Ageing and gait variability

20. Sayer AA, Dennison EM, Syddall HE et al. Type 2 diabetes, muscle strength and impaired physical function: the tip of the iceberg? Diabetes Care 2005; 28: 25412. 21. Sayer AA, Syddall HE, Martin HJ et al. Is grip strength associated with health-related quality of life? Findings from the Hertfordshire Cohort Study. Age Ageing 2006; 35: 40915. 22. van Mil HG, Geukes Foppen RJ, Siegenbeek vH. The influence of bumetanide on the membrane potential of mouse skeletal muscle cells in isotonic and hypertonic media. Br J Pharmacol 1997; 120: 3944. 23. Tsau YK, Tsai WY, Lu FL et al. Symptomatic hypomagnesemia in children. Chung Hua Min Kuo Hsiao Erh Ko I Hsueh Hui Tsa Chih 1998; 39: 3937. 24. Shintani S, Shiigai T, Tsukagoshi H. Marked hypokalemic rhabdomyolysis with myoglobinuria due to diuretic treatment. Eur Neurol 1991; 31: 3968. 25. Joint Formulary Committee. British National Formulary. 55th ed. London: British Medical Association and Royal Pharmaceutical Society of Great Britain, 2008. 26. Stamler JS, Meissner G. Physiology of nitric oxide in skeletal muscle. Physiol Rev 2001; 81: 20937. 27. Forrest KY, Zmuda JM, Cauley JA. Patterns and determinants of muscle strength change with aging in older men. Aging Male 2005; 8: 1516. 28. Ozkul Y. Influence of calcium channel blocker drugs in neuromuscular transmission. Clin Neurophysiol 2007; 118: 20058. 29. Matzno S, Yasuda S, Kitada Y et al. Clofibrate-induced apoptosis is mediated by Ca2+-dependent caspase-12 activation. Life Sci 2006; 78: 18929. 30. Agostini JV, Tinetti ME, Han L et al. Effects of statin use on muscle strength, cognition, and depressive symptoms in older adults. J Am Geriatr Soc 2007; 55: 4205. 31. Traustadttir T, Stock AA, Harman SM. High-dose statin use does not impair aerobic capacity or skeletal muscle function in older adults. Age (Dordr). 2008; 30: 28391. 32. Grundy SM. Can statins cause chronic low-grade myopathy. Ann Intern Med 2002; 137: 6178. 33. Sumukadas D, Witham MD, Struthers AD et al. Effect of perindopril on physical function in elderly people with functional impairment: a randomized controlled trial. CMAJ 2007; 917786774. 34. Syddall HE, Simmonds SJ, Martin HJ et al for the Hertfordshire Cohort Study Group. Cohort profile: the Hertfordshire Ageing Study (HAS). Int J Epidemiol 2009 Jan 8. [Epub ahead of print].
Received 6 May 7 October 2009 2009; accepted in revised form

Age and Ageing 2010; 39: 191197 The Author 2010. Published by Oxford University Press on behalf of the British Geriatrics Society. doi: 10.1093/ageing/afp250 All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org Published electronically 18 January 2010

Ageing and gait variabilitya population-based study of older people

MICHELE L. CALLISAYA1, LEIGH BLIZZARD1, MICHAEL D. SCHMIDT2 JENNIFER L. MCGINLEY3, VELANDAI K. SRIKANTH1,4
Menzies Research Institute, University of Tasmania, Private Bag 23, Hobart, Tasmania 7001, Australia Department of Kinesiology, University of Georgia, 101D Ramsey Center, 330 River Road, Athens, GA 30602, USA 3 Gait CCRE, Hugh Williamson Gait Analysis Service, Murdoch Childrens Research Institute, Royal Children's Hospital, Flemington Road, Parkville, Victoria 3052, Australia 4 Department of Medicine, Monash Medical Centre, 246 Clayton Road, Clayton, Victoria 3168, Australia
2 1

Address correspondence to: M. L. Callisaya. Tel: (+61) 3 6226 7700; Fax: (+61) 3 6226 7704. Email: michelec@utas.edu.au

Abstract
Background: gait variability may be an important predictor of falls risk, but its characteristics are poorly understood. Objective: to examine the relationship between age and gait variability in a population-based sample of older people. Design: cross-sectional study. Methods: in people aged 6086 years (n =412), temporal and spatial gait variability measures were recorded with a GAITRite walkway. Regression analysis was used to model the relationship between age and gait variability adjusting for height, weight and self-reported chronic disease. Further adjustment was made for gait speed to examine its inuence on the associations. Results: older age was associated with greater variability (P <0.05) in all gait measures. All relationships were linear, except that between age and step time variability, which was curvilinear in women. Adjusting for gait speed changed the magnitude of the age coecient by 6286% for temporal variability measures, 25% for step length variability and 512% for step width variability.

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Conclusion: age is linearly associated with greater intra-individual gait variability for most gait measures, except for step time variability in women. Gait speed may mediate the association between age and temporal variability measures. Further study is needed to understand the factors responsible for the greater gait variability with ageing.
Keywords: ageing, gait variability, population-based, elderly

Introduction
The ability to walk eciently and safely is important for older people to maintain independence and avoid falls [1]. Intra-individual gait variability refers to the uctuation in the value of a gait measure from one step to the next. It is considered likely to reect disruptions in intrinsic motor or postural control during walking resulting from age- or disease-related decline in the central and peripheral nervous systems [2, 3]. Gait variability measures have been described to be better predictors of falls and decline in mobility than absolute gait measures such as gait speed [48]. Given the high risk of falls and mobility problems in older people [9, 10], it is important to clearly characterise the relationship between ageing and gait variability. Such data may enhance the understanding of motor control in older age and assist in dening older people at particular risk of falling. Although there have been previous studies examining the eect of age on gait variability [7, 1120], signicant gaps still exist in the literature. Firstly, the majority of previous studies have only compared younger with older adults [1115, 17, 18, 20]. Their results have been inconsistent with some reporting greater gait variability [12, 14, 15, 17, 20] and others no dierences in the younger versus older groups [11, 14, 15, 18, 20] probably reecting the low subject numbers and dierent populations sampled. These studies do not provide data on whether age-related changes in gait variability continue in older age. A few small studies of older adults have reported increased variability with advancing age [7, 16, 19] but none have examined both spatial and temporal variables. Furthermore, no data are available on the relationship between age and gait variability at a population level, with prior studies being performed in either convenient samples of healthy volunteers or clinical samples [7, 16, 19]. Age may aect gait speed and other absolute gait measures in men and women [21], but it is unknown whether such an interaction between age and sex also occurs with regards to gait variability. Walking speed slows in older age [12] and there is greater variability in some gait measures at slower speeds [20, 22]. Therefore, increased variability found with advancing age may simply be due to slower walking speeds [20] rather than an independent intrinsic phenomenon. Understanding the eect of speed in the relationship between age and gait variability may further clarify mechanisms underlying gait variability. We conducted a population-based study to investigate the relationship between age and gait variability in older

people. The aims were to: (i) study the magnitude and shape of associations between age and a range of gait variability measures; (ii) investigate whether sex modied these associations; and (iii) examine the eect of gait speed on these associations.

Methods
Study participants

Participants aged 6086 years (n =412) were randomly selected from the Southern Tasmanian electoral roll (postcodes 70007199) to participate in the Tasmanian Study of Cognition and Gait, conducted at the Menzies Research Institute, Hobart, Tasmania, Australia. Southern Tasmania has a total population of 239,444 people including 46,159 persons aged at least 60 years [23]. Eligible participants were rstly sent an invitation to participate, followed by a phone call. Transport was provided if required. Data collection started in January 2005 and nished in November 2007. Participants were excluded if they lived in a nursing home, were unable to follow simple commands in English, were unable to walk without a gait aid or had any contraindications to magnetic resonance imaging as this was part of a larger study. The Southern Tasmanian Health and Medical Human Research Ethics Committee approved this study and written consent was obtained from all participants.
Gait analysis

Gait variables (step time, step length, step width and double support time (DST)) were measured at preferred speed using the 4.6-m GAITRite system (CIR Systems, Havertown, PA, USA). Variables are dened in the GAITRite manual [24]. Participants started and nished walking 2 m before and after the mat to allow for acceleration and deceleration. After two practice trials, participants performed six walks [25]. These variables were chosen as they represent both temporal and spatial measures and have been examined in previous studies of falls risk [46]. The variability of each measure was calculated as the standard deviation [3, 6, 7, 17] across all step measures from the six walks.
Other measurements

Height (cm), weight (kg) and self-reported history of lower limb arthritis, hypertension, stroke, Parkinsons disease,

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diabetes mellitus, dementia and falls (in the preceding 12 months) were recorded using a standardised questionnaire. To allow estimation of potential non-response bias, non-responders completed a brief phone interview providing similar details about their medical history.
Data analysis

Table 1. Sample characteristics (n =411)

Characteristic

............................................................
Age, mean (SD) Height [cm], mean (SD)* Weight [kg], mean (SD)* Self-reported medical history, n (%) Hypertension Diabetes Stroke Parkinsons disease Dementia Arthritis Falls in previous 12months Gait characteristics, mean (SD) Speed [cm/s]*** Cadence [steps/min]* Step time [s]* Step length [cm]* Double support time [s] Step width [cm]* Step time variability [s] Step length variability [cm]*** Double support time variability [s]*** Step width variability [cm]** 72.4 (7.0) 172.6 (6.4) 82.8 (13.9) 71.6 (7.1) 159.5 (6.0) 71.2 (14.1)

Males (n = 235)

Females (n = 176)

Dierences in demographic, medical and gait characteristics between men and women were analysed using chi-square test, Students t tests and the two-sample Wilcoxon ranksum test. Spearman correlation coecients were used to measure the associations between gait variables, age, height, weight and speed. Linear regression methods were used to assess the relationship between gait measures and age. In multivariable linear regression, the association of gait variables with age independently of height, weight and each chronic disease was assessed. Stroke, dementia and Parkinsons disease were grouped as one variable called central nervous system (CNS) disease due to low subject numbers in each group. Speed was added to determine its eect on the nal regression models. At walking speeds other than preferred, temporal and spatial variability are higher, and there is less stability at the head and pelvis [26, 27]. We, therefore, chose a modelling approach including preferred speed as a covariate rather than introducing additional speed walking trials. In the correlation and regression analysis, gait variables were transformed when required to remove skewness. One slow-paced woman was excluded from analysis after examination for outliers because her data were highly inuential in increasing the value of the regression coecients. This woman was severely physically and cognitively disabled. Statistical interaction between age and sex was assessed by a test of signicance of a (age sex) product term for men, and by a partial-F test for the inclusion of two product terms (age sex, age2 sex) in the model for step time in women. Finally, log-binomial regression analysis was used to determine whether gait variability measures increased the risk of self-reported falls after adjustment for age, sex, height and weight. For this analysis, step time and DST variability were converted to milliseconds. Analyses were performed using Stata 10.0 (StataCorp LP, TX, USA).

112 35 22 2 2 97 27

(47.7%) (14.9) (9.4) (0.9) (0.9) (41.3) (11.5)

91 16 12 0 0 85 42

(51.7) (9.1) (6.8) (0.0) (0.0) (48.9) (23.9)

116.03 107.21 0.56 64.72 0.26 10.96 0.02 2.81 0.02 2.21

(21.07) (9.04) (0.05) (8.98) (0.05) (2.89) (0.01) (0.95) (0.01) (0.75)

110.60 114.60 0.53 57.55 0.25 8.71 0.02 2.61 0.02 1.99

(21.11) (10.30) (0.05) (7.88) (0.07) (2.49) (0.01) (0.86) (0.01) (0.59)

SD, standard deviation; cm, centimetres; kg, kilogrammes; s, seconds. * P < 0.001. ** P < 0.01. *** P < 0.05.

Results
The sample response proportion was 51% (412/804). Nonresponders were older (P = 0.01) with a higher incidence of hypertension (P = 0.03). Demographic, medical and gait characteristics are summarised in Table 1. An average of 27.3 (SD 5.4) steps were recorded per person. There were no dierences between left and right variability measures (P > 0.05), and results are based on the average of the left and right sides. Men walked faster (P = 0.01) and had greater variability in step length (P = 0.03), DST (P = 0.04) and step width (P = 0.003) than women. Associations between age, speed and the gait variability measures are shown in

Table 2. Older age was associated with greater variability in all gait measures in both men and women (P < 0.05) and this was demonstrable for increasing age category as well (Appendix 1 in the supplementary data in Age and Ageing online.). Faster speed was associated with less variability in all measures (P < 0.05) except for step width. All relationships were linear, except for a curvilinear association (P < 0.001) between age and step time variability for women (Appendix 2 in the supplementary data in Age and Ageing online.). Results of the multivariable linear regression of age with gait variability measures adjusting for height and weight are shown in Table 3. Age remained positively associated with all measures of gait variability in both men and women. In women, the association between age and step time variability was stronger in the older age groups. There was little change to the associations even after controlling for the presence of each chronic disease. Furthermore, chronic diseases were not associated with any of the gait variability measures except for self-reported history of arthritis, which was associated with greater step time variability in both sexes (P <0.01). Adjusting for speed markedly reduced (range 6286%) the magnitude of the age coecient for temporal variability measures, but there was little change in the coecient of the speed variable in the model with age when compared to its value in the model without age (range 410%). In contrast, adjusting for speed reduced the magnitude of the age coecient by 25% in both sexes for step length variability. For step width

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Table 2. Correlations between subject characteristics and gait variables (n =411)
Men Women Age 0.24** 0.30* 0.34* 0.28* 0.27* 0.18*** 0.30* Height 0.31* 0.33* 0.21** 0.10 0.03 0.01 0.13 Weight 0.37* 0.43* 0.10 0.06 0.13 0.02 0.05 Speed 0.41* 0.29* 0.08 0.70* 0.31* 0.04 0.55*

.............................................................................................................................
Age Height Weight Speed Step time variability Step length variability Step width variability Double support time variability
*

Step time variability

Step length variability 0.17** 0.02 0.03 0.15*** 0.35* 0.10 0.47*

Step width variability 0.15*** 0.12 0.02 0.07 0.17** 0.21** 0.17***

Double support time variability 0.25* 0.02 0.06 0.50* 0.46* 0.33* 0.16***

0.26* 0.09 0.07 0.52* 0.48* 0.16 *** 0.60*

P < 0.001. P < 0.01. *** P < 0.05.

**

Table 3. Multivariable regressioncross-sectional eect of an additional year of age on gait variability measures (n =411)
Gait measure Model 1 (95% CI) Regression coefficients () adjusted for: Model 2 (95% CI) Model 3 (95% CI)

.............................................................................................................................
Men Step time variabilitya Step length variability Step width variability Double support time variabilitya Women Step time variabilityab At age 65years At age 75years At age 85years Step length variability Step width variability Double Support time variabilitya 0.254 0.022 0.016 0.257 (0.133, (0.008, (0.004, (0.144, 0.375)* 0.036)** 0.027)** 0.371)* 0.267 0.028 0.021 0.314 (0.135, (0.012, (0.008, (0.192, 0.400)* 0.043)** 0.033)** 0.437)* 0.064 0.021 0.020 0.106 (0.063, 0.190) (0.004, 0.037)** (0.007, 0.034)** (0.091, 0.222)

0.093 0.455 2.280 0.031 0.014 0.297

(0.382, 0.197) (0.273, 0.638)* (0.111, 4.449)*** (0.015, 0.047)* (0.002, 0.026)*** (0.165, 0.429)*

0.051 0.483 2.350 0.040 0.017 0.316

(0.325, 0.222) (0.295, 0.672)* (0.139, 4.560)*** (0.023, 0.057)* (0.004, 0.030)** (0.181, 0.451)*

0.084 (0.334, 0.166) 0.095 (0.062, 0.253) 0.329 (0.285, 0.943) 0.030 (0.012, 0.048)** 0.019 (0.005, 0.033)** 0.119 (0.089, 0.246)

Model 1, unadjusted; Model 2, adjusted for height and weight; Model 3, adjusted for height, weight and speed. * P < 0.001. ** P < 0.01. *** P < 0.05. a Coecient multiplied by 1,000. b Because of the non-linear association between step time variability and age for women, the cross-sectional eect of an additional year of age was dierent at each age. Here, we show estimates for 65-, 75- and 85-year-olds.

variability the magnitude of the age coecient decreased by 5% in men and increased by 12% in women after adjusting for speed. There were no signicant interactions between age and sex for any of the gait variables. The risk of a self-reported fall in the past twelve months was increased in those with greater DST variability (relative risk (RR) 1.03, 95% condence interval (CI) 1.01, 1.05), greater step time variability (RR 1.03, 95% CI 1.02, 1.04) and greater step length variability (RR 1.19, 95% CI 0.99, 1.43).

Discussion
This is the rst population-based study to characterise in detail the relationships between age and a range of temporal and spatial gait variability measures in older people. We found greater age was associated with greater intra-individ-

ual variability in all gait measures, independent of height, weight and self-reported chronic disease. All relationships were linear, except for step time variability in women, which showed stronger associations in older age groups. Previous studies have suggested measures of gait variability are useful indicators of falls [47]. Screening of gait in people >60 years may, therefore, be valuable in identifying those at risk. Adjustment for gait speed produced marked reductions in the estimated eect of age on temporal variability measures, suggesting that speed is an intermediate in the pathway between age and these measures. In contrast, speed is more likely to confound the relation between age and spatial variability measures. This nding has implications for how gait variability measures are analysed in future studies of ageing.

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Our ndings highlight that variability in step length and step time is greater in older adults in the general population and not just in those with disease [28]. This may represent decline in the automatic stepping mechanism or worsening central motor control [2, 11] and may contribute to an increased risk of falls due to poor foot placement or insucient postural stability [6]. The greater step time variability with advancing age is consistent with results of other clinical studies of geriatric patients and functionally impaired older adults [7, 19]. However, we found that, although there were no signicant dierences between the sexes, stronger associations between step time variability and age were found in women of older ages. This may indicate that older women may increasingly require closer monitoring of their gait in relation to falls risk and also raises interesting questions about sex-related dierences in mechanisms underlying step time variability. To our knowledge, there are no previous studies examining the associations between age and step length variability in older adults. Studies comparing much younger and older adults have been inconsistent, with some studies reporting greater step length variability in older groups [13, 17, 20] and others reporting no dierence [11, 14, 15]. These seemingly conicting ndings may reect the relatively healthy nature of the older participants or the limited statistical power associated with the small samples. Furthermore, these ndings highlight that step length variability and step time variability are greater in older adults in the general population and not just in those with disease [28]. Greater step width and DST variability with advancing age may indicate impaired dynamic balance control during walking [11]. For example, in an attempt to control the centre of mass within their base of support, older people may continually adjust their step width or the duration of DST to compensate for poor balance. Our results are in agreement with a single study of older people nding greater step width variability in older age. Studies comparing step width variability between younger and older adults have found contrasting results, some reporting greater step width variability in older adults [1315, 17] and others nding no dierence by age [11, 20]. Moreover, it is unknown how much step width variability is optimal. There is limited evidence that either excessive or insu cient step width variability may be risk factors for falling [4, 6]. Indeed, Brach et al. hypothesised that a certain minimal level of variability may be needed to adjust step width to maintain stability [4]. Our ndings, however, did not reect this, with only linear relationships found between age and step width variability. Dierences in results may be due to dierent denitions of step width or data collection methods used [4, 6, 20]. For example, data capture with metatarsal markers is likely to systematically vary from that collected with heel markers due to external foot progression [6]. Further work is needed to determine threshold values in each variability measure that are predictive of future risk of falls. The underlying mechanisms leading to increased variability in each of the gait measures with age are as yet uncertain. It is possible that mechanisms dier across variables [3]. Presence of chronic disease may have contributed to the associations between age and the gait variability measures. For example, diabetes may lead to peripheral neuropathy, possibly reducing stability whilst walking and resulting in greater gait variability [29]. However, the inclusion of selfreported chronic disease in the nal models did not signicantly alter the associations. This suggests other factors or diseases may explain the associations with age. The importance of the CNS in controlling rhythmical gait is reected by the increased gait variability found in age-related changes or diseases of the CNS [28] and under dual task conditions [30]. Ageing is associated with changes in brain structure, involving regions that are important for intrinsic automaticity of gait such as the basal ganglia [28], potentially leading to greater gait variability. Psychological factors or age-related changes in strength and balance have also been found to be associated with an inconsistent walking pattern [3, 7, 19, 31]. In this study, arthritis was the only chronic disease associated with gait, and only with greater step time variability. This may have been due to impairments commonly associated with arthritis such as pain or decreased strength [32] interfering with timing of steps. The lack of association between other chronic diseases and gait variability in this study could have been due to low numbers, mildness of disease or the relatively unchallenging task. To our knowledge, no previous studies have examined the eect of speed on the relationship between age and gait variability in the general older population. Our results suggest that speed is an intermediate in the pathway between age and temporal gait variables, indicating that age-related changes in temporal variability measures may be largely due to reduced walking speed. It is possible that, at slower walking speeds, the temporal automaticity of gait is impaired, resulting in reduced consistency from step to step. Spatial variability measures were less dependent on gait speed, and speed did not appear to mediate the relationship of spatial variability with age. These results suggest gait speed should be considered particularly when measuring temporal variability measures in further research and clinical practice. The strengths of this study are its population-based design, the size of the sample, the use of sophisticated measurements by trained sta using standardised protocols and the range of measures of gait variability studied. The association of gait variability measures with retrospective recall of self-reported falls in our sample was consistent with previous reports [18], supporting the validity of the gait measures. The random selection of participants from a de ned population enhances the generalizability of the ndings to older people in general. In addition, we examined the eect of speed on these relationships and tested for non-linear associations and interactions, adding signicantly to knowledge in the eld. Our ndings are, however, limited by their cross-sectional nature, with longitudinal follow-up needed to characterise actual changes in gait variability with ageing. In addition, we sampled a relatively small number of steps using a computerised mat. This restricted us to collect-

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ing the magnitude of variability rather than examining the long-range correlations in these step uctuations [2, 33]. However, it did allow us to collect both spatial and temporal variables, and participants were unlikely to be aected by fatigue over the short distance walked. Such simple measurement protocols have particular potential for inclusion in clinic-based screening.
tributing impairments in older persons. Gait Posture 2008; 27: 4319. Brach JS, Berlin JE, Vanswearingen JM, Newman AB, Studenski SA. Too much or too little step width variability is associated with a fall history in older persons who walk at or near normal gait speed. J Neuroengineering Rehabil 2005; 2: 21. Guimaraes RM, Isaacs B. Characteristics of the gait in old people who fall. Int Rehabil Med 1980; 2: 17780. Maki BE. Gait changes in older adults: predictors of falls or indicators of fear. J Am Geriatr Soc 1997; 45: 31320. Hausdorff JM, Rios DA, Edelberg HK. Gait variability and fall risk in community-living older adults: a 1-year prospective study. Arch Phys Med Rehabil 2001; 82: 10506. Brach JS, Studenski SA, Perera S, VanSwearingen JM, Newman AB. Gait variability and the risk of incident mobility disability in community-dwelling older adults. J Gerontol A Biol Sci Med Sci 2007; 62: 9838. Verghese J, LeValley A, Hall CB, Katz MJ, Ambrose AF, Lipton RB. Epidemiology of gait disorders in communityresiding older adults. J Am Geriatr Soc 2006; 54: 25561. Rubenstein LZ, Josephson KR. The epidemiology of falls and syncope. Clin Geriatr Med 2002; 18: 14158. Gabell A, Nayak U. The effect of age on variability in gait. J Gerontol 1984; 39: 6626. Menz HB, Lord SR, Fitzpatrick RC. Age-related differences in walking stability. Age Ageing 2003; 32: 13742. Woledge RC, Birtles DB, Newham DJ. The variable component of lateral body sway during walking in young and older humans. J Gerontol A Biol Sci Med Sci 2005; 60: 14638. Owings TM, Grabiner MD. Variability of step kinematics in young and older adults. Gait Posture 2004; 20: 269. Stolze H, Friedrich HJ, Steinauer K, Vieregge P. Stride parameters in healthy young and old women measurement variability on a simple walkway. Exp Aging Res 2000; 26: 15968. Helbostad JL, Moe-Nilssen R. The effect of gait speed on lateral balance control during walking in healthy elderly. Gait Posture 2003; 18: 2736. Grabiner PC, Biswas ST, Grabiner MD. Age-related changes in spatial and temporal gait variables. Arch Phys Med Rehabil 2001; 82: 315. Hausdorff JM, Edelberg HK, Mitchell SL, Goldberger AL, Wei JY. Increased gait unsteadiness in community-dwelling elderly fallers. Arch Phys Med Rehabil 1997; 78: 27883. Hausdorff JM, Nelson ME, Kaliton D et al. Etiology and modification of gait instability in older adults: a randomized controlled trial of exercise. J Appl Physiol 2001; 90: 211729. Kang HG, Dingwell JB. Separating the effects of age and walking speed on gait variability. Gait Posture 2008; 27: 5727. Callisaya ML, Blizzard L, Schmidt MD, McGinley JL, Srikanth VK. Sex modifies the relationship between age and gait: a population-based study of older adults. J Gerontol A Biol Sci Med Sci 2008; 63: 16570. Brach JS, Berthold R, Craik R, VanSwearingen JM, Newman AB. Gait variability in community-dwelling older adults. J Am Geriatr Soc 2001; 49: 164650. ABS. Population by age and sex, Tasmania [data cube: Super Table online. ABS publication 2005 [cited 2006 December 10]. Available from: http://www.abs.gov.au/AUSSTATS. CIR Systems I. The GAITRite Electronic Walkway Measurements & Definitions. 2006 [cited 2009 1 June]. Available from: http:// www.gaitrite.com/Downloads/GAITRite_Measurement_ Definitions.pdf.

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5. 6.

Key points
In this first population-based study of older adults, we found that older age was associated with greater temporal and spatial variability in both sexes. Step time variability was greater in women of older age. Gait speed should be considered particularly when measuring temporal variability measures in further research and clinical practice. Further research is needed to study optimal levels and determinants of each gait variability measure, and the role of gait variability as a component of falls risk screening programmes.

7.

8.

9.

10. 11. 12.

Conflicts of interest
There are no conicts of interest.

13.

14. 15.

Funding
This work was supported by the National Health and Medical Research Council (grant number 403000BH), Physiotherapy Research Foundation (grant number BH036/05), Perpetual Trustees, Brain Foundation, Royal Hobart Hospital Research Foundation (grant number 341M), ANZ Charitable Trust and Masonic Centenary Medical Research Foundation. The sponsors had no role in the design, execution, analysis and interpretation of data, or writing of the study.

16.

17.

18.

19.

Supplementary data
20.

Supplementary data mentioned in the text is available to subscribers in Age and Ageing online.

21.

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Received 15 June 2009; accepted in revised form 25 November 2009

Age and Ageing 2010; 39: 197203 The Author 2009. Published by Oxford University Press on behalf of the British Geriatrics Society. doi: 10.1093/ageing/afp204 All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org Published electronically 8 December 2009

Prevalence and correlates of frailty among community-dwelling older men and women: findings from the Hertfordshire Cohort Study
HOLLY SYDDALL1, HELEN C ROBERTS2, MARIA EVANDROU3, CYRUS COOPER1, HOWARD BERGMAN4, AVAN AIHIE SAYER1,2
MRC Epidemiology Resource Centre, University of Southampton, UK Academic Geriatric Medicine, University of Southampton, UK 3 Centre for Research on Ageing, University of Southampton, UK 4 Division of Geriatric Medicine, Jewish General Hospital/McGill University, Montreal, Canada
2 1

Address correspondence to: H. Syddall. SO16 6YD, UK. Tel: (+44) 23 8077 7624; Fax: (+44) 23 8070 4021. Email: hes@mrc. soton.ac.uk

Abstract
Background: frailty, a multi-dimensional geriatric syndrome, confers a high risk for falls, disability, hospitalisation and mortality. The prevalence and correlates of frailty in the UK are unknown. Methods: frailty, dened by Fried, was examined among community-dwelling young-old (6474 years) men (n = 320) and women (n = 318) who participated in the Hertfordshire Cohort Study, UK. Results: the prevalence of frailty was 8.5% among women and 4.1% among men (P = 0.02). Among men, older age (P = 0.009), younger age of leaving education (P = 0.05), not owning/mortgaging one's home (odds ratio [OR] for frailty 3.45 [95% condence interval {CI} 1.0111.81], P = 0.05, in comparison with owner/mortgage occupiers) and reduced car availability (OR for frailty 3.57 per unit decrease in number of cars available [95% CI 1.32, 10.0], P = 0.01) were associated with increased odds of frailty. Among women, not owning/mortgaging one's home (P = 0.02) was associated with frailty. With the exception of car availability among men (P = 0.03), all associations were non-signicant (P > 0.05) after adjustment for co-morbidity. Conclusions: frailty is not uncommon even among community-dwelling young-old men and women in the UK. There are social inequalities in frailty which appear to be mediated by co-morbidity.
Keywords: frailty, prevalence, older people, social inequalities, co-morbidity, elderly

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