Multiple modes of assessment of gait are better than one to predict incident falls

Background: Though gait evaluation is recommended as a core component of fall risk assessments, a systematic examination of the predictive validity of different modes of gait assessments for falls is lacking. Objective: To compare three commonly employed gait assessments - self-reported walking difficulties, clinical evaluation, and quantitative gait - to predict incident falls. Materials and methods: 380 community-dwelling older adults (mean age 76.5 +/- 6.8 y, 55.8% female) were evaluated with three independent gait assessment modes: patient-centered, quantitative, and clinician-diagnosed. The association of these three gait assessment modes with incident falls was examined using Cox proportional hazards models. Results: 23.2% of participants self-reported walking difficulties, 15.5% had slow gait, and 48.4% clinical gait abnormalities. 30.3% had abnormalities on only one assessment, whereas only 6.3% had abnormalities on all three. Over a mean follow-up of 24.2 months, 137 participants (36.1%) fell. Those with at least two abnormal gait assessments presented an increased risk of incident falls (hazard ratio (HR): 1.61, 95% confidence interval (CI): 1.04-2.49) in comparison to the 169 participants without any abnormalities on any of the three assessments. Conclusions: Multiple modes of gait evaluation provide a more comprehensive mobility assessment than only one assessment alone, and better identify incident falls in older adults. (C) 2015 Elsevier Ireland Ltd. All rights reserved.