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gait evaluation

Indications: - low risk, high value assessment of movement disorders [7] Procedure: Formal procedures include: - Tinnetti gait evaluation - get-up & go test - gait speed: - time to walk 4 meters [2] - naming animals while assessing gait speed discriminates elderly with cognitive impairment from normal elderly, 77% for mild cognitive impairment (MCI), > 99% for dementia [8] - stride length variability while naming animals was the most effective for discriminating between MCI & dementia, 97% [8] Notes: - simple walking speed predicts mortality, disability, cognitive impairment, falls, & institutionalization [1] - gait speed < 0.6 m/s (< 20 feet in 10 seconds) predicts poor outcome [6] - gait speed < 0.8 m/s predicts poor outcome [2] - simple walking speed (> 1.0 meters/sec) associated with healthier aging [3] - survival increases across the full range of gait speeds, with significant increments per 0.1 m/s [1] - >= 6 seconds to walk 5 meters (0.8 m/s) predicts higher risk of mortality & major morbidity after cardiac surgery in vulnerable elderly [4] - slow walking speed in older people is strongly associated with an increased risk of cardiovascular mortality [5] - short steps, slow wlaking speed & difficulty turning suggest peripheral neuropathy [3]

Related

gait

Specific

get up & go test (timed up & go, TUG) Tinetti gait & balance evaluation

General

functional assessment

References

  1. Studenski S et al. Gait speed and survival in older adults. JAMA 2011 Jan 5; 305:50. PMID: 21205966
  2. Abellan van Kan G, Rolland Y, Andrieu S, 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 Dec;13(10):881-9. Review. PMID: 19924348
  3. Geriatric Review Syllabus, 8th edition (GRS8) Durso SC and Sullivan GN (eds) American Geriatrics Society, 2013 - Geriatric Review Syllabus, 10th edition (GRS10) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2019
  4. Afilalo J, Eisenberg MJ, Morin JF Gait speed as an incremental predictor of mortality and major morbidity in elderly patients undergoing cardiac surgery. J Am Coll Cardiol. 2010 Nov 9;56(20):1668-76. PMID: 21050978
  5. Dumurgier J, Elbaz A, Ducimetiere P et al Slow walking speed and cardiovascular death in well functioning older adults: prospective cohort study. BMJ. 2009 Nov 10;339:b4460 PMID: 19903980
  6. Cesari M, Kritchevsky SB, Penninx BW, et al. Prognostic value of usual gait speed in well-functioning older people. J Am Geriatr Soc. 2005;53(10):1675-1680 PMID: 16181165
  7. Medical Knowledge Self Assessment Program (MKSAP) 17, American College of Physicians, Philadelphia 2015
  8. Ali P, Renaud P, Montero-Odasso M et al Gait performance in older adults across the cognitive spectrum: Results from the GAIT cohort. J Am Geriatr Soc. 2024 Aug 29. PMID: 39206968 https://agsjournals.onlinelibrary.wiley.com/doi/10.1111/jgs.19162