Epidemiology of gait disorders in community-residing older adults.

OBJECTIVES To study the epidemiology of gait disorders in community-residing older adults and their association with death and institutionalization. DESIGN Community-based cohort study. SETTING Bronx County and the research center at Albert Einstein College of Medicine. PARTICIPANTS The Einstein Aging study recruited 488 adults aged 70 to 99 between 1999 and 2001. At entry and during annual visits over 5 years, subjects received clinical evaluations to determine presence of neurological or nonneurological gait abnormalities. MEASUREMENTS Prevalence and incidence of gait disorders based on clinical evaluations and time to institutionalization and death. RESULTS Of 468 subjects (95.9%) with baseline gait evaluations, 168 had abnormal gaits: 70 neurological, 81 nonneurological, and 17 both. Prevalence of abnormal gait was 35.0% (95% confidence interval (CI) = 28.6-42.1). Incidence of abnormal gait was 168.6 per 1,000 person-years (95% CI = 117.4-242.0) and increased with age. Men had a higher incidence of neurological gait abnormalities, whereas women had a higher incidence of nonneurological gaits. Abnormal gaits were associated with greater risk of institutionalization and death (hazard ratio (HR) = 2.2, 95% CI =1.5-3.2). The risk was strongly related to severity of impairment; subjects with moderate to severe gait abnormalities (HR = 3.2, 95% CI = 1.9-5.2) were at higher risk than those with mild gait abnormalities (HR = 1.8, 95% CI = 1.0-2.8). CONCLUSION The incidence and prevalence of gait disorders are high in community-residing older adults and are associated with greater risk of institutionalization and death.