Blog # 15- Gait and Disability Risk in Older Adults

Resources used:

  • Perera, S., Patel, K.V., Rosano, C., Rubin, S.M, Satterfield, S., Harris, T., Ensrud, K., Orwoll, E., Lee, C.G., Chandler, J.M., Newman, Anne B., Cauley, J.A., Guralnik, J.M., Ferrucci, L., Studenski, S.A. (2015). “Gait Speed Predicts Incident Disability: A Pooled Analysis” Journals of Gerontology: Medical Sciences. The Gerontological Society of America. https://doi.org/10.1093/gerona/glv126. Published 10 Jul 2015. Pp. 63-71. Vol. 71. doi: 10.1093/Gerona/glv126

Gait is an essential function that individuals maintain for living independently. When one acquires a disability due to aging; poor health; cognitive issues; or a poor physical performance, an impairment in gait can result in the older adult. However, disability is difficult to apply in the context of gait studies in older adults because, “outcomes is more difficult due to heterogeneity of terminology related to disability states. For example, disability severity can be obtained by queries about difficulty, dependence, or inability” (Perera, Rosano, Rubin, Satterfield, Harris, Ensrud, Orwoll, Lee, Chandler, Newman, Cauley, Guralnik, Ferrucci, Studenski, 2015). Some older adults cannot perform or comprehend daily living tasks (i.e. bathing, dressing, eating, toileting) because they are too strenuous, and/or the tasks are difficult to understand. Other older adults may have trouble performing daily living tasks independently, and so they rely on informal and formal supports to help them to complete these daily living tasks (especially those that require mobility). Sometimes, disability can result in death which can affect the outcomes of gait studies in older adults. Understanding gait in the context of older adults with disabilities, in my opinion, however, will help us as a society to better understand their concerns and needs to promote universal design in a variety of environments where older adults with disabilities are able to maintain their independence, and to have the ability to contribute to society.

Reviewing this study, I would like to analyze the two levels of disability in the context of older adults with disabilities: self-care dependence (bathing or dressing) and mobility difficulty. Before going into depth, something interesting to note is that the study states a, “15-foot speed in one study was considered equivalent to a 4-m speed” (Perera, Rosano, Rubin, Satterfield, Harris, Ensrud, Orwoll, Lee, Chandler, Newman, Cauley, Guralnik, Ferrucci, Studenski, 2015). While age is one factor that can alter the gait speed in an older adult, other factors that can alter an older adult’s gait speed include gender status; race/ethnicity, height and weight, blood pressure, global health, hospitalizations, and medical conditions older adults may acquire such as cancer, diabetes, arthritis, and heart disease.

Focusing now on the two levels of disability, I am going to give an analysis of the participant characteristics that were involved in this study. One characteristic that stands out is that 6,704 older adults in this study have difficulty with bathing and dressing while 10,349 older adults in this study have difficulty with mobility. Why do you think there is more older adults with mobility issues than those with issues involving bathing and dressing? I think one point I could make is that there are more resources, supports, and services that aging service agencies and independent living facilities can offer in the context of bathing and dressing in addition to having other formal supports as well as informal supports such as family and friends. Mobility, there are environmental barriers like a lack of accessibility to certain facilities where for example there may not be a ramp for someone with a wheelchair, or the weather where one may be at risk of falls and fractures if they cannot promote a proper gait speed. With race and ethnicity, most older adults fall within the “White” category while few to no older adults fall within the “Black” or “Hispanic” categories. What this means is that for older adults with bathing and dressing difficulties, 6,684 older adults of the 6,704 older adults that are White experience these difficulties while only about 20 older adults that are either Black or Hispanic experience issues with self-care dependence. Of the 10,349 older adults with mobility difficulty, 9,662 older adults that are White, 654 Black older adults, and 33 Hispanic older adults experience mobility issues.

Age is another characteristic being analyzed in this study. The average age for the older adult female with bathing and dressing dependence is 74.9 years with a standard deviation of 4.8 years while the average age for the older adult female with mobility difficulty is 71.8 years with a standard deviation of 5.2 years. The average age for the older adult male is 73.7 years with a standard deviation of 5.2 years. What this tells us is that for older adult females with self-care dependence (bathing or dressing) the average lifespan is between 70 and 80 years of age while older adult females with mobility difficulty have an average lifespan between 67 and 77 years of age. With advancements in healthcare and technology with assistive devices to help older adult females with bathing and dressing, in addition to the support of informal and formal supports, older female adults with bathing and dressing issues can be better supported in contrast to older adult females that have trouble with mobility given some of the environmental, psychological, social, and physical barriers that make it difficult for older adult females to move. Older adult males, regardless of bathing and dressing dependence or mobility difficulty, have an average lifespan between 68 and 79 years of age. With regards to gait speed, which is meters per second (m/s), for older adult females with bathing and dressing dependence, their average is 0.89 m/s with a standard deviation of 0.22 m/s, while older adult females with mobility difficulty have an average gait speed of 0.95 m/s with a standard deviation of 0.22 m/s. Older adult males, whether they have bathing or dressing dependence, or mobility difficulty, tend to have an average gait speed of 0.90 m/s with a standard deviation of 0.24 m/s. For older adult females with bathing and dressing dependence, the span of gait speed ranges anywhere from 0.67 m/s to 1.11 m/s, while for older adult females with mobility difficulty, the span of gait speed ranges anywhere from 0.73 m/s to 1.17 m/s. I think these calculations make sense especially for someone with bathing and dressing dependence where they take their time to get dressed or to get into the tub, and the amount of room available to walk in a bathroom or a bedroom while for someone with mobility issues they are able to walk a variety of distances. However, the average gait speed span for both bathing and dressing dependence and mobility difficulty for older adult females which would be between 0.67 m/s and 1.17 m/s indicate the likelihood for falls, hospitalizations, disability, cognitive decline, and possibly death, especially without any resources or aids, in addition to informal and formal supports. The average gait speed span for an older adult male is between 0.66 m/s and 1.12 m/s so the same circumstances that apply to older adult females would also likely apply to older adult males. What the data shows is that for older adult males and females, there does seem to be an indirect relationship between gait speed and disability risk (and in a few cases, death where gait speed is profoundly minimal to none). As gait speed decreases, disability risk increases.

Lastly, I would like to analyze the affects of disease on gait speed. Reviewing the study, reviewing common diseases in older adults such as cancer, arthritis, diabetes, and heart disease, the majority of older adults (both male and female) with issues with bathing, dressing, and mobility difficulties have arthritis. In fact, in this study, 4,223 of the 6,704 older adults with bathing and dressing dependence have arthritis while 6,002 of the 10,349 older adults with mobility difficulty have arthritis. Arthritis can affect the gait speed of an older adult because arthritis involves, “inflammation of one or more of your joints, and the main symptoms of arthritis are joint pain and stiffness, which typically worsen with age” (Mayo Clinic), which would decrease the range of motion for an older adult regardless of any daily living activities they are trying to perform whether that be dressing, bathing, or walking as examples.

The reality is that when a person gets older, their gait speed will decline. However, the lower an older adult’s gait speed, regardless of bathing and dressing dependence or mobility difficulty, the more likely they are at risk of falls, fractures, disability, hospitalizations, impairments in cognition and memory, and death as a possibility. However, I do think that evaluating an older adult’s gait speed can greatly contribute in evaluating a person’s overall independence as well as whether there is need for social, medical, and/or independent living supports which can help the person not only get properly treated for their medical conditions and their living situations, but to help them to increase longevity in order for them to live longer and to continue to live productive lives.

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