Abstract
Background:
Gait parameters such as gait speed (GS) are important indicators of functional capacity. Frailty Syndrome is closely related to GS and is also capable of predicting adverse outcomes. The cognitive demand of gait control is usually explored with dual-task (DT) methodology.
Objective:
To investigate the effect of DT and frailty on the spatio-temporal parameters of gait in older people and identify which variables relate to GS.
Method:
The presence of frailty was verified by Fried's Frailty Criteria. Cognitive function was evaluated with the Mini-Mental State Exam (MMSE) and gait parameters were analyzed through the GAITRite(r) system in the single-task and DT conditions. The Kolmogorov-Smirnov, ANOVA, and Pearson's Correlation tests were administered.
Results:
The participants were assigned to the groups frail (FG), pre-frail (PFG), and non-frail (NFG). During the DT, the three groups showed a decrease in GS, cadence, and stride length and an increase in stride time (p<0.001). The reduction in the GS of the FG during the DT showed a positive correlation with the MMSE scores (r=730; p=0.001) and with grip strength (r=681; p=0.001).
Conclusions:
Gait parameters are more affected by the DT, especially in the frail older subjects. The reduction in GS in the FG is associated with lower grip strength and lower scores in the MMSE. The GS was able to discriminate the older adults in the three levels of frailty, being an important measure of the functional capacity in this population.
aged; frail elderly; dual task; gait parameters; gait speed; physical therapy
Introduction
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. The cognitive demand of gait control can be
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. For example,
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. Gait alterations associated with the
aging process have been interpreted as a more cautious gait pattern, adopted to increase
stability and reduce the risk of falls. However, a more conscientious pattern may
require higher cognitive control and result in the need for higher attention to
locomotion, making the elderly gait more sensitive to DT1818. Olivier I, Cuisinier R, Vaugoyeau M, Nougier V, Assaiante C.
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. Among these factors, frailty is the
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Frailty Syndrome (FS) is closely related to GS and is also capable of predicting adverse
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death2121. Ahmed N, Mandel R, Fain MJ. Frailty: an emerging geriatric syndrome.
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. In spite of the current lack of a consensus
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2001;56(3):M146-56. proposed five criteria to identify FS, namely
unintentional weight loss in the previous year, muscle weakness, gait slowness, low
levels of physical activity, and the feeling of exhaustion. Recent studies suggest that
GS has a close correlation with FS and with future adverse events, therefore
constituting a practical and reproducible method of diagnosis that is able to identify
the frail elderly2626. Montero-Odasso M, Schapira M, Duque G, Soriano E, Kaplan R, Camera
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,
2727. Cesari M, Kritchevsky S, Penninx B, Nicklas B, Simonsick E, Newman
A, et al. 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(10):1675-9. PMid:16181165.
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.
It is known that both frailty and DT lead to changes in gait. However, it is necessary to identify whether DT affects spatio-temporal parameters of gait differently in older people at different levels of frailty. The hypothesis of this study is that DT has a prominent influence on the gait of frail elderly subjects. A better understanding of the interaction between DT, frailty, and gait could help researchers and professionals to plan appropriate intervention studies and help clinicians in the decision-making process. In particular, this study aims to investigate the effect of DT and frailty on the spatio-temporal parameters of gait in older people as well as to identify which variables relate to GS at the different levels of frailty (cognitive function, handgrip strength, and number of diseases).
Method
Sample
Eighty-one individuals of both genders, selected by convenience, participated in the
study. The exclusion criteria were: surgical procedure in the lower limbs or in the
vertebral column in the last year; reported pain in the lower limbs on the day of the
assessment or inability to walk without a walking aid for one minute; severe balance
impairment; uncompensated neurological, cardiac or vascular conditions;
musculoskeletal diseases that could hinder the performance of the tests; and a
clinical scenario suggestive of cognitive alterations ascertained by the Mini-Mental
State Exam (MMSE)2828. Bertolucci PH, Brucki SM, Campacci SR, Juliano Y. O mini-exame do
estado mental em uma população geral: impacto da escolaridade. Arq Neuro-Psiquiatr.
1994;52(1):1-7. http://dx.doi.org/10.1590/S0004-282X1994000100001
http://dx.doi.org/10.1590/S0004-282X1994...
. The participants signed
an informed consent form agreeing to participate. This study was approved by the
Research Ethics Committee of Universidade Federal de Minas Gerais (UFMG), Belo
Horizonte, MG, Brazil (protocol no. CAAE-0700.0.203.000-11).
Instruments
The presence of frailty was verified by the five components of Fried's frailty
criteria2525. Fried LP, Tangen C, Walston J, Newman A, Hirsch C, Gottdiener J, et
al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Med Sci.
2001;56(3):M146-56.: unintentional weight loss in
the last year (≥4.5 kg or 10% of body weight); self-reported exhaustion (determined
by the answers "a moderate amount of the time" or "most of the time" to one of the
two statements - "I felt that everything I did was an effort" and "I could not get
going"); diminished hand grip strength (measured with a hand grip dynamometer -
JAMAR) with cutoff points determined by the calculation of the 20th
percentile of the sample, adjusted for gender and body mass index; gait slowness
(determined by the time spent in seconds to cover a distance of 4.6 m at a
comfortable speed, also with cutoff points defined at the 20th percentile
of the sample adjusted for gender and height); and low level of physical activity
(determined using the Active Australia2929. Heesch KC, Hill RL, Van Uffelen JGZ, Brown WJ. Are active australia
physical activity questions valid for older adults? J Sci Med Sport.
2011;14(3):233-7. PMid:21276752.
http://dx.doi.org/10.1016/j.jsams.2010.11.004
http://dx.doi.org/10.1016/j.jsams.2010.1...
questionnaire with cutoff points determined by the 20th percentile of the
sample for men and women).
This questionnaire is used in population surveys to determine the weekly caloric
expenditure and contains information about frequency, intensity, duration, and type
of activity. It is a reliable instrument that can be applied quickly and is valid for
use in community-dwelling elderly3030. Yorston LC, Kolt GS, Rosenkranz RR. Physical activity and physical
function in older adults: the 45 and up study. J Am Geriatr Soc. 2012;60(4):719-25.
PMid:22486736. http://dx.doi.org/10.1111/j.1532-5415.2012.03906.x
http://dx.doi.org/10.1111/j.1532-5415.20...
. Elderly
adults with a positive score in 3 or more of the 5 criteria were considered frail;
those with one or two positive items, pre-frail; and those with all negative scores
were considered non-frail.
To screen for possible cognitive deficits, the MMSE was administered. This instrument
is comprised of seven categories, each of them designed to assess temporal and
spatial orientation, naming and subsequent recalling of three words, attention and
calculation, language and visual constructive praxis. The MMSE score ranges from zero
to 30 points, and the following cutoff points were considered according to the level
of education: 13 for illiterate, 18 for one to seven years of schooling, and 26 for
those with eight or more years of schooling2828. Bertolucci PH, Brucki SM, Campacci SR, Juliano Y. O mini-exame do
estado mental em uma população geral: impacto da escolaridade. Arq Neuro-Psiquiatr.
1994;52(1):1-7. http://dx.doi.org/10.1590/S0004-282X1994000100001
http://dx.doi.org/10.1590/S0004-282X1994...
.
The gait parameters were analyzed using the GAITRite(r) system (MAP/CIR
INK, Haverton, PA, USA), which consists of an electronic vinyl carpet capable of
registering the plantar impression, allowing the calculation of spatial and temporal
gait data2727. Cesari M, Kritchevsky S, Penninx B, Nicklas B, Simonsick E, Newman
A, et al. 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(10):1675-9. PMid:16181165.
http://dx.doi.org/10.1111/j.1532-5415.2005.53501.x
http://dx.doi.org/10.1111/j.1532-5415.20...
. The carpet is 90 cm wide by 566
cm long by 0.6 cm high and contains 18,824 embedded pressure sensors. The system has
software for data analysis and documentation of nine temporal parameters and six
spatial parameters. The present study used the data from GS, cadence (CAD), stride
length (SL), and stride time (STi). A number of studies have shown the validity and
reliability of its measures compared to existing techniques, including studies in
older adults3131. Youdas JW, Hollman JH, Aalbers MJ, Ahrenholz HN, Aten RA, Cremers
JJ. Agreement between the GAITRite walkway system and a stopwatch-footfall count
method for measurement of temporal and spatial gait parameters. Arch Phys Med
Rehabil. 2006;87(12):1648-52. PMid:17141647.
http://dx.doi.org/10.1016/j.apmr.2006.09.012
http://dx.doi.org/10.1016/j.apmr.2006.09...
32. Webster KE, Wittwer J, Feller JA. Validity of the GAITRite walkway
system for the measurement of averaged and individual step parameters of gait. Gait
Posture. 2005;22(4):317-21. PMid:16274913.
http://dx.doi.org/10.1016/j.gaitpost.2004.10.005
http://dx.doi.org/10.1016/j.gaitpost.200...
-
3333. Menz HB, Latt MD, Tiedemann A, Mun San Kwan M, Lord SR. Reliability
of the GAITRite(r) walkway system for the quantification of temporo-spatial
parameters of gait in young and older people. Gait Posture. 2004;20(1):20-5.
http://dx.doi.org/10.1016/S0966-6362(03)00068-7
http://dx.doi.org/10.1016/S0966-6362(03)...
.
Procedures
Initially, the participants responded to a questionnaire with demographic and clinical data created for this study to characterize the participants and classify them as frail, pre-frail, and non-frail. After that, the MMSE was administered to screen for possible cognitive deficits. The gait analysis on the GAITRite(r) system was performed at two time points. First, the participants were asked to walk in silence for 1 minute on the carpet, characterizing the single task (ST), then after a 5-minute interval, they were asked to walk for 1 more minute on the carpet while responding to the question "What was the best moment of your life and why?", characterizing the DT. If the participant finished answering before the end of the 1 minute, the researcher asked a new question regarding the theme to keep the participant talking for the duration of the assessment.
Statistical analysis
Descriptive analysis was done using mean and standard deviation for continuous variables. The Kolmogorov-Smirnov test determined the normal distribution of data, justifying the use of parametric tests. To evaluate differences between non-frail, pre frail, and frail older people in relation to age, body mass index, handgrip strength, MMSE, number of diseases and number of medicines, we used ANOVA with Tukey's post-hoc test. In the comparisons of gait parameters (GS, CAD, SL, and STi) in ST and DT situations, a 3×2 repeated-measures ANOVA (three levels of frailty × two tasks) was used. Correlations between VM, age, BMI, handgrip strength, MMSE, number of diseases and medications were investigated using Pearson's test. The level of significance was set at 5% for all the tests. The power was set at 80% to detect differences between the variables.
Results
The participants included in the study were assigned to the groups frail (FG), pre-frail (PFG), and non-frail (NFG). The clinical and demographic data (Table 1) show that the FG is composed of participants with a higher number of diseases who used a higher number of medications regularly, in addition to presenting lower handgrip strength and lower scores in the MMSE.
Figures 1, 2, and 3 showed the effect of the DT in the three groups, leading to statistically significant reductions in GS (m/s), CAD (steps/min), and SL (cm), respectively. Repeated-measures ANOVA showed effects of group (F2,52=226.57, p=0.000) and task (F1,26=447.59, p=0.000), but not of interaction in GS (F2,52=3.03, p=0.057). Regarding CAD, this test showed effects of group (F2,52=9.65, p=0.001) and task (F1,26=40.84, p=0.000), but not interaction (F2,52=0.60, p=0.512). Concerning SL, this statistical test also showed effects of group (F2,52=73.53, p=0.000) and task (F1,26=117.82, p=0.000), but not interaction (F2,52=0.046, p=0.955).
Mean and standard deviation values for gait speed in both tasks (single and dual) for each group (frail, pre-frail, non-frail).
Mean and standard deviation values for cadence in both tasks (single and dual) for each group (frail, pre-frail, non-frail).
Mean and standard deviation values for stride length in both tasks (single and dual) for each group (frail, pre-frail, non-frail).
In the DT situation, the GS fell by 20% in the FG, 13.2% in the PFG, and 10% in the NFG compared to the ST situation. CAD fell by 8.6% in the FG, 6.4% in the PFG, and 5.5% in the NFG. SL fell by 8% in the FG, 6.1% in the PFG, and 5.3% in the NFG. In relation to STi (s), there was an increase of 15.2% in the GF, 6.4% in the PFG, and 5% in the NFG compared to the ST situation.
Table 2 shows that, in the ST and DT situations, GS and SL were different in the three groups (FG<PFG<NFG). It can also be observed that both in the ST and DT situations, the FG differed to the other groups with regards to the spatio-temporal gait parameters.
The reduction in GS in the FG during the performance of the DT showed a positive correlation with the scores obtained in the MMSE (r=730; p=0.001) and with hand grip strength (r=681; p=0.001). Furthermore, 55.5% (n=15) of the FG and 33.3% (n=9) of the PFG participants were positive for this item of the phenotype for frailty.
Discussion
The aim of this study was to investigate the effect of DT and frailty on the spatio-temporal parameters of elderly individuals. The results obtained in the present study showed that the impact of spontaneous narrative on the spatio-temporal gait parameters was evident. All of the participants, regardless of their level of frailty, slowed down significantly, with reductions in SL and CAD and increase in STi. The frail participants were the ones with the most intense changes.
Although gait seems to be an automatic motor activity, evidence suggests that the act of
walking requires attention to environmental characteristics and the recovery of postural
disturbances to avoid falls1212. Holtzer R, Wang C, Verghese J. The relationship between attention
and gait in aging: facts and fallacies. Motor Control.
2012;16(1):64-80.
13. Montero-Odasso M, Verghese J, Beauchet O, Hausdorff JM. Gait and
cognition: a complementary approach to understanding brain function and the risk of
falling. J Am Geriatr Soc. 2012;60(11):2127-36. PMid:23110433
PMCid:PMC3498517.
-
1414. Hall CD, Echt KV, Wolf SL, Rogers WA. Cognitive and motor mechanisms
underlying older adults' ability to divide attention while walking. Phys Ther.
2011;91(7):1039-50. PMid:21527384.
http://dx.doi.org/10.2522/ptj.20100114
http://dx.doi.org/10.2522/ptj.20100114...
. The allocation of attention in concurrent
activities represents executive processes that are sensitive to the aging process, which
makes gait more cautious and more influenced by the DT3434. Beauchet O, Annweiler C, Dubost V, Allali G, Kressig RW, Bridenbaugh
S, et al. Stops walking when talking: a predictor of falls in older adults? Eur J
Neurol. 2009;16(7):786-95. PMid:19473368.
http://dx.doi.org/10.1111/j.1468-1331.2009.02612.x
http://dx.doi.org/10.1111/j.1468-1331.20...
. The findings of the present study are in accordance with the results
obtained in a recent systematic review that highlighted the reductions in GS, CAD, and
SL and the increase in STi as the most important changes in gait found in the DT
situation in older adults1515. Al-Yahya E, Dawes H, Smith L, Dennis A, Howells K, Cockburn J.
Cognitive motor interference while walking: a systematic review and meta-analysis.
Neurosci Biobehav Rev. 2011;35(3):715-28. PMid:20833198.
http://dx.doi.org/10.1016/j.neubiorev.2010.08.008
http://dx.doi.org/10.1016/j.neubiorev.20...
. While approximately
55% of falls are related to abnormal gait3535. Rubenstein LZ. Falls in older people: epidemiology, risk factors and
strategies for prevention. Age Ageing. 2006;35(Suppl 2):ii37-41. PMid:16926202.
http://dx.doi.org/10.1093/ageing/afl084
http://dx.doi.org/10.1093/ageing/afl084...
and
considering that performing two simultaneous tasks is necessary for independence in
ADLs, it becomes necessary to incorporate the DT methodology into the rehabilitation of
older persons in general, but especially of frail elderly individuals.
The choice for using the DT methodology was based on the fact that walking and talking
simultaneously consists in a very ecological and necessary task to ADLs and seems to
require more attention and to produce a higher interference in the motor task1717. Neider MB, Gaspar JG, McCarley JS, Crowell JA, Kaczmarski H, Kramer
AF. Walking and talking: dual-task effects on street crossing behavior in older
adults. Psychol Aging. 2011;26(2):260-8. PMid:21401262 PMCid:PMC3699858.
http://dx.doi.org/10.1037/a0021566
http://dx.doi.org/10.1037/a0021566...
,
3636. Plummer-D'Amato P, Altmann LJP, Reilly K. Dual-task effects of
spontaneous speech and executive function on gait in aging: exaggerated effects in
slow walkers. Gait Posture. 2011;33(2):233-7. PMid:21193313.
http://dx.doi.org/10.1016/j.gaitpost.2010.11.011
http://dx.doi.org/10.1016/j.gaitpost.201...
. Considering that theoretical framework,
Al-Yahya et al.1515. Al-Yahya E, Dawes H, Smith L, Dennis A, Howells K, Cockburn J.
Cognitive motor interference while walking: a systematic review and meta-analysis.
Neurosci Biobehav Rev. 2011;35(3):715-28. PMid:20833198.
http://dx.doi.org/10.1016/j.neubiorev.2010.08.008
http://dx.doi.org/10.1016/j.neubiorev.20...
used the question "what was the
best vacation of your life, and why?". In the present study, the same methodology was
used, but in order to culturally adapt the meaning of the question, an expert committee
was formed to discuss how the question might be modified to adjust to the Brazilian
elderly population.
It has been suggested that the size of the interference of the DT on gait is influenced
by self-selected GS, with greater changes in subjects with GS≤1.0 m/s3737. Verghese J, Kuslansky G, Holtzer R, Katz M, Xue X, Buschke H, et al.
Walking while talking: effect of task prioritization in the elderly. Arch Phys Med
Rehab. 2007;88(1):50-3. PMid:17207675 PMCid:PMC1894901.
http://dx.doi.org/10.1016/j.apmr.2006.10.007
http://dx.doi.org/10.1016/j.apmr.2006.10...
,
3838. Perry J, Garrett M, Gronley JK, Mulroy SJ. Classification of walking
handicap in the stroke population. Stroke. 1995;26(6):982-9. PMid:7762050.
http://dx.doi.org/10.1161/01.STR.26.6.982
http://dx.doi.org/10.1161/01.STR.26.6.98...
and fewer changes in those with GS≥1.2
m/s3939. Hollman JH, Kovash FM, Kubik JJ, Linbo RA. Age-related differences
in spatiotemporal markers of gait stability during dual task walking. Gait Posture.
2007;26(1):113-9. PMid:16959488.
http://dx.doi.org/10.1016/j.gaitpost.2006.08.005
http://dx.doi.org/10.1016/j.gaitpost.200...
. The present study also identified
greater changes in the FG (reductions in GS [20%], CAD [8.6%], and SL [8%] and increases
in STi [15.2%]) and fewer changes in the NFG (reductions in GS [10%], CAD [5.5%], and SL
[5.3%] and increases in STi [5%]). These findings confirm the idea that frail older
people walk more slowly and suffer greater influence of DT compared with non-frail older
individuals.
If we consider that a GS below 0.6 m/s is associated with dependence in basic and
instrumental ADLs and gait limited to the home environment11. Fritz S, Lusardi M. White paper: walking speed: the sixth vital sign.
J Geriatr Phys Ther. 2009;32(2):2-5.
http://dx.doi.org/10.1519/00139143-200932020-00002
http://dx.doi.org/10.1519/00139143-20093...
, we can infer that the FG is significantly limited in the
performance of motor tasks associated with spontaneous speaking, since this group showed
GS=0.60 m/s in the DT situation. In comparison, the GS necessary to safely cross the
street at a traffic signal must be equal to or greater than 1.2 m/s1717. Neider MB, Gaspar JG, McCarley JS, Crowell JA, Kaczmarski H, Kramer
AF. Walking and talking: dual-task effects on street crossing behavior in older
adults. Psychol Aging. 2011;26(2):260-8. PMid:21401262 PMCid:PMC3699858.
http://dx.doi.org/10.1037/a0021566
http://dx.doi.org/10.1037/a0021566...
,
3636. Plummer-D'Amato P, Altmann LJP, Reilly K. Dual-task effects of
spontaneous speech and executive function on gait in aging: exaggerated effects in
slow walkers. Gait Posture. 2011;33(2):233-7. PMid:21193313.
http://dx.doi.org/10.1016/j.gaitpost.2010.11.011
http://dx.doi.org/10.1016/j.gaitpost.201...
,
3939. Hollman JH, Kovash FM, Kubik JJ, Linbo RA. Age-related differences
in spatiotemporal markers of gait stability during dual task walking. Gait Posture.
2007;26(1):113-9. PMid:16959488.
http://dx.doi.org/10.1016/j.gaitpost.2006.08.005
http://dx.doi.org/10.1016/j.gaitpost.200...
. The PFG and NFG also had values below this in
the DT situation. Considering that walking and talking simultaneously consists in an
extremely functional and common action in ADLs, all of the participants would probably
have difficulty crossing a street, being therefore at greater risk of accidents and
dependence in outdoor mobility.
Epidemiological studies and clinical trials show that gait and cognition are
inter-related. Gait changes are associated with falls, dementia, and disability1212. Holtzer R, Wang C, Verghese J. The relationship between attention
and gait in aging: facts and fallacies. Motor Control.
2012;16(1):64-80.
,
1313. Montero-Odasso M, Verghese J, Beauchet O, Hausdorff JM. Gait and
cognition: a complementary approach to understanding brain function and the risk of
falling. J Am Geriatr Soc. 2012;60(11):2127-36. PMid:23110433
PMCid:PMC3498517., and gait speed reduction can start up to 12
years before the clinical presentation of cognitive impairment1313. Montero-Odasso M, Verghese J, Beauchet O, Hausdorff JM. Gait and
cognition: a complementary approach to understanding brain function and the risk of
falling. J Am Geriatr Soc. 2012;60(11):2127-36. PMid:23110433
PMCid:PMC3498517.. Moreover, changes in attention, memory, and executive function
are related to gait slowness and help to predict loss of mobility, falls, and
progression of cognitive decline1212. Holtzer R, Wang C, Verghese J. The relationship between attention
and gait in aging: facts and fallacies. Motor Control.
2012;16(1):64-80.. There is
robust evidence to suggest a strong correlation between cognitive level measured by the
MMSE and GS, and this relationship becomes more evident when the task is more
challenging or when the gait pattern is already impaired1212. Holtzer R, Wang C, Verghese J. The relationship between attention
and gait in aging: facts and fallacies. Motor Control.
2012;16(1):64-80.
,
1313. Montero-Odasso M, Verghese J, Beauchet O, Hausdorff JM. Gait and
cognition: a complementary approach to understanding brain function and the risk of
falling. J Am Geriatr Soc. 2012;60(11):2127-36. PMid:23110433
PMCid:PMC3498517.
,
4040. Hahn M, Wild-Wall N, Falkenstein M. Age-related differences in
performance and stimulus processing in dual task situation. Brain Res.
2011;1414:66-76. PMid:21871612.
http://dx.doi.org/10.1016/j.brainres.2011.07.051
http://dx.doi.org/10.1016/j.brainres.201...
41. Toulotte C, Thevenon A, Watelain E, Fabre C. Identification of
healthy elderly fallers and non-fallers by gait analysis under dual-task conditions.
Clin Rehabil. 2006;20(3):269-76. PMid:16634347.
http://dx.doi.org/10.1191/0269215506cr929oa
http://dx.doi.org/10.1191/0269215506cr92...
-
4242. 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(4):259-64. PMid:15967751.. In the current study, this association was
identified only in the FG, reinforcing the hypothesis that lower scores in the MMSE can
reduce the allocation sources for attention, compromising gait.
Considering that GS is the product of CAD and SL4343. Perry J. Análise de marcha. Barueri: Manole; 2005., one can observe that frail, pre-frail, and non-frail older adults use the
same gait adaptation strategies in the DT situation; thus, they reduce CAD and SL, with
a consequent reduction in GS. The FG was the group that showed a more accentuated
reduction in GS during the DT, and this reduction showed a strong positive correlation
with handgrip strength. It is known that this measure is able to represent global
strength, and that lower values are related to sarcopenia4444. Lee WJ, Liu LK, Peng LN, Lin MH, Chen LK; The ILAS Research Group.
Comparisons of sarcopenia defined by IWGS and EWGSOP criteria among older people:
results from the I-Lan longitudinal aging study. J Am Med Dir Assoc.
2013;14(7):528e1-7. http://dx.doi.org/10.1016/j.jamda.2013.03.019
http://dx.doi.org/10.1016/j.jamda.2013.0...
. The lower muscle strength of the FG may have played a significant role in
GS reduction, impairing gait propulsion and consequently reducing SL.
During the last years, GS has been reported as an efficient measure to identify older
adults at higher risk of adverse events, as it is an easy, simple, and low-cost
measurement that can be used both in clinical settings and research4545. Van Kan GA, Rolland Y, Andrieu S, Bauer J, Beauchet O, Bonnefoy M,
et al. Gait speed at usual pace as a predictor of adverse outcomes in
community-dwelling older people: an International Academy on Nutrition and Aging
(IANA) task force. J Nutr Health Aging. 2009;13(10):881-9.
http://dx.doi.org/10.1007/s12603-009-0246-z
http://dx.doi.org/10.1007/s12603-009-024...
. In the present study, GS was able to differentiate the three
groups, both in the ST and DT situations. The participants from the FG showed lower GS
and more chronic diseases, used a greater number of medications, had lower handgrip
strength, and showed lower cognitive ability. Similarly to Rothman et al., more than
half of the GF and a third of the PFG participants scored positively on the GS item of
the frailty criteria4646. Rothman MD, Leo-Summers L, Gill TM. Prognostic significance of
potential frailty criteria. J Am Geriatr Soc. 2008;56(12):2211-6. PMid:19093920
PMCid:PMC2782664. http://dx.doi.org/10.1111/j.1532-5415.2008.02008.x
http://dx.doi.org/10.1111/j.1532-5415.20...
. These findings allow us
to deduce that GS plays an important role in the Frailty Syndrome classification and,
additionally, might provide information about the general health status of older
individuals, being thus an important vital sign measure for functional capacity in this
population.
Despite the statistically significant negative correlation found between GS and MMSE scores due to the exclusion criteria of the study, it was not feasible to analyze this correlation for individuals with cognitive deficits ascertained by the MMSE scores. Thus, future research must address this issue.
Conclusion
The results have shown that the gait of frail older adults is more affected by the dual task, showing a greater reduction in speed, cadence, and stride length and increase in stride time compared to pre-frail and non-frail older adults. The reduction in gait speed in the frail elderly is associated with lower hand grip strength and lower scores in the MMSE. Moreover, gait speed was able to discriminate the older subjects, stratifying them into the three levels of the frailty syndrome, thus being an important measure of functional capacity in this population. Considering the importance of DT in the ADLs of older individuals, this methodology should be part of a comprehensive functional assessment and physical therapy approach designed for these individuals, particularly those who are frail with lower MMSE scores and handgrip impairment.
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Publication Dates
-
Publication in this collection
12 Sept 2014 -
Date of issue
Sept-Oct 2014
History
-
Received
16 Dec 2013 -
Reviewed
01 Mar 2014 -
Accepted
05 May 2014