Community Ambulation in Older Adults: Which Internal Characteristics Are Important?

Lord SE, Weatherall M, Rochester L. Community ambulation in older adults: which internal characteristics are important? Arch Phys Med Rehabil 2010;91:378-83. Objective: To examine the internal characteristics of older adults independent in community ambulation to gain further understanding of the skills required for its successful execution. Design: Exploratory factor analysis. Setting: General community. Participants: Healthy, community dwelling older adults (N=113) who were cognitively intact and walked outdoors independently. Interventions: Not applicable. Main Outcome Measures: Spatiotemporal gait parameters derived from accelerometry over 6 minutes walking outdoors and a battery of measures for motor, cognitive, executive, and behavioral characteristics. Results: Mean participant age +/- SD was 75.8+/-7.3 years, with almost a third of the sample over 80 years. Four factors emerged from the Factor Analysis of 23 variables: motor control, self-efficacy, executive function, and cognitive-motor interference, which together explained 61.4% of common variance. Eight variables loaded onto motor control, accounting for 34.5% of common variance; 7 items loaded onto self-efficacy, which explained 12.4% of common variance; 5 variables loaded onto executive function, accounting for 8.4% of common variance; and 3 variables loaded onto cognitive-motor interference, explaining 6% of the variance. Conclusions: Results of this study indicate that factors beyond motor control contribute to independent community ambulation in older adults, reflecting the multidimensional, complex nature of the task. Self-efficacy was shown to be more relevant than executive function to gait performance, suggesting the need for a broader approach to assessment and intervention strategies.