ELGAM--extra-laboratory gait assessment method: identification of risk factors for falls among the elderly at home.

Abstract

Gait and balance disturbances are recognized risk factors for falls among elderly persons. The prevention of falls and their adverse complications is one of the challenges in geriatric care, requiring the early detection of risk factors. Heretofore, gait assessment procedures have required considerable investment in equipment for sophisticated biomechanical testing. This has limited the use of gait-testing procedures to the laboratory or clinic. We describe a simple and effective method for at-home or community gait testing, ELGAM (extra-laboratory gait assessment method). ELGAM was field-tested as part of a study of 36 community-dwelling elderly in Beer Sheba, Israel. The ELGAM parameters studied included step length, walking speed, initial starting style of walking, ability to turn head while walking, and static balance. Slow walking speed (less than 0.5 m/s), small steps, difficulty in turning the head, and impaired balance were significantly associated (chi-square analyses, p less than 0.01) with unstable gait. The parameters were also positively associated one with another, except for head turning. The ELGAM parameters were significantly related to self-assessed fall frequency, and reported 'near falls' among women only. In addition, among women only, slow walking speed was associated with depressive symptoms as detected by a validated screening test, the Short Geriatric Depression Scale, and with poor subjective health rating. Among 58% of this independently living elderly sample, ELGAM detected one or more risk factors. ELGAM is a 'low-tech', functionally based, effective method for direct recording of gait parameters that is applicable for community studies of the early detection of risk factors for falls and mobility problems.