful...

Table 4. Multiple Logistic Regression Modeling Results

Variable FES ABC

OR (95% CI)* p OR (95% CI) p

Depression by CES-D 1.9 (1.1, 3.4) 0.028 1.6 (1.3, 2.3) 0.012
Use of Walking Aid 2.1 (1.2, 3.7) 0.008 1.4 (1.2, 1.9) 0.001
Slow Gait Speed 2.1 (1.2, 3.7) 0.009 1.5 (1.3, 2.2) 0.006
Ethnicity: African American 1.2 (0.7, 2.2) 0.492 2.0 (1.3, 2.5) 0.025
*OR = Odds Ratio, CI = Confidence Interval

Kressig RW, Wolf SL, Sattin RW et al. Associations of demographic, functional and behavioral
characteristics with activity related fear of falling among older adults transitioning to frailty.
J Am Geriatr Soc 2001; 49:1456-1462.
Fear of Falling and Gait Performance

Descriptive Statistics (mean ± SD) for the Gait Measures

Non-fallers Fallers
Fearless Fearful Fearless Fearful
n = 19 n = 13 n = 17 n = 26

Gait Measure

Stride length (m) 1.01 ± 0.23 0.87 ± 0.17 0.89 ± 0.19 0.83 ± 0.16

Stride width (m) 0.14 ± 0.04 0.14 ± 0.03 0.15 ± 0.03 0.16 ± 0.04

Double support (% of stride) 14.1 ± 4.40 19.0 ± 5.00 18.2 ± 6.00 19.8 ± 5.50

Stride velocity (ms) 0.79 ± 0.20 0.68 ±0.19 0.76 ± 0.19 0.66 ± 0.19

Maki BE. Gait changes in older adults : Predictors of falls or indicators of fear ? J Am Geriatr Soc 1997 ;
45:313-320.
 Associations of Gait Measures with Falling
and Fear of Falling

Gait Measure OR for Falling OR for Fear of Falling

(95% confidence interval) (95% confidence interval)

Stride-to-Stride Average
Stride length 1.25 (0.64-2.47) 1.98 (1.04-3.75)*
Double-support 1.38 (0.76-2.50) 1.98 (1.10-3.54)*
Stride velocity 0.90 (0.50-1.63) 1.74 (1.01-3.02)*

Stride-to-Stride SD
Stride length 1.95 (1.08-3.52)* 1.27 (0.77-2.11)
Double-support 2.05 (1.11-3.77)* 1.38 (0.83-2.27)
Stride velocity 2.30 (1.17-4.51)* 0.94 (0.58-1.51)
* (p < 0.05)

Maki BE. Gait changes in older adults: Predictors of falls of indicators of fear ?
J Am Geriatr Soc 1997;45:313-20.
Correlation of Perceived Physical Health Status (Sickness Impact
Profile Score, SIP) and Depression (CES-D Scale) With Gait Speed
(N = 152, Age = 75±4.4)

Pearson R p-value

SIP Physical -.42 < .01

Depression (CES-D) -.22 < .01

Notes : CES-D scored from 0 (best) to 60 (worst). SIP scored from 0 (best) to 100 (worst)

Buchner DM, Cress ME, Esselman PC et al. Factors Associated with changes in gait speed in
older adults. J Gerontol 1996,51 :M297-302.
 Gait Changes Related to :

Increased Falling Risk

Gait Variability: Stride-to-Stride Variability

Example: Stride Length

Coefficient of Variation, CoVar = (SD/M) 100

 Stride-to-Stride Variability
and Falls in Older Adults

Odds Ratio for

Falling
Gait Measure Change (95% Confidence Interval)

Stride-to-Stride-Standard Deviation
Stride Length +0.017m 1.95(1.08-3.52)
Double-Support +0.72% 2.05(1.11-3.77)
Stride Velocity +0.016m/s 2.30(1.17-4.51)

Maki BE. Gait changes in older adults: Predictors of falling or indicators of fear? J Am Geriatr Soc 1997;45:313-320
 Stride/Swing Time Variability
and Falls in Older Adults
(N = 52; mean age = 80.3 years)

Gait Measure Fallers Non-Fallers p

(n = 20) (n = 32)

Stride time variability (msec) 106 ± 30 49 ± 4 < .04

Swing time variability (msec) 39 ± 4 27 ± 2 < .03

Hausdorff J, Rios D, Edelberg H. Gait variability and fall risk in community-living older adults:
A 1-year prospective Study. Arch Phys Med Rehabil 2001; 82: 1050-6.
 Spatial and Temporal
Gait Changes
Related to Interventions ?
 Individual Balance Training

Tinetti ME, Baker DI, Garrett PA et al. Yale FICSIT: Risk factor abatement strategy for fall prevention.
J Am Geriatr Soc 1993;41:315-20
T’ai Chi Inspired Exercise Program

Kressig RW, Wolf SL. Exploring guidelines for the application of T’ai Chi to
patients with stroke. Neurology Report 2001;25:50-54
Resistance Training
 Take Home Messages (1)
In comparison to the young, the elderly

walk slower,
have a shorter step length
an increase in stance time and double support,
and a far less vigorous push off.

Adaptations representing a safer gait pattern

 Take Home Messages (2)
Reduced speed,
reduced stride length,
and increased double support time

- are associated with fear of falling

- but show no association with falling

 Take Home Messages (3)
Stride-to-stride variability in the control of gait

• is an independent predictor of falling

• may be an important measure for

- identifying high risk individuals
- evaluating preventive interventions