Gait characteristics in hospitalized elderly adults with high risk of falls

doi:10.3877/cma.j.issn.1674-134X.2026.04.005

Abstract

Abstract:

Objective

To investigate the associations of six-degree-of-freedom (6-DOF) continuous gait characteristics of the hip, knee, and ankle joints and dual-task cost (DTC) with fall risk in hospitalized older adults under single-task walking and dual-task walking (DTW) conditions with different cognitive loads.

Methods

A total of 156 older patients admitted to Taikang Xianlin Drum Tower Hospital, Nanjing, from May 2024 to June 2025 were enrolled. Patients aged ≥60 years who were conscious, able to walk independently for >10 m, and willing to participate were included. Patients who were unable to complete the walking tests because of severe trauma or other conditions, whose falls were caused by external violence or acute diseases, or who declined participation were excluded. Demographic characteristics and lower-limb six-degrees of freedom gait data were collected at baseline during single-task walking and three DTW conditions, including (100-1) DTW, (100-7) DTW, and digit-memory DTW, and DTC was calculated. Falls were recorded during a one-year follow-up. Depending on data distribution, between-group comparisons were performed using the independent-samples t test or Mann-Whitney U test. Continuous six-degrees of freedom gait curves were compared using one-dimensional statistical parametric mapping (SPM1D), and receiver operating characteristic analysis was used to evaluate the discriminative ability of DTC for fall risk.

Results

Among the 156 patients, 46 experienced falls, corresponding to a fall rate of 29.5%. During single-task walking, no significant between-group differences were observed in gait speed (t=0.342), gait cycle (Z=0.312), step length (Z=0.734), or cadence (t=0.354) (all P>0.05). Under all three DTW conditions, the fall group showed lower gait speed, step length, and cadence and a longer gait cycle (all P<0.05). DTC was significantly higher in the fall group during (100-1) DTW, (100-7) DTW, and digit-memory DTW (t=3.885, 4.221, and 5.112, respectively; all P<0.001). Analysis of the six-degrees of freedom gait curves showed reduced upward displacement of both knees in the fall group. The minimum SPM{t} values for the left knee during single-task walking, (100-1) DTW, (100-7) DTW, and digit-memory DTW were −4.3, −4.7, −4.6, and −5.6, respectively, while those for the right knee were −2.5, −3.7, −4.7, and −5.2, respectively (all P<0.01). Right-knee extension angles were greater in the fall group, with corresponding maximum SPM{t} values of 4.6, 5.2, 6.1, and 6.3, respectively (all P<0.05). Under DTW conditions, ankle extension angles were greater in the fall group during several phases of the gait cycle; the maximum SPM{t} values were 3.7 for the left ankle and 5.8 for the right ankle during (100-1) DTW, 5.0 for the right ankle during (100-7) DTW, and 4.1 for the right ankle during digit-memory DTW. In addition, the right-hip abduction angle was greater in the fall group during 7%–73% of the gait cycle in (100-7) DTW [maximum SPM{t}=2.93, P<0.01] and during 8% to 71% of the gait cycle in digit-memory DTW [maximum SPM{t}=2.89, P<0.01]. During digit-memory DTW, the left-knee abduction angle was greater during 67%–94% of the gait cycle [maximum SPM{t}=2.16, P=0.014]. The left-ankle adduction angle was also greater during 26%–65% of the gait cycle in (100-1) DTW [maximum SPM{t}=4.40] and during 26% to 32% and 40% to 65% of the gait cycle in (100-7) DTW [maximum SPM{t}=4.20].

Conclusions

Compared with single-task walking, dual-task walking may further reveal gait abnormalities in older patients at risk of falls, characterized by deterioration in conventional gait parameters, increased DTC, and altered 6-DOF movement patterns of the hip, knee, and ankle joints during specific phases of the gait cycle. Continuous 6-DOF gait analysis combined with DTC may provide objective kinematic evidence for identifying fall risk in hospitalized older adults.

Key words: Aged, Accidental falls, Walking, Gait

Lanfei Ouyang, Dongyu Zeng, Peipei Yang, Xing Huang, Yanzhen Zhan, Minghua Xian, Haiqing Zhang, Yu Zhang, Xuping Wang. Gait characteristics in hospitalized elderly adults with high risk of falls[J]. Chinese Journal of Joint Surgery(Electronic Edition), 2026, 20(04): 431-443.

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Figures/Tables 6

Table 1 Comparison of general characteristics between the two groups

组别 Groups	例数 Number of cases	年龄［岁，（ $x ¯$ ±s）］ Age（year）	身高［cm，（ $x ¯$ ±s）］ Height	体重［kg，（ $x ¯$ ±s）］ Weight	BMI ［kg/m²，（ $x ¯$ ±s）］	性别［n（%）］ Gender
组别 Groups	例数 Number of cases	年龄［岁，（ $x ¯$ ±s）］ Age（year）	身高［cm，（ $x ¯$ ±s）］ Height	体重［kg，（ $x ¯$ ±s）］ Weight	BMI ［kg/m²，（ $x ¯$ ±s）］	男Male	女Female
跌倒组 Fall group	46	73±10	159±8	59±9	24±3	12（26.1）	34（73.9）
非跌倒组 Non-fall group	110	76±9	165±32	62±12	24±7	53（48.2）	57（51.8）
统计值 Statistical values		t=1.33	t=1.70	t=1.30	t=0.08	χ²=6.51
P值		＞0.05	＞0.05	＞0.05	＞0.05	＜0.05

Table 1 Comparison of general characteristics between the two groups

组别 Groups	例数 Number of cases	年龄［岁，（ $x ¯$ ±s）］ Age（year）	身高［cm，（ $x ¯$ ±s）］ Height	体重［kg，（ $x ¯$ ±s）］ Weight	BMI ［kg/m²，（ $x ¯$ ±s）］	性别［n（%）］ Gender
组别 Groups	例数 Number of cases	年龄［岁，（ $x ¯$ ±s）］ Age（year）	身高［cm，（ $x ¯$ ±s）］ Height	体重［kg，（ $x ¯$ ±s）］ Weight	BMI ［kg/m²，（ $x ¯$ ±s）］	男Male	女Female
跌倒组 Fall group	46	73±10	159±8	59±9	24±3	12（26.1）	34（73.9）
非跌倒组 Non-fall group	110	76±9	165±32	62±12	24±7	53（48.2）	57（51.8）
统计值 Statistical values		t=1.33	t=1.70	t=1.30	t=0.08	χ²=6.51
P值		＞0.05	＞0.05	＞0.05	＞0.05	＜0.05

Table 2 Comparison of gait parameters between the fall and non-fall groups under different test conditions

组别 Groups	例数 Number of cases	单任务行走Single task walking
组别 Groups	例数 Number of cases	速度［m/s，（ $x ¯$ ±s）］ Velocity	步行周期［s，M（P₂₅，P₇₅）］ Gait cycle	步长/跨步长［m，M（P₂₅，P₇₅）］ Step length/stride length	步频［步/min，（ $x ¯$ ±s）］ Cadence（step/min）	DTC ［%，（ $x ¯$ ±s）］
跌倒组	46	1.16±0.14	1.11（1.03，1.16）	1.12（1.03，1.18）	109.55±8.28	-
非跌倒组	110	1.18±0.16	1.12（1.05，1.16）	1.11（1.05，1.18）	110.15±8.65	-
统计值 Statistical values		t=0.342	Z=0.312	Z=0.734	t=0.354	-
P值		＞0.05	＞0.05	＞0.05	＞0.05	-
组别 Groups	例数 Number of cases	（100-1）DTW
组别 Groups	例数 Number of cases	速度［m/s，（ $x ¯$ ±s）］ Velocity	步行周期［s，M（P₂₅，P₇₅）］ Gait cycle	步长/跨步长［m，M（P₂₅，P₇₅）］ Step length/stride length	步频［步/min，（ $x ¯$ ±s）］ Cadence（step/min）	DTC ［%，（ $x ¯$ ±s）］
跌倒组	46	0.82±0.17	1.32（1.20，1.45）	0.98（0.93，1.06）	93.45±12.50	25.10±12.30
非跌倒组	110	0.88±0.14	1.25（1.16，1.38）	1.05（0.97，1.11）	96.88±11.20	19.05±11.00
统计值 Statistical values		t=3.112	Z=2.402	Z=3.421	t=2.232	t=3.885
P值		＜0.01	＜0.05	＜0.01	＜0.05	＜0.001
组别 Groups	例数 Number of cases	（100-7）DTW
组别 Groups	例数 Number of cases	速度［m/s，（ $x ¯$ ±s）］ Velocity	步行周期［s，M（P₂₅，P₇₅）］ Gait cycle	步长/跨步长［m，M（P₂₅，P₇₅）］ Step length/stride length	步频［步/min，（ $x ¯$ ±s）］ Cadence（step/min）	DTC ［%，（ $x ¯$ ±s）］
跌倒组	46	0.80±0.15	1.29（1.20，1.43）	0.99（0.93，1.07）	93.50±11.60	26.00±11.50
非跌倒组	110	0.85±0.16	1.23（1.16，1.33）	1.03（0.96，1.12）	98.02±11.40	18.50±10.20
统计值 Statistical values		t=3.501	Z=2.754	Z=2.981	t=2.845	t=4.221
P值		＜0.001	＜0.01	＜0.01	＜0.01	＜0.001
组别 Groups	例数 Number of cases	记忆数字DTW
组别 Groups	例数 Number of cases	速度［m/s，（ $x ¯$ ±s）］ Velocity	步行周期［s，M（P₂₅，P₇₅）］ Gait cycle	步长/跨步长［m，M（P₂₅，P₇₅）］ Step length/stride length	步频［步/min，（ $x ¯$ ±s）］ Cadence（step/min）	DTC ［%，（ $x ¯$ ±s）］
跌倒组	46	0.72±0.16	1.35（1.23，1.49）	0.94（0.88，1.05）	89.75±12.10	31.25±11.80
非跌倒组	110	0.83±0.13	1.26（1.18，1.41）	1.01（0.93，1.10）	94.50±10.90	22.75±10.30
统计值 Statistical values		t=5.012	Z=3.275	Z=3.592	t=3.672	t=5.112
P值		＜0.001	＜0.01	＜0.001	＜0.001	＜0.001

Table 2 Comparison of gait parameters between the fall and non-fall groups under different test conditions

组别 Groups	例数 Number of cases	单任务行走Single task walking
组别 Groups	例数 Number of cases	速度［m/s，（ $x ¯$ ±s）］ Velocity	步行周期［s，M（P₂₅，P₇₅）］ Gait cycle	步长/跨步长［m，M（P₂₅，P₇₅）］ Step length/stride length	步频［步/min，（ $x ¯$ ±s）］ Cadence（step/min）	DTC ［%，（ $x ¯$ ±s）］
跌倒组	46	1.16±0.14	1.11（1.03，1.16）	1.12（1.03，1.18）	109.55±8.28	-
非跌倒组	110	1.18±0.16	1.12（1.05，1.16）	1.11（1.05，1.18）	110.15±8.65	-
统计值 Statistical values		t=0.342	Z=0.312	Z=0.734	t=0.354	-
P值		＞0.05	＞0.05	＞0.05	＞0.05	-
组别 Groups	例数 Number of cases	（100-1）DTW
组别 Groups	例数 Number of cases	速度［m/s，（ $x ¯$ ±s）］ Velocity	步行周期［s，M（P₂₅，P₇₅）］ Gait cycle	步长/跨步长［m，M（P₂₅，P₇₅）］ Step length/stride length	步频［步/min，（ $x ¯$ ±s）］ Cadence（step/min）	DTC ［%，（ $x ¯$ ±s）］
跌倒组	46	0.82±0.17	1.32（1.20，1.45）	0.98（0.93，1.06）	93.45±12.50	25.10±12.30
非跌倒组	110	0.88±0.14	1.25（1.16，1.38）	1.05（0.97，1.11）	96.88±11.20	19.05±11.00
统计值 Statistical values		t=3.112	Z=2.402	Z=3.421	t=2.232	t=3.885
P值		＜0.01	＜0.05	＜0.01	＜0.05	＜0.001
组别 Groups	例数 Number of cases	（100-7）DTW
组别 Groups	例数 Number of cases	速度［m/s，（ $x ¯$ ±s）］ Velocity	步行周期［s，M（P₂₅，P₇₅）］ Gait cycle	步长/跨步长［m，M（P₂₅，P₇₅）］ Step length/stride length	步频［步/min，（ $x ¯$ ±s）］ Cadence（step/min）	DTC ［%，（ $x ¯$ ±s）］
跌倒组	46	0.80±0.15	1.29（1.20，1.43）	0.99（0.93，1.07）	93.50±11.60	26.00±11.50
非跌倒组	110	0.85±0.16	1.23（1.16，1.33）	1.03（0.96，1.12）	98.02±11.40	18.50±10.20
统计值 Statistical values		t=3.501	Z=2.754	Z=2.981	t=2.845	t=4.221
P值		＜0.001	＜0.01	＜0.01	＜0.01	＜0.001
组别 Groups	例数 Number of cases	记忆数字DTW
组别 Groups	例数 Number of cases	速度［m/s，（ $x ¯$ ±s）］ Velocity	步行周期［s，M（P₂₅，P₇₅）］ Gait cycle	步长/跨步长［m，M（P₂₅，P₇₅）］ Step length/stride length	步频［步/min，（ $x ¯$ ±s）］ Cadence（step/min）	DTC ［%，（ $x ¯$ ±s）］
跌倒组	46	0.72±0.16	1.35（1.23，1.49）	0.94（0.88，1.05）	89.75±12.10	31.25±11.80
非跌倒组	110	0.83±0.13	1.26（1.18，1.41）	1.01（0.93，1.10）	94.50±10.90	22.75±10.30
统计值 Statistical values		t=5.012	Z=3.275	Z=3.592	t=3.672	t=5.112
P值		＜0.001	＜0.01	＜0.001	＜0.001	＜0.001

Figure 1 Hip gait plots for different walking tasks. A and B show left and right hip gait plots for the single-task condition; C and D show left and right hip gait plots for the (100-1) DTW task; E and F show left and right hip gait plots for the (100-7) DTW task; G and H show left and right hip gait plots for the DTW digit memory task Note: The solid red lines and the distances between these lines and the solid or dashed red lines above or below them represent the mean and standard deviation of the gait cycles in the fall group; the solid blue lines and the distances between these lines and the solid or dashed blue lines above or below them represent the mean and standard deviation of the gait cycles in the non-fall group; the results of the SPM t-test comparing the fall group and the non-fall group are shown below the gait plots

Figure 2 Knee gait patterns for different walking tasks. A and B show left and right knee gait patterns for the single-task condition; C and D show left and right knee gait patterns for the (100-1) DTW task; E and F show left and right knee gait patterns for the (100-7) DTW task; G and H show left and right knee gait patterns for the DTW number-memory task Note: The solid red lines and the distances between these lines and the solid or dashed red lines above or below them represent the mean and standard deviation of the gait cycles in the fall group; the solid blue lines and the distances between these lines and the solid or dashed blue lines above or below them represent the mean and standard deviation of the gait cycles in the non-fall group; the results of the SPM t test comparing the fall group and the non-fall group are shown below the gait plots

Figure 3 Ankle gait plots for different walking tasks. A and B show left and right ankle gait plots for the single-task condition; C and D show left and right ankle gait plots for the (100-1) DTW task; E and F show left and right ankle gait plots for the (100-7) DTW task; G and H show left and right ankle gait plots for the DTW digit memory task Note: The solid red line and the distance between the solid red line and the solid or dashed red lines above or below it represent the mean and standard deviation of the gait cycle in the fall group; the solid blue line and the distance between the solid blue line and the solid or dashed blue lines above or below it represent the mean and standard deviation of the gait cycle in the non-fall group. The results of the SPM t-test comparing the fall group and the non-fall group are shown below the gait plot

Figure 4 ROC (receiver operating characteristic) curve analysis of DTC (dual-task cost) in the DTW (dual-task walking) digital memory task

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