Background: New technologies for gait assessment are emerging and have provided new avenues for accurately measuring gait characteristics in home and clinic. However, potential meaningful clinical gait parameters beyond speed have received little attention in frailty research. Objective: To study gait characteristics in different frailty status groups for identifying the most useful parameters and assessment protocols for frailty diagnosis. Methods: We searched PubMed, Embase, PsycINFO, CINAHL, Web of Science, Cochrane Library, and Age Line. Articles were selected according to the following criteria: (1) population: individuals defined as frail, prefrail, or transitioning to frail, and (2) outcome measures: quantitative gait variables as obtained by biomechanical analysis. Effect sizes (d) were calculated for the ability of parameters to discriminate between different frailty status groups. Results: Eleven publications met inclusion criteria. Frailty definitions, gait protocols and parameters were inconsistent, which made comparison of outcomes difficult. Effect sizes were calculated only for the three studies which compared at least two different frailty status groups. Gait speed shows the highest effect size to discriminate between frailty subgroups, in particular during habitual walking (d = 0.76-6.17). Gait variability also discriminates between different frailty status groups in particular during fast walking. Prominent parameters related to prefrailty are reduced cadence (d = 1.43) and increased step width variability (d = 0.64), whereas frailty (vs. prefrail status) is characterized by reduced step length during habitual walking (d = 1.32) and increased double support during fast walking (d = 0.78). Interestingly, one study suggested that dual-task walking speed can be used to predict prospective frailty development. Conclusion: Gait characteristics in people with frailty are insufficiently analyzed in the literature and represent a major area for innovation. Despite the paucity of work, current results suggest that parameters beyond speed could be helpful in identifying different categories of frailty. Increased gait variability might reflect a multisystem reduction and may be useful in identifying frailty. In addition, a demanding task such as fast walking or adding a cognitive distractor might enhance the sensitivity and specificity of frailty risk prediction and classification, and is recommended for frailty assessment using gait analysis.

Keywords:
Gait, Technology, Analysis, Assessment, Measurement, Frailty, Older adults
1.
Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, Seeman T, Tracy R, Kop WJ, Burke G, McBurnie MA: Frailty in older adults: evidence for a phenotype. Biol Sci Med Sci 2001;56:M146-M156.
2.
Sternberg SA, Wershof Schwartz A, Karunananthan S, Bergman H, Mark Clarfield A: The identification of frailty: A systematic literature review. J Am Geriatr Soc 2011;59:2129-2138.
3.
Fassbender K, Fainsinger RL, Carson M, Finegan BA: Cost trajectories at the end of life: The Canadian experience. J Pain Symptom Manage 2009;38:75-80.
4.
Cesari M, Kritchevsky SB, Penninx BW, Nicklas BJ, Simonsick EM, Newman AB, Tylavsky FA, Brach JS, Satterfield S, Bauer DC, Visser M, Rubin SM, Harris TB, Pahor M: Prognostic value of usual gait speed in well-functioning older people - results from the Health, Aging and Body Composition Study. J Am Geriatr Soc 2005;53:1675-1680.
5.
Gill TM, Williams CS, Tinetti ME: Assessing risk for the onset of functional dependence among older adults: the role of physical performance. J Am Geriatr Soc 1995;43:603-609.
6.
Purser JL, Kuchibhatla MN, Fillenbaum GG, Harding T, Peterson ED, Alexander KP: Identifying frailty in hospitalized older adults with significant coronary artery disease. J Am Geriatr Soc 2006;54:1674-1681.
7.
Najafi B, Khan T, Wrobel J: Laboratory in a box: wearable sensors and its advantages for gait analysis. IEEE Engineering in Medicine and Biology Society Conference. Conf Proc IEEE Eng Med Biol Soc 2011;2011:6507-6510.
8.
McGough JJ, Faraone SV: Estimating the size of treatment effects: moving beyond p values. Psychiatry (Edgmont) 2009;6:21.
9.
Kressig RW, Gregor RJ, Oliver A, Waddell D, Smith W, O'Grady M, Curns AT, Kutner M, Wolf SL: Temporal and spatial features of gait in older adults transitioning to frailty. Gait Posture 2004;20:30-35.
10.
Montero-Odasso M, Muir SW, Hall M, Doherty TJ, Kloseck M, Beauchet O, Speechley M: Gait variability is associated with frailty in community-dwelling older adults. J Gerontol A Biol Sci Med Sci 2011;66:568-576.
11.
Mooyeon O-P, Holtzer R, Mahoney J, Cuiling W, Verghese J: Effect of treadmill training on specific gait parameters in older adults with frailty: case series. J Geriatr Phys Ther 2011;34:184-188.
12.
Verghese J, Holtzer R, Lipton RB, Wang C: Mobility stress test approach to predicting frailty, disability, and mortality in high-functioning older adults. J Am Geriatr Soc 2012;60:1901-1905.
13.
Beauchet O, Dubost V, Aminian K, Gonthier R, Kressig RW: Dual-task-related gait changes in the elderly: does the type of cognitive task matter? J Mot Behav 2005;37:259-264.
14.
Beauchet O, Dubost V, Gonthier R, Kressig RW: Dual-task-related gait changes in transitionally frail older adults: the type of the walking-associated cognitive task matters. Gerontology 2005;51:48-52.
15.
Beauchet O, Dubost V, Herrmann F, Rabilloud M, Gonthier R, Kressig RW: Relationship between dual-task related gait changes and intrinsic risk factors for falls among transitional frail older adults. Aging Clin Exp Res 2005;17:270-275.
16.
Brown M, Sinacore DR, Binder EF, Kohrt WM: Physical and performance measures for the identification of mild to moderate frailty. J Gerontol A Biol Sci Med Sci 2000;55A:M350-M355.
17.
Brown M, Sinacore DR, Ehsani AA, Binder EF, Holloszy JO, Kohrt WM: Low-intensity exercise as a modifier of physical frailty in older adults. Arch Phys Med Rehabil 2000;81:960-965.
18.
Da Silva SLA, Viana JU, Da Silva VG, Dias JMD, Pereira LSM, Dias RC: Influence of frailty and falls on functional capacity and gait in community-dwelling elderly individuals. Top Geriatric Rehabil 2012;28:128-134.
19.
Hass CJ, Gregor RJ, Waddell DE, Oliver A, Smith DW, Fleming RP, Wolf SL: The influence of tai chi training on the center of pressure trajectory during gait initiation in older adults. Arch Phys Med Rehabil 2004;85:1593-1598.
20.
Hass CJ, Waddell DE, Wolf SL, Juncos JL, Gregor RJ: Gait initiation in older adults with postural instability. Clin Biomech (Bristol, Avon) 2008;23:743-753.
21.
Speechley M, Tinetti M: Falls and injuries in frail and vigorous community elderly persons. J Am Geriatr Soc 1991;39:46-52.
22.
Ensrud KE, Ewing SK, Taylor BC, Fink HA, Cawthon PM, Stone KL, Hillier TA, Cauley JA, Hochberg MC, Rodondi N, Tracy JK, Cummings SR: Comparison of two frailty indexes for prediction of falls, disability, fractures, and death in older women. Arch Intern Med 2008;168:382-389.
23.
Reuben DB, Siu AL: An objective measure of physical function of elderly outpatients. The Physical Performance Test. J Am Geriatr Soc 1990;38:1105-1112.
24.
Halliday SE, Winter DA, Frank JS, Patla AE, Prince F: The initiation of gait in young, elderly, and Parkinson's disease subjects. Gait Posture 1998;8:8-14.
25.
Guralnik JM, Simonsick EM, Ferrucci L, Glynn RJ, Berkman LF, Blazer DG, Scherr PA, Wallace RB: A Short Physical Performance Battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. J Gerontol 1994;49:M85-M94.
26.
Lindemann U, Najafi B, Zijlstra W, Hauer K, Muche R, Becker C, Aminian K: Distance to achieve steady-state walking speed in frail elderly persons. Gait Posture 2008;27:91-96.
27.
Schwenk M, Schmidt M, Pfisterer M, Oster P, Hauer K: Rollator use adversely impacts on assessment of gait and mobility during geriatric rehabilitation. J Rehabil Med 2011;43:424-429.
28.
Judge JO, Davis RB 3rd, Ounpuu S: Step length reductions in advanced age: the role of ankle and hip kinetics. Biol Sci Med Sci 1996;51:M303-M312.
29.
Aizen E: Cautious gait and fear of falling in the elderly (in Hebrew). Harefuah 2001;140:1091-1094, 1115.
30.
Brach JS, Berlin JE, VanSwearingen JM, Newman AB, Studenski SA: Too much or too little step width variability is associated with a fall history in older persons who walk at or near normal gait speed. J Neuroeng Rehabil 2005;2:21.
31.
Callisaya ML, Blizzard L, Schmidt MD, Martin KL, McGinley JL, Sanders LM, Srikanth VK: Gait, gait variability and the risk of multiple incident falls in older people: a population-based study. Age Ageing 2011;40:481-487.
32.
Woollacott MH, Tang P-F: Balance control during walking in the older adult: research and its implications. Phys Ther 1997;77:646-660.
33.
Kan GA, Rolland Y, Bergman H, Morley JE, Kritchevsky SB, Vellas B: The IANA Task Force on frailty assessment of older people in clinical practice. J Nutr Health Aging 2008;12:29-37.
34.
Brach JS, Wert D, VanSwearingen JM, Newman AB, Studenski SA: Use of stance time variability for predicting mobility disability in community-dwelling older persons: a prospective study. J Geriatr Phys Ther 2012;35:112-117.
35.
Lord S, Howe T, Greenland J, Simpson L, Rochester L: Gait variability in older adults: a structured review of testing protocol and clinimetric properties. Gait Posture 2011;34:443-450.
© 2013 S. Karger AG, Basel
2013
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.