Gait dynamics to optimize fall risk assessment in geriatric patients admitted to an outpatient diagnostic clinic

PLoS One. 2017 Jun 2;12(6):e0178615. doi: 10.1371/journal.pone.0178615. eCollection 2017.

Abstract

Fall prediction in geriatric patients remains challenging because the increased fall risk involves multiple, interrelated factors caused by natural aging and/or pathology. Therefore, we used a multi-factorial statistical approach to model categories of modifiable fall risk factors among geriatric patients to identify fallers with highest sensitivity and specificity with a focus on gait performance. Patients (n = 61, age = 79; 41% fallers) underwent extensive screening in three categories: (1) patient characteristics (e.g., handgrip strength, medication use, osteoporosis-related factors) (2) cognitive function (global cognition, memory, executive function), and (3) gait performance (speed-related and dynamic outcomes assessed by tri-axial trunk accelerometry). Falls were registered prospectively (mean follow-up 8.6 months) and one year retrospectively. Principal Component Analysis (PCA) on 11 gait variables was performed to determine underlying gait properties. Three fall-classification models were then built using Partial Least Squares-Discriminant Analysis (PLS-DA), with separate and combined analyses of the fall risk factors. PCA identified 'pace', 'variability', and 'coordination' as key properties of gait. The best PLS-DA model produced a fall classification accuracy of AUC = 0.93. The specificity of the model using patient characteristics was 60% but reached 80% when cognitive and gait outcomes were added. The inclusion of cognition and gait dynamics in fall classification models reduced misclassification. We therefore recommend assessing geriatric patients' fall risk using a multi-factorial approach that incorporates patient characteristics, cognition, and gait dynamics.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Ambulatory Care Facilities*
  • Female
  • Gait*
  • Humans
  • Male
  • Patient Admission*
  • Principal Component Analysis
  • Prospective Studies
  • Risk Assessment

Grants and funding

This study was supported by the French National Research Agency in the framework of the “Programme d’Investissements d’Avenir IRT Nanoelec,” grants ANR-10-AIRT-05 and ANR-15-IDEX-02. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.