Gait, mobility, and falls in older people

My doctoral thesis contributes to the understanding of gait, mobility, and falls in older people. All presented projects investigated the most prominent and sensitive markers for fall-related gait changes, that is gait velocity and gait variability. Based on the measurement of these spatio-temporal gait parameters, particularly when using a change-sensitive dual task paradigm, it is possible to make conclusions regarding walking, balance, activities of daily living, and falls in older people. The research summarized in my doctoral thesis will help in the detection of early fall risk and modulation of therapeutic interventions to improve gait and consequently reduce fall risk in older people. To identify modifiable fall risk factors, such as gait disorders, the GAITRite electronic walkway system was used for objective spatio-temporal gait analysis. The simplicity and feasibility of the administration of single and dual task gait analysis make it a desirable clinical and research measurement tool. Gait analysis with walking as a single task condition alone is often insufficient to reveal underlying gait disorders present during everyday activities. However, measuring gait with a dual task paradigm can detect subtle gait deficits. Dual-tasking, walking while simultaneously performing an additional task, was used to assess the effects of divided attention on motor performance and gait control. The presented publications in this doctoral thesis investigated the association between gait parameters and several hypothesized fall-related modalities: (a) Our first review article highlighted the association between gait disorders and falls, and how related motor and cognitive impairments can be detected by measuring gait while dual-tasking. (b) A second review looked at how the dual task paradigm can be used for gait assessment in older people and how spatio-temporal gait parameters are associated with increased fall risk. (c) Our systematic literature review provided evidence about effective fall prevention interventions (exercise, home modifications, footwear, and walking aids) to reduce the risk of falls in vulnerable older people. (d) To evaluate which exercise modalities are effective in modifying risk factors for falls, we conducted an eight-week salsa intervention trial and measured the effect of dancing on static and dynamic balance, and leg muscle power in older people. (e) Besides exercise, inadequate nutritional intake is another modifiable risk factor for falls in older people, and therefore our most recent cross-sectional study examined how serum 25-hydroxvitamin D levels are associated with functional mobility in older people assessed in a memory clinic. (c) Walking aids are commonly prescribed for older people with a high risk of falls which is why we examined the influence of walking aids on spatio-temporal gait parameters in older people who used a cane, a crutch or a walker. (g) Finally, besides predominantly investigating fall risk factors for motor abilities, our prolonged and ongoing randomized, double-blind, and placebo-controlled intervention trial explores the potential influence of ginkgo biloba on the cognitive domain relevant for dual-tasking in older people with mild cognitive impairment.