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

Gérontopôle, Department of Geriatric Medicine, Toulouse University Hospital, Toulouse, France.
The Journal of Nutrition Health and Aging (Impact Factor: 3). 12/2009; 13(10):881-9.
Source: PubMed


The use of a simple, safe, and easy to perform assessment tool, like gait speed, to evaluate vulnerability to adverse outcomes in community-dwelling older people is appealing, but its predictive capacity is still questioned. The present manuscript summarises the conclusions of an expert panel in the domain of physical performance measures and frailty in older people, who reviewed and discussed the existing literature in a 2-day meeting held in Toulouse, France on March 12-13, 2009. The aim of the IANA Task Force was to state if, in the light of actual scientific evidence, gait speed assessed at usual pace had the capacity to identify community-dwelling older people at risk of adverse outcomes, and if gait speed could be used as a single-item tool instead of more comprehensive but more time-consuming assessment instruments.
A systematic review of literature was performed prior to the meeting (Medline search and additional pearling of reference lists and key-articles supplied by Task Force members). Manuscripts were retained for the present revision only when a high level of evidence was present following 4 pre-selected criteria: a) gait speed, at usual pace, had to be specifically assessed as a single-item tool, b) gait speed should be measured over a short distance, c) at baseline, participants had to be autonomous, community-dwelling older people, and d) the evaluation of onset of adverse outcomes (i.e. disability, cognitive impairment, institutionalisation, falls, and/or mortality) had to be assessed longitudinally over time. Based on the prior criteria, a final selection of 27 articles was used for the present manuscript.
Gait speed at usual pace was found to be a consistent risk factor for disability, cognitive impairment, institutionalisation, falls, and/or mortality. In predicting these adverse outcomes over time, gait speed was at least as sensible as composite tools.
Although more specific surveys needs to be performed, there is sufficient evidence to state that gait speed identifies autonomous community-dwelling older people at risk of adverse outcomes and can be used as a single-item assessment tool. The assessment at usual pace over 4 meters was the most often used method in literature and might represent a quick, safe, inexpensive and highly reliable instrument to be implemented.

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    • "The reliability and validity of the CWS were high for the general population (Abellan van Kan et al., 2009; Cooper, Kuh, & Hardy, 2010; Connelly, Stevenson & Vandervoort 1996; Steffen & Seney, 2008; Steffen et al., 2002), and the test–retest reliability in older adults with ID was excellent (ICCs 0.96 for same-day interval and 0.93 for a 2-week interval; Hilgenkamp et al., 2012). Using indicators on the floor (tape) at 0 m, 3 m, and 8 m, the participant walked (with guidance) a distance of 5 m in three intervals with a start-up of 3 m. "
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    ABSTRACT: Background: The ability to perform activities of daily living (ADL) as a component of participation is one of the factors that contribute to quality of life. The ability to perform ADL for persons experiencing severe/profound intellectual disability (ID) may be reduced due to their cognitive and physical capacities. However, until recently, the impact of the significantly prevalent visual impairments on the performance of activities of daily living has not yet been revealed within this group. Aim: The purpose of this prospective cross-sectional study was to investigate the impact of visual impairment on the performance of activities of daily living for persons with a severe/profound intellectual disability. Method: The Barthel Index (BI) and Comfortable Walking Speed (CWS) were used to measure the ability of performing activities of daily living (ADL) in 240 persons with severe/profound ID and having Gross Motor Functioning Classification System (GMFCS) levels I, II or III; this included 120 persons with visual impairment. The impact of visual impairment on ADL was analyzed with linear regression. Results: The results of the study demonstrated that visual impairment slightly affects the ability of performing activities of daily living (BI) for persons experiencing a severe/profound intellectual disability. GMFCS Levels II or III, profound ID level, and visual impairment each have the effect of lowering BI scores. GMFCS Levels II or III, and profound ID level each have the effect of increasing CWS scores, which indicates a lower walking speed. A main effect of visual impairment is present on CWS, but our results do show a substantive interaction effect between GMFCS level III and visual impairment on Comfortable Walking Speed in persons with a severe/profound intellectual disability. Conclusions: Visual impairment has a slight effect on ability to perform ADL in persons experiencing severe/profound ID.
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    • "It is generally accepted that walking speed is an indicator of function[2]and that walking speeds slower than 1.0 m/s are associated with adverse outcomes, including falls in older people[6,7]. The link between walking speed and cognitive function is also well documented, with the slowing of gait being independently associated with poorer performance in cognitive tasks[26]. "
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    ABSTRACT: Reduced walking speed in older adults is associated with adverse health outcomes. This review aims to examine the effect of a cognitive dual-task on the gait speed of community-dwelling older adults with no significant pathology affecting gait.
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    • "While the general healthy population showed walking limitations only after testing of complex walking situations (Shumway-Cook et al. 2007; Bock 2008), abnormal walking patterns were observed in walking tests of persons with intellectual disability (Hale et al. 2007; Horvat et al. 2012). The implications of these tests are important, as changes in gait and walking mechanisms contribute to negative health outcomes, including falls (Abellan van Kan et al. 2009; Paterson et al. 2011). Due to the association between increased age and poor gait among the general population, and especially among the continuously increasing intellectual disability population (Enkelaar et al. 2013; Verlinden et al. 2013), along with the lack of descriptive gait data, it is important to have gait data of a comparable cohort. "
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