title: Daily-Life Gait Quality as Predictor of Falls in Older People: A 1-Year Prospective Cohort Study.
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.
authors.affiliation: MOVE Research Institute Amsterdam, Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
authors.forename: Kimberley S
authors.initials: KS
authors.lastname: van Schooten
authors.affiliation: MOVE Research Institute Amsterdam, Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
authors.forename: Mirjam
authors.initials: M
authors.lastname: Pijnappels
authors.affiliation: MOVE Research Institute Amsterdam, Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
authors.forename: Sietse M
authors.initials: SM
authors.lastname: Rispens
authors.affiliation: EMGO+ Institute, Department of General Practice and Elderly Care, VU Medical Center, Amsterdam, the Netherlands.
authors.forename: Petra J M
authors.initials: PJ
authors.lastname: Elders
authors.affiliation: MOVE Research Institute Amsterdam, Department of Internal Medicine, VU Medical Center, Amsterdam, the Netherlands.
authors.forename: Paul
authors.initials: P
authors.lastname: Lips
authors.affiliation: MOVE Research Institute Amsterdam, Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
authors.forename: Andreas
authors.initials: A
authors.lastname: Daffertshofer
authors.affiliation: MOVE Research Institute Amsterdam, Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Beek
authors.affiliation: MOVE Research Institute Amsterdam, Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
authors.forename: Jaap H
authors.initials: JH
authors.lastname: van Dieën
mesh_terms: D061725:Accelerometry; D000058:Accidental Falls / Q000517:prevention & control* / Q000706:statistics & numerical data*; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005684:Gait / Q000502:physiology*; D015577:Geriatric Assessment; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008019:Life Style; D008297:Male; D025341:Principal Component Analysis; D011446:Prospective Studies; D011788:Quality of Life; D015203:Reproducibility of Results; D012307:Risk Factors; D011795:Surveys and Questionnaires