Bernard Isaacs

Characteristics of the gait in old people who fall

Observations were made of the gait of 30 people aged 65 and over who were admitted to hospital shortly after suffering a fall without bone injury. These were compared with 22 patients of similar age admitted to the same hospital who had not suffered a recent fall; with 23 normal active old people of whom 7 had fallen recently; and with 24 normal young subjects. The gait of the hospitalized fallers differed from all other groups, and had the following characteristics: slow speed, short step length, narrow stride width, wide range of stepping frequency, large variability of step length, and increasing variability with increasing frequency. These characteristics may reflect loss of automaticity of gait, and this finding may have implications for pathogenesis and rehabilitation.

The life-space diary: A measure of mobility in old people at home

Thirty people aged 64 and over living at home were asked to complete a life-space diary for 1 month during which they were invited to attend a gait laboratory for measurements of gait and balance. Twenty-eight subjects completed the diary satisfactorily, and 24 of these also undertook the laboratory tests. The diary was acceptable and gave a good indication of the subjects mobility. There was a close correlation between mobility as derived from the diary and the laboratory measurements of gait speed and mean sway path. The diary is worthy of further evaluation as an objective record of mobility in old people at home.

Clinical and laboratory studies of falls in old people. Prospects for prevention.

Elderly people at risk of falling may be divided into high, intermediate, and low-risk groups. In all three, but especially in the low-risk group, a large number of people have to be treated in order to prevent an unfavorable outcome. Attempts have been made to prevent further falls, fractures, hospitalization, and death by domiciliary treatment of high-risk patients and by exercise and dance in low-risk subjects. These studies have proved difficult to establish and to evaluate, and as yet no clear evidence has been produced on the effectiveness of these interventions.

Domiciliary physiotherapy for old people who have fallen

One hundred patients aged 65 and over who had recently fallen were allocated to a short or a long course of domiciliary physiotherapy. Mobility, gait and balance were measured before, and 2 and 4 months after, completion of treatment. Falls occurred in fewer than one-half of the patients following treatment, and improvement in mobility and balance was recorded in one-third to one-half of patients. There was no difference in outcome between patients treated for short or for longer periods. If domiciliary physiotherapy is beneficial in this type of patient no advantage is conferred by prolonging the course of treatment.