Research article

Gait disorders are associated with non-cardiovascular falls in elderly people: a preliminary study

Manuel Montero-Odasso^1,2,3,5,6 , Marcelo Schapira^2,3,5 , Gustavo Duque¹ , Enrique R Soriano^3,4 , Roberto Kaplan^2,3,5 and Luis A Camera^1,3

¹Division of Geriatric Medicine, McGill University, Montreal, Canada

²Geriatric Medicine Section, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina

³Internal Medicine Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina

⁴Informatics and Biostatistics Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina

⁵Geriatric Fellowship, Faculty of Medicine, University of Buenos Aires, Buenos Aires, Argentina

⁶Solidage: McGill University, Université de Montréal Research Group on Integrated Services for Older Persons, Montréal, Canada

author email corresponding author email

BMC Geriatrics 2005, 5:15doi:10.1186/1471-2318-5-15

Published:	1 December 2005

Abstract

Background

The association between unexplained falls and cardiovascular causes is increasingly recognized. Neurally mediated cardiovascular disorders and hypotensive syndromes are found in almost 20 percent of the patients with unexplained falls. However, the approach to these patients remains unclear. Gait assessment might be an interesting approach to these patients as clinical observations suggests that those with cardiovascular or hypotensive causes may not manifest obvious gait alterations. Our primary objective is to analyze the association between gait disorders and a non-cardiovascular cause of falls in patients with unexplained falls. A second objective is to test the sensitivity and specificity of a gait assessment approach for detecting non-cardiovascular causes when compared with intrinsic-extrinsic classification.

Methods

Cross-sectional study performed in a falls clinic at a university hospital in 41 ambulatory elderly participants with unexplained falls. Neurally mediated cardiovascular conditions, neurological diseases, gait and balance problems were assessed. Gait disorder was defined as a gait velocity < 0.8 m/s or Tinetti Gait Score <9. An attributable etiology of the fall was determined in each participant. Comparisons between the gait assessment approach and the attributable etiology regarding a neurally mediated cardiovascular cause were performed. Fisher exact test was used to test the association hypothesis. Sensitivity and specificity of gait assessment approach and intrinsic-extrinsic classification to detect a non-cardiovascular mediated fall was calculated with 95% confidence intervals (CI95%).

Results

A cardiovascular etiology (orthostatic and postprandial hypotension, vasovagal syndrome and carotid sinus hypersensitivity) was identified in 14% of participants (6/41). Of 35 patients with a gait disorder, 34 had a non-cardiovascular etiology of fall; whereas in 5 out of 6 patients without a gait disorder, a cardiovascular diagnosis was identified (p < 0.001). Sensitivity and specificity of the presence of gait disorder for identifying a non-cardiovascular mediated cause was 97.1% (CI95% = 85–99) and 83% (CI95% = 36–99), respectively.

Conclusion

In community dwelling older persons with unexplained falls, gait disorders were associated with non-cardiovascular diagnosis of falls. Gait assessment was a useful approach for the detection of a non-cardiovascular mediated cause of falls, providing additional value to this assessment.